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Golombek DA, Eyre H, Spiousas I, Casiraghi LP, Hartikainen KM, Partonen T, Pyykkö M, Reynolds CF, Hynes WM, Bassetti CLA, Berk M, Hu K, Ibañez A. Sleep Capital: Linking Brain Health to Wellbeing and Economic Productivity Across the Lifespan. Am J Geriatr Psychiatry 2024:S1064-7481(24)00405-6. [PMID: 39117505 DOI: 10.1016/j.jagp.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION AND FRAMEWORK Sleep capital contributes to individual and societal wellbeing, productivity, and economic outcomes and involves a novel aspect of brain capital. It encompasses the quality and quantity of sleep as integral components that influence cognitive abilities, mental and brain health, and physical health, affecting workplace productivity, learning, decision-making, and overall economic performance. Here, we bring a framework to understand the complex relationship between sleep quality, health, wellbeing, and economic productivity. Then we outline the multilevel impact of sleep on cognitive abilities, mental/brain health, and economic indicators, providing evidence for the substantial returns on investment in sleep health initiatives. Moreover, sleep capital is a key factor when considering brain health across the lifespan, especially for the aging population. DISCUSSION We propose specific elements and main variables to develop specific indexes of sleep capital to address its impacts on health, wellbeing and productivity. CONCLUSION Finally, we suggest policy recommendations, workplace interventions, and individual strategies to promote sleep health and brain capital. Investing in sleep capital is essential for fostering a healthier, happier, fairer and more productive society.
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Affiliation(s)
- Diego A Golombek
- Laboratorio Interdisciplinario del Tiempo (LITERA) (DAG, IS, LPC), Universidad de San Andrés/CONICET, Buenos Aires, Argentina.
| | - Harris Eyre
- Baker Institute for Public Policy (HE), Rice University, Houston, TX, USA; Global Brain Health Institute (HE), University of California San Francisco (UCSF), San Francisco, CA, USA; Department of Psychiatry and Behavioral Science (HE), (UCSF), San Francisco, CA, USA; Department of Psychiatry and Behavioral Science (HE), Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry and Behavioral Science (HE), Houston Methodist, Houston, TX, USA; Department of Psychiatry and Behavioral Science (HE), The University of Texas Health Sciences Center at Houston, Houston, TX, USA; Institute for Mental and Physical Health and Clinical Translation (IMPACT) (HE), Deakin University, Geelong, Victoria, Australia; Euro-Mediterranean Economists Association (HE), Barcelona, Spain; Meadows Mental Health Policy Institute (HE), Dallas, TX, USA; Frontier Technology Lab, School of Engineering (HE), Stanford University, Palo Alto, CA, USA
| | - Ignacio Spiousas
- Laboratorio Interdisciplinario del Tiempo (LITERA) (DAG, IS, LPC), Universidad de San Andrés/CONICET, Buenos Aires, Argentina
| | - Leandro P Casiraghi
- Laboratorio Interdisciplinario del Tiempo (LITERA) (DAG, IS, LPC), Universidad de San Andrés/CONICET, Buenos Aires, Argentina
| | - Kaisa M Hartikainen
- Faculty of Medicine and Health Technology (KMH), Tampere University, Tampere, Finland; Behavioral Neurology Research Group (KMH), Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; National Brain Health Programme (KMH), Helsinki, Finland
| | - Timo Partonen
- Finnish Institute for Health and Welfare (TP), Helsinki, Finland; Department of Psychiatry (TP), University of Helsinki, Helsinki, Finland
| | - Mika Pyykkö
- Finnish Brain Association and Finnish Centre for Health Promotion (MP), Helsinki, Finland
| | - Charles F Reynolds
- Graduate School of Public Health, University of Pittsburgh School of Medicine (CFR), Pittsburgh, PA, USA
| | - William M Hynes
- Institute for Global Prosperity (MH), University College London, London, UK; Santa Fe Institute (MH), Santa Fe, NM, USA; World Bank (MH), Washington, DC, USA
| | - Claudio L A Bassetti
- Neurology Department, Inselspital (CLAB), University of Bern, Bern, Switzerland; Swiss Brain Health Plan (CLAB), Bern, Switzerland
| | - Michael Berk
- School of Medicine (MB), Deakin University and Barwon Health. Institute for Mental and Physical Health and Clinical Translation (IMPACT), Victoria, Australia
| | - Kun Hu
- Division of Sleep Medicine (KH), Harvard Medical School, Boston, MA, USA; Medical Biodynamics Center (KH), Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Agustín Ibañez
- Latin American Brain Health institute (Brainlat) (CSCN) (AI), Universidad Adolfo Ibanez, Santiago, Chile; ChileGlobal Brain Health Institute, Trinity College Dublin, Ireland; Center for Social and Cognitive Neuroscience (CSCN) (AI), Universidad Adolfo Ibanez, Santiago, Chile; Universidad de San Andrés (AI), Buenos Aires, Argentina
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Chacon AN, Su W, Hou T, Guo Z, Gong MC. Exenatide administration time determines the effects on blood pressure dipping in db/db mice via modulation of food intake and sympathetic activity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.02.601700. [PMID: 39005289 PMCID: PMC11245019 DOI: 10.1101/2024.07.02.601700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Type 2 diabetics have an increased prevalence of hypertension and nondipping blood pressure (BP), which worsen cardiovascular outcomes. Exenatide, a short acting glucagon-like peptide-1 receptor agonist (GLP-1RA) used to treat type 2 diabetes, also demonstrates blood pressure (BP)-lowering effects. However, the mechanisms behind this and the impact of administration timing on BP dipping remain unclear. We investigated the effects of exenatide intraperitoneal injected at light onset (ZT0) or dark onset (ZT12) in diabetic (db/db) mice and nondiabetic controls. Using radio-telemetry and BioDAQ cages, we continuously monitored BP and food intake. Db/db mice exhibited non-dipping BP and increased food intake. ZT0 exenatide administration restored BP dipping by specifically lowering light-phase BP, while ZT12 exenatide reversed dipping by lowering dark-phase BP. These effects correlated with altered food intake patterns, and importantly, were abolished when food access was removed. Additionally, urinary norepinephrine excretion, measured by HPLC, was significantly reduced 6 hours post-exenatide at both ZT0 and ZT12, suggesting sympathetic nervous system involvement. Notably, combining exenatide with either ganglionic blocker mecamylamine or α-blocker prazosin did not enhance BP reduction beyond the individual effects of each blocker. These findings reveal that exenatide, when administered at light onset, restores BP dipping in db/db mice by suppressing light-phase food intake and sympathetic activity. Importantly, the efficacy of exenatide is dependent on food availability and its timing relative to circadian rhythms, highlighting the potential for chronotherapy in optimizing GLP-1RA- based treatments for type 2 diabetes and hypertension. Graphic Abstract Article Highlights Maintaining a normal blood pressure (BP) circadian rhythm is vital for cardiovascular health, but diabetes often disrupts this rhythm. The effect of exenatide, a GLP-1 receptor agonist (GLP-1RA), on BP rhythm in diabetes is uncertain.This study investigates the impact of exenatide administration timing on BP patterns in diabetic db/db mice.Findings indicate that exenatide given at the onset of rest restores normal BP dipping, while at the start of the active phase worsens BP rhythm by modulating food intake and sympathetic activity.Timing GLP-1 RA administration may optimize BP control and provide cardiovascular benefits for type 2 diabetes patients.
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Farag HI, Murphy BA, Templeman JR, Hanlon C, Joshua J, Koch TG, Niel L, Shoveller AK, Bedecarrats GY, Ellison A, Wilcockson D, Martino TA. One Health: Circadian Medicine Benefits Both Non-human Animals and Humans Alike. J Biol Rhythms 2024; 39:237-269. [PMID: 38379166 PMCID: PMC11141112 DOI: 10.1177/07487304241228021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Circadian biology's impact on human physical health and its role in disease development and progression is widely recognized. The forefront of circadian rhythm research now focuses on translational applications to clinical medicine, aiming to enhance disease diagnosis, prognosis, and treatment responses. However, the field of circadian medicine has predominantly concentrated on human healthcare, neglecting its potential for transformative applications in veterinary medicine, thereby overlooking opportunities to improve non-human animal health and welfare. This review consists of three main sections. The first section focuses on the translational potential of circadian medicine into current industry practices of agricultural animals, with a particular emphasis on horses, broiler chickens, and laying hens. The second section delves into the potential applications of circadian medicine in small animal veterinary care, primarily focusing on our companion animals, namely dogs and cats. The final section explores emerging frontiers in circadian medicine, encompassing aquaculture, veterinary hospital care, and non-human animal welfare and concludes with the integration of One Health principles. In summary, circadian medicine represents a highly promising field of medicine that holds the potential to significantly enhance the clinical care and overall health of all animals, extending its impact beyond human healthcare.
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Affiliation(s)
- Hesham I. Farag
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- Centre for Cardiovascular Investigations, University of Guelph, Guelph, ON, Canada
| | - Barbara A. Murphy
- School of Agriculture and Food Science, University College, Dublin, Ireland
| | - James R. Templeman
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
| | - Charlene Hanlon
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
- Department of Poultry Science, Auburn University, Auburn, Alabama, USA
| | - Jessica Joshua
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Thomas G. Koch
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Lee Niel
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
| | - Anna K. Shoveller
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
| | | | - Amy Ellison
- School of Natural Sciences, Bangor University, Bangor, UK
| | - David Wilcockson
- Department of Life Sciences, Aberystwyth University, Aberystwyth, UK
| | - Tami A. Martino
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- Centre for Cardiovascular Investigations, University of Guelph, Guelph, ON, Canada
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Kervezee L, Dashti HS, Pilz LK, Skarke C, Ruben MD. Using routinely collected clinical data for circadian medicine: A review of opportunities and challenges. PLOS DIGITAL HEALTH 2024; 3:e0000511. [PMID: 38781189 PMCID: PMC11115276 DOI: 10.1371/journal.pdig.0000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
A wealth of data is available from electronic health records (EHR) that are collected as part of routine clinical care in hospitals worldwide. These rich, longitudinal data offer an attractive object of study for the field of circadian medicine, which aims to translate knowledge of circadian rhythms to improve patient health. This narrative review aims to discuss opportunities for EHR in studies of circadian medicine, highlight the methodological challenges, and provide recommendations for using these data to advance the field. In the existing literature, we find that data collected in real-world clinical settings have the potential to shed light on key questions in circadian medicine, including how 24-hour rhythms in clinical features are associated with-or even predictive of-health outcomes, whether the effect of medication or other clinical activities depend on time of day, and how circadian rhythms in physiology may influence clinical reference ranges or sampling protocols. However, optimal use of EHR to advance circadian medicine requires careful consideration of the limitations and sources of bias that are inherent to these data sources. In particular, time of day influences almost every interaction between a patient and the healthcare system, creating operational 24-hour patterns in the data that have little or nothing to do with biology. Addressing these challenges could help to expand the evidence base for the use of EHR in the field of circadian medicine.
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Affiliation(s)
- Laura Kervezee
- Group of Circadian Medicine, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hassan S. Dashti
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Luísa K. Pilz
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- ECRC Experimental and Clinical Research Center, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Chronobiology and Sleep Institute (CSI), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Marc D. Ruben
- Divisions of Pulmonary and Sleep Medicine and Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
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Chiu JC. Editorial: Rising stars in chronobiology 2022. Front Physiol 2024; 15:1412956. [PMID: 38725565 PMCID: PMC11079284 DOI: 10.3389/fphys.2024.1412956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Joanna C. Chiu
- Department of Entomology and Nematology, College of Agricultural and Environmental Sciences, University of California, Davis, CA, United States
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Abstract
The brain is a complex organ, fundamentally changing across the day to perform basic functions like sleep, thought, and regulating whole-body physiology. This requires a complex symphony of nutrients, hormones, ions, neurotransmitters and more to be properly distributed across the brain to maintain homeostasis throughout 24 hours. These solutes are distributed both by the blood and by cerebrospinal fluid. Cerebrospinal fluid contents are distinct from the general circulation because of regulation at brain barriers including the choroid plexus, glymphatic system, and blood-brain barrier. In this review, we discuss the overlapping circadian (≈24-hour) rhythms in brain fluid biology and at the brain barriers. Our goal is for the reader to gain both a fundamental understanding of brain barriers alongside an understanding of the interactions between these fluids and the circadian timing system. Ultimately, this review will provide new insight into how alterations in these finely tuned clocks may lead to pathology.
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Affiliation(s)
- Velia S Vizcarra
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ryann M Fame
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Lauren M Hablitz
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
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Mok H, Ostendorf E, Ganninger A, Adler AJ, Hazan G, Haspel JA. Circadian immunity from bench to bedside: a practical guide. J Clin Invest 2024; 134:e175706. [PMID: 38299593 PMCID: PMC10836804 DOI: 10.1172/jci175706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
The immune system is built to counteract unpredictable threats, yet it relies on predictable cycles of activity to function properly. Daily rhythms in immune function are an expanding area of study, and many originate from a genetically based timekeeping mechanism known as the circadian clock. The challenge is how to harness these biological rhythms to improve medical interventions. Here, we review recent literature documenting how circadian clocks organize fundamental innate and adaptive immune activities, the immunologic consequences of circadian rhythm and sleep disruption, and persisting knowledge gaps in the field. We then consider the evidence linking circadian rhythms to vaccination, an important clinical realization of immune function. Finally, we discuss practical steps to translate circadian immunity to the patient's bedside.
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Affiliation(s)
- Huram Mok
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Elaine Ostendorf
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alex Ganninger
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Avi J. Adler
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Guy Hazan
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Research and Innovation Center, Saban Children’s Hospital, Beer-Sheva, Israel
| | - Jeffrey A. Haspel
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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McCullar KS, Abbaspour S, Wang W, Aguirre AD, Westover MB, Klerman EB. Timing of diuretic administration effects on urine volume in hospitalized patients. Front Physiol 2024; 14:1208324. [PMID: 38321985 PMCID: PMC10844419 DOI: 10.3389/fphys.2023.1208324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024] Open
Abstract
Importance: Some medications have effects that depend on the time of day they are given. Current knowledge of the time-of-day effects of specific medications in hospitalized patients with cardiovascular disease is very limited. In hospitalized patients, increased medication efficiency might reduce dose (and associated side effects) and/or the length of time in the Intensive Care Unit (ICU) or hospital-potentially improving patient outcomes and patient and family quality of life and reducing financial costs. We studied whether the time of day or night patients in Cardiac or Intensive Care Units receive a diuretic affects urine volume. Methods: In this observational study, data were collected from 7,685 patients (63% male, 18 to 98 years old) admitted to one hospital's Acute Care Cardiac units, Cardiac ICUs, Cardiac Surgery ICUs, and/or Non-cardiac ICUs who received intravenous furosemide (a diuretic), had measurements of urine volume, were hospitalized for ≥3 days between January 2016 to July 2021 and were older than 18 years. The outcomes of interest were urine volume normalized by the most recent (not older than 24 h) weight or body mass index (BMI), (i) in the hour after the time of diuretic administration, and (ii) when no diuretics were administered for the previous 3 h. Results: We identified diuretic medication administration time 23:00-04:59 as a predictor of higher urine volume response. For patients without recent diuretic medication, higher urine volume was predicted 11:00-16:59 and 17:00-22:59. Other factors that affected urine volume response to the diuretic were sex, age, medication dose, creatinine concentration, diagnoses, and hospital unit. Discussion: Time-of-day of medication administration may be a factor associated with increased medication efficiency. Randomized controlled trials should be conducted to quantify the relative effect of modifiable factors, such as time of medication administration, that may affect short- and longer-term outcomes.
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Affiliation(s)
- Katie S. McCullar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Sara Abbaspour
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Wei Wang
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States
| | - Aaron D. Aguirre
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - M. Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Elizabeth B. Klerman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States
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Paul CJ, Erickson BA, Nepple KG, Tracy CR. Does Rounding Order Bias Discharge Efficiency? Predictors of Discharge Timing on an Academic Urology Service. J Healthc Qual 2024; 46:12-21. [PMID: 38166162 DOI: 10.1097/jhq.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
ABSTRACT No previous works have analyzed whether the order in which surgical teams see patients on morning rounds affects discharge efficiency at teaching hospitals. We obtained perioperative urologic surgery timing data at our academic institution from 2014 to 2019. We limited the analysis to routine postoperative day 1 discharges. Univariate and multivariate analyses were performed to determine whether various hospital and patient factors were associated with discharge timing. We analyzed 1,494 patients. Average discharge order time was 11:22 a.m. and hospital discharge 1:24 p.m. Univariate regression revealed earlier discharge order time for patients seen later in rounds by 4 minutes per sequential room cluster (p = .013) and by 12 minutes per cluster when excluding short-stay patients. Multivariate analysis revealed discharge order placement did not vary significantly by rounding order. However, time of hospital discharge did (p < .001), likely due to speed of discharge in the designated short-stay units. Attending physician was the most consistent predictor in variations of discharge timing, with statistical significance across all measured outcomes. Patients seen later in rounding progression received earlier discharge orders, but this relationship does not remain in multivariate modeling or translate to earlier discharge. These findings have helped guide quality improvement efforts focused on discharge efficiency.
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Shafer BM, Kogan SA, McHill AW. Pressure Building Against the Clock: The Impact of Circadian Misalignment on Blood Pressure. Curr Hypertens Rep 2024; 26:31-42. [PMID: 37837518 PMCID: PMC10916535 DOI: 10.1007/s11906-023-01274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Misalignment between the endogenous biological timing system and behavioral activities (i.e., sleep/wake, eating, activity) contributes to adverse cardiovascular health. In this review, we discuss the effects of recurring circadian misalignment on blood pressure regulation and the implications for hypertension development. Additionally, we highlight emerging therapeutic approaches designed to mitigate the negative cardiovascular consequences elicited by circadian disruption. RECENT FINDINGS Circadian misalignment elicited by work schedules that require individuals to be awake during the biological night (i.e., shift work) alters 24-h blood pressure rhythms. Mechanistically, circadian misalignment appears to alter blood pressure via changes in autonomic nervous system balance, variations to sodium retention, dysregulation of endothelial vasodilatory responsiveness, and activation of proinflammatory mechanisms. Recurring circadian misalignment produced by a mismatch in sleep timing on free days vs. work days (i.e., social jetlag) appears to have no direct effects on prevailing blood pressure levels in healthy adults; though, circadian disruptions resulting from social jetlag may increase the risk of hypertension through enhanced sympathetic activation and/or obesity. Furthermore, social jetlag assessment may be a useful metric in shift work populations where the magnitude of circadian misalignment may be greater than in the general population. Circadian misalignment promotes unfavorable changes to 24-h blood pressure rhythms, most notably in shift working populations. While light therapy, melatonin supplementation, and the timing of drug administration may improve cardiovascular outcomes, interventions designed to target the effects of circadian misalignment on blood pressure regulation are warranted.
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Affiliation(s)
- Brooke M Shafer
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Sophia A Kogan
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Andrew W McHill
- Sleep, Chronobiology, and Health Laboratory, School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA.
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11
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Baum L, Johns M, Poikela M, Möller R, Ananthasubramaniam B, Prasser F. Data integration and analysis for circadian medicine. Acta Physiol (Oxf) 2023; 237:e13951. [PMID: 36790321 DOI: 10.1111/apha.13951] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Data integration, data sharing, and standardized analyses are important enablers for data-driven medical research. Circadian medicine is an emerging field with a particularly high need for coordinated and systematic collaboration between researchers from different disciplines. Datasets in circadian medicine are multimodal, ranging from molecular circadian profiles and clinical parameters to physiological measurements and data obtained from (wearable) sensors or reported by patients. Uniquely, data spanning both the time dimension and the spatial dimension (across tissues) are needed to obtain a holistic view of the circadian system. The study of human rhythms in the context of circadian medicine has to confront the heterogeneity of clock properties within and across subjects and our inability to repeatedly obtain relevant biosamples from one subject. This requires informatics solutions for integrating and visualizing relevant data types at various temporal resolutions ranging from milliseconds and seconds to minutes and several hours. Associated challenges range from a lack of standards that can be used to represent all required data in a common interoperable form, to challenges related to data storage, to the need to perform transformations for integrated visualizations, and to privacy issues. The downstream analysis of circadian rhythms requires specialized approaches for the identification, characterization, and discrimination of rhythms. We conclude that circadian medicine research provides an ideal environment for developing innovative methods to address challenges related to the collection, integration, visualization, and analysis of multimodal multidimensional biomedical data.
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Affiliation(s)
- Lena Baum
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Johns
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maija Poikela
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Möller
- Institute of Information Systems, University of Lübeck, Lübeck, Germany
| | | | - Fabian Prasser
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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12
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Moreno CRC, Raad R, Gusmão WDP, Luz CS, Silva VM, Prestes RM, Saraiva SP, Lemos LC, Vasconcelos SP, Nehme PXSA, Louzada FM, Marqueze EC. Are We Ready to Implement Circadian Hygiene Interventions and Programs? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16772. [PMID: 36554651 PMCID: PMC9781949 DOI: 10.3390/ijerph192416772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Circadian hygiene, a concept not to be confused with the notion of public or social hygiene, should be discussed among experts and society. Light-dark cycles and other possible synchronizers of the human circadian timing system affect ways of life, including sleeping, eating, working and physical activity. Some of these behaviors have also been investigated individually as synchronizers (e.g., eating times). Therefore, the knowledge held today about circadian rhythms, and their implications for health, allows future perspectives in this field to be mapped. The present article summarizes the latest knowledge on factors influencing circadian rhythms to discuss a perspective for the future of health promotion based on circadian hygiene. However, it is important to highlight that circadian hygiene is the product of an imbrication of individual and societal involvement. First, it is important to adopt practices and devise public health policies in line with circadian hygiene. Second, individual healthy habits require internal rhythms to be examined. Last, the research agenda on circadian hygiene can be developed on a public as well as individual level, raising the question as to how much society is willing to embrace this change.
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Affiliation(s)
- Claudia R. C. Moreno
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Rose Raad
- Department of Technology of Architecture, School of Architecture and Urbanism, University of São Paulo, São Paulo 05508-080, Brazil
| | - Waléria D. P. Gusmão
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Cristina S. Luz
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Victor M. Silva
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Renilda M. Prestes
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Susy P. Saraiva
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Lucia C. Lemos
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Suleima P. Vasconcelos
- Public Health Graduate Program, Federal University of Acre, Rio Branco 69920-900, Brazil
| | - Patrícia X. S. A. Nehme
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Fernando M. Louzada
- Department of Physiology, Federal University of Paraná, Curitiba 81531-980, Brazil
| | - Elaine C. Marqueze
- Department of Epidemiology, Public Health Graduate Program, Catholic University of Santos, Santos 11015-001, Brazil
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13
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Lecour S, Du Pré BC, Bøtker HE, Brundel BJJM, Daiber A, Davidson SM, Ferdinandy P, Girao H, Gollmann-Tepeköylü C, Gyöngyösi M, Hausenloy DJ, Madonna R, Marber M, Perrino C, Pesce M, Schulz R, Sluijter JPG, Steffens S, Van Linthout S, Young ME, Van Laake LW. Circadian rhythms in ischaemic heart disease: key aspects for preclinical and translational research: position paper of the ESC working group on cellular biology of the heart. Cardiovasc Res 2022; 118:2566-2581. [PMID: 34505881 DOI: 10.1093/cvr/cvab293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/04/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Circadian rhythms are internal regulatory processes controlled by molecular clocks present in essentially every mammalian organ that temporally regulate major physiological functions. In the cardiovascular system, the circadian clock governs heart rate, blood pressure, cardiac metabolism, contractility, and coagulation. Recent experimental and clinical studies highlight the possible importance of circadian rhythms in the pathophysiology, outcome, or treatment success of cardiovascular disease, including ischaemic heart disease. Disturbances in circadian rhythms are associated with increased cardiovascular risk and worsen outcome. Therefore, it is important to consider circadian rhythms as a key research parameter to better understand cardiac physiology/pathology, and to improve the chances of translation and efficacy of cardiac therapies, including those for ischaemic heart disease. The aim of this Position Paper by the European Society of Cardiology Working Group Cellular Biology of the Heart is to highlight key aspects of circadian rhythms to consider for improvement of preclinical and translational studies related to ischaemic heart disease and cardioprotection. Applying these considerations to future studies may increase the potential for better translation of new treatments into successful clinical outcomes.
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Affiliation(s)
- Sandrine Lecour
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Bastiaan C Du Pré
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Andreas Daiber
- Department of Cardiology, Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Henrique Girao
- Faculty of Medicine, Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Center for Innovative Biomedicine and Biotechnology (CIBB), Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | | | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Pisa, Italy
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, TX, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Joost P G Sluijter
- Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Berlin 10178, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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OUP accepted manuscript. Brain 2022; 145:3225-3235. [DOI: 10.1093/brain/awac147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
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15
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Abstract
Circadian clocks are biological timing mechanisms that generate 24-h rhythms of physiology and behavior, exemplified by cycles of sleep/wake, hormone release, and metabolism. The adaptive value of clocks is evident when internal body clocks and daily environmental cycles are mismatched, such as in the case of shift work and jet lag or even mistimed eating, all of which are associated with physiological disruption and disease. Studies with animal and human models have also unraveled an important role of functional circadian clocks in modulating cellular and organismal responses to physiological cues (ex., food intake, exercise), pathological insults (e.g. virus and parasite infections), and medical interventions (e.g. medication). With growing knowledge of the molecular and cellular mechanisms underlying circadian physiology and pathophysiology, it is becoming possible to target circadian rhythms for disease prevention and treatment. In this review, we discuss recent advances in circadian research and the potential for therapeutic applications that take patient circadian rhythms into account in treating disease.
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Affiliation(s)
- Yool Lee
- Department of Translational Medicine and Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Jeffrey M. Field
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amita Sehgal
- Howard Hughes Medical Institute, Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Koritala BSC, Conroy Z, Smith DF. Circadian Biology in Obstructive Sleep Apnea. Diagnostics (Basel) 2021; 11:1082. [PMID: 34199193 PMCID: PMC8231795 DOI: 10.3390/diagnostics11061082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a complex process that can lead to the dysregulation of the molecular clock, as well as 24 h rhythms of sleep and wake, blood pressure, and other associated biological processes. Previous work has demonstrated crosstalk between the circadian clock and hypoxia-responsive pathways. However, even in the absence of OSA, disrupted clocks can exacerbate OSA-associated outcomes (e.g., cardiovascular or cognitive outcomes). As we expand our understanding of circadian biology in the setting of OSA, this information could play a significant role in the diagnosis and treatment of OSA. Here, we summarize the pre-existing knowledge of circadian biology in patients with OSA and examine the utility of circadian biomarkers as alternative clinical tools.
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Affiliation(s)
- Bala S. C. Koritala
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Zachary Conroy
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - David F. Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- The Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- The Center for Circadian Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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17
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Costa R. Frontiers in Chronobiology: Endogenous Clocks at the Core of Signaling Pathways in Physiology. Front Physiol 2021; 12:684745. [PMID: 34093241 PMCID: PMC8173170 DOI: 10.3389/fphys.2021.684745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rodolfo Costa
- Department of Biology, University of Padova, Italian National Research Council (CNR) Institute of Neuroscience, Padova, Italy
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18
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Smolensky MH, Hermida RC, Geng YJ. Chronotherapy of cardiac and vascular disease: timing medications to circadian rhythms to optimize treatment effects and outcomes. Curr Opin Pharmacol 2020; 57:41-48. [PMID: 33279870 DOI: 10.1016/j.coph.2020.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
Circadian rhythms impact cardiac and vascular pathophysiology, resulting in 24-hour patterning of symptoms and life-threatening/ending events (chronopathology), plus kinetics and dynamics of medications (chronopharmacology), resulting in administration-time differences in efficacy and safety. Scheduling medications according to circadian rhythm determinants (chronotherapy) can improve treatment effects, for example, before dinner/bedtime ingestion of cholesterol-lowering medications and acetylsalicylic acid, respectively, exerts enhanced control of hypercholesterolemia and after-awakening peak of platelet aggregation; bedtime ingestion of conventional hypertension medications optimizes normalization of sleep-time blood pressure (BP)-strongest independent BP marker of cardiovascular disease (CVD) risk-and most effectively prevents (chronoprevention) CVD morbidity and mortality. Exploration of chronotherapeutic strategies to improve management of cardiac arrhythmias and vascular pathophysiology is still awaited.
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Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic) University of Vigo, Vigo, Spain
| | - Yong-Jian Geng
- Department of Internal Medicine, McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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19
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Moškon M. CosinorPy: a python package for cosinor-based rhythmometry. BMC Bioinformatics 2020; 21:485. [PMID: 33121431 PMCID: PMC7597035 DOI: 10.1186/s12859-020-03830-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Even though several computational methods for rhythmicity detection and analysis of biological data have been proposed in recent years, classical trigonometric regression based on cosinor still has several advantages over these methods and is still widely used. Different software packages for cosinor-based rhythmometry exist, but lack certain functionalities and require data in different, non-unified input formats. Results We present CosinorPy, a Python implementation of cosinor-based methods for rhythmicity detection and analysis. CosinorPy merges and extends the functionalities of existing cosinor packages. It supports the analysis of rhythmic data using single- or multi-component cosinor models, automatic selection of the best model, population-mean cosinor regression, and differential rhythmicity assessment. Moreover, it implements functions that can be used in a design of experiments, a synthetic data generator, and import and export of data in different formats. Conclusion CosinorPy is an easy-to-use Python package for straightforward detection and analysis of rhythmicity requiring minimal statistical knowledge, and produces publication-ready figures. Its code, examples, and documentation are available to download from https://github.com/mmoskon/CosinorPy. CosinorPy can be installed manually or by using pip, the package manager for Python packages. The implementation reported in this paper corresponds to the software release v1.1.
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Affiliation(s)
- Miha Moškon
- Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000, Ljubljana, Slovenia.
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20
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Hesse J, Malhan D, Yalҫin M, Aboumanify O, Basti A, Relógio A. An Optimal Time for Treatment-Predicting Circadian Time by Machine Learning and Mathematical Modelling. Cancers (Basel) 2020; 12:cancers12113103. [PMID: 33114254 PMCID: PMC7690897 DOI: 10.3390/cancers12113103] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
Tailoring medical interventions to a particular patient and pathology has been termed personalized medicine. The outcome of cancer treatments is improved when the intervention is timed in accordance with the patient's internal time. Yet, one challenge of personalized medicine is how to consider the biological time of the patient. Prerequisite for this so-called chronotherapy is an accurate characterization of the internal circadian time of the patient. As an alternative to time-consuming measurements in a sleep-laboratory, recent studies in chronobiology predict circadian time by applying machine learning approaches and mathematical modelling to easier accessible observables such as gene expression. Embedding these results into the mathematical dynamics between clock and cancer in mammals, we review the precision of predictions and the potential usage with respect to cancer treatment and discuss whether the patient's internal time and circadian observables, may provide an additional indication for individualized treatment timing. Besides the health improvement, timing treatment may imply financial advantages, by ameliorating side effects of treatments, thus reducing costs. Summarizing the advances of recent years, this review brings together the current clinical standard for measuring biological time, the general assessment of circadian rhythmicity, the usage of rhythmic variables to predict biological time and models of circadian rhythmicity.
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Affiliation(s)
- Janina Hesse
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Deeksha Malhan
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Müge Yalҫin
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Ouda Aboumanify
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Alireza Basti
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Angela Relógio
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
- Department of Human Medicine, Institute for Systems Medicine and Bioinformatics, MSH Medical School Hamburg—University of Applied Sciences and Medical University, 20457 Hamburg, Germany
- Correspondence: or
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