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Munshi PN, McCurdy SR. Age barriers in allogeneic hematopoietic cell transplantation: Raising the silver curtain. Am J Hematol 2024; 99:922-937. [PMID: 38414188 DOI: 10.1002/ajh.27228] [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] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 01/01/2024] [Indexed: 02/29/2024]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is no longer exclusively for the young. With an aging population, development of non-intensive remission-inducing strategies for hematologic malignancies, and novel graft-versus-host disease-prevention platforms, an older population of patients is pursuing HCT. The evolving population of HCT recipients requires an overhaul in the way we risk-stratify and optimize patients prior to HCT. Here, we review the history and current state of HCT for older adults and propose an assessment and intervention flow to bridge the gaps in today's clinical guidelines.
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Affiliation(s)
- Pashna N Munshi
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shannon R McCurdy
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Vedpathak S, Sharma A, Palkar S, Bhatt VR, Patil VC, Kakrani AL, Mishra A, Bhosle D, Arankalle VA, Shrivastava S. Platelet derived exosomes disrupt endothelial cell monolayer integrity and enhance vascular inflammation in dengue patients. Front Immunol 2024; 14:1285162. [PMID: 38235130 PMCID: PMC10791899 DOI: 10.3389/fimmu.2023.1285162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
Background Thrombocytopenia is the most notable phenomenon in dengue. Activation status of platelets and interaction of platelets with endothelium contribute towards dengue disease pathogenesis. Platelets are the major cell types known to release extracellular vesicles, especially exosomes in circulation. However, the role of platelet derived exosomes (PLT-EXOs) in endothelial dysfunction during dengue infection remains unknown. Methods In this study, we recruited 28 healthy subjects and 69 dengue patients categorized as WS- (n=31), WS+ (n=29) and SD (n=9). Platelets were isolated from platelet rich plasma of dengue patients and their activation was assessed by flow cytometry. PLT-EXOs were isolated by ultracentrifugation method. Western blot analyses were performed to characterize the exosomes. Exosome uptake experiment was carried out to see the internalization of exosomes inside endothelial cells (HUVECs). To observe the effect of exosomes on endothelial cells, exosomes were added on HUVECs and expression of adherens and tight junctional proteins were examined by immunofluorescence assay and western blot. Expression levels of vascular injury markers were measured in the culture supernatants of Exosome-HUVEC coculture and sera of dengue patients by MSD-multiplex assay. Results As compared to healthy subjects, CD41/CD61 expression was significantly reduced (p<0.0001) and CD62p expression was significantly increased (p<0.0001) on platelets in dengue patients. PLT-EXOs isolated from the dengue patients showed higher expression of CD63 and CD9 proteins than the healthy subjects. With in-vitro immunofluorescence assays, we illustrated the internalization of PLT-EXOs by the HUVECs and observed disruption of endothelial cell monolayer integrity in the presence of PLT-EXOs from WS+ and SD patients. Furthermore, the significant reduction in the expressions of ZO-2, VE-Cadherin and CD31 in endothelial cells following exposure to PLT-EXOs from the dengue patients provide direct evidence of PLT-EXOs mediated vascular permeability. PLT-EXOs stimulated the release of inflammatory markers CRP, SAA, sVCAM-1 and sICAM-1 in the supernatants of HUVEC cells. Importantly, significantly higher levels of CRP, sVCAM-1 and sICAM-1 in the sera of severe than mild dengue patients (p<0.0001) suggest their role in disease severity. Conclusions In summary, our data suggest that PLT-EXOs promote vascular leakage via release of proinflammatory mediators and compromise vascular barrier integrity in dengue patients.
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Affiliation(s)
- Sayali Vedpathak
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Archana Sharma
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Sonali Palkar
- Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, India
| | - Varsha R. Bhatt
- Department of Clinical Immunology and Rheumatology, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, India
| | - Vishwanath Chandrashekhar Patil
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, India
| | - Arjun L. Kakrani
- Department of Medicine, Dr. D. Y. Patil Medical College Hospital & Research Centre, Dr. D .Y. Patil Vidyapeeth, Pune, India
| | - AkhileshChandra Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Deepak Bhosle
- Department of Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, India
| | - Vidya A. Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shubham Shrivastava
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
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3
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Gilmore N, Loh KP, Liposits G, Arora SP, Vertino P, Janelsins M. Epigenetic and inflammatory markers in older adults with cancer: A Young International Society of Geriatric Oncology narrative review. J Geriatr Oncol 2024; 15:101655. [PMID: 37931584 PMCID: PMC10841884 DOI: 10.1016/j.jgo.2023.101655] [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] [Received: 09/13/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
The number of adults aged ≥ 65 years with cancer is rapidly increasing. Older adults with cancer are susceptible to treatment-related acute and chronic adverse events, resulting in loss of independence, reduction in physical function, and decreased quality of life. Nevertheless, evidence-based interventions to prevent or treat acute and chronic adverse events in older adults with cancer are limited. Several promising blood-based biomarkers related to inflammation and epigenetic modifications are available to identify older adults with cancer who are at increased risk of accelerated aging and physical, functional, and cognitive impairments caused by the cancer and its treatment. Inflammatory changes and epigenetic modifications can be reversible and targeted by lifestyle changes and interventions. Here we discuss ways in which changes in inflammatory and epigenetic pathways influence the aging process and how these pathways can be targeted by interventions aimed at reducing inflammation and aging-associated biological markers. As the number of older adults with cancer entering survivorship continues to increase, it is becoming progressively more important to understand ways in which the benefit from treatment can be enhanced while reducing the effects of accelerated aging.
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Affiliation(s)
- Nikesha Gilmore
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA; James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Gabor Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark; Department of Oncology, Regional Hospital Gødstrup, Herning, Denmark.
| | - Sukeshi Patel Arora
- Division of Hematology/Oncology, Department of Medicine, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA.
| | - Paula Vertino
- James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Michelle Janelsins
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA; James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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4
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Kraus VB, Ma S, Tourani R, Fillenbaum GG, Burchett BM, Parker DC, Kraus WE, Connelly MA, Otvos JD, Cohen HJ, Orenduff MC, Pieper CF, Zhang X, Aliferis CF. Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults. EBioMedicine 2022; 85:104292. [PMID: 36182774 PMCID: PMC9526168 DOI: 10.1016/j.ebiom.2022.104292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/15/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The hard endpoint of death is one of the most significant outcomes in both clinical practice and research settings. Our goal was to discover direct causes of longevity from medically accessible data. METHODS Using a framework that combines local causal discovery algorithms with discovery of maximally predictive and compact feature sets (the "Markov boundaries" of the response) and equivalence classes, we examined 186 variables and their relationships with survival over 27 years in 1507 participants, aged ≥71 years, of the longitudinal, community-based D-EPESE study. FINDINGS As few as 8-15 variables predicted longevity at 2-, 5- and 10-years with predictive performance (area under receiver operator characteristic curve) of 0·76 (95% CIs 0·69, 0·83), 0·76 (0·72, 0·81) and 0·66 (0·61, 0·71), respectively. Numbers of small high-density lipoprotein particles, younger age, and fewer pack years of cigarette smoking were the strongest determinants of longevity at 2-, 5- and 10-years, respectively. Physical function was a prominent predictor of longevity at all time horizons. Age and cognitive function contributed to predictions at 5 and 10 years. Age was not among the local 2-year prediction variables (although significant in univariable analysis), thus establishing that age is not a direct cause of 2-year longevity in the context of measured factors in our data that determine longevity. INTERPRETATION The discoveries in this study proceed from causal data science analyses of deep clinical and molecular phenotyping data in a community-based cohort of older adults with known lifespan. FUNDING NIH/NIA R01AG054840, R01AG12765, and P30-AG028716, NIH/NIA Contract N01-AG-12102 and NCRR 1UL1TR002494-01.
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Affiliation(s)
- Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States.
| | - Sisi Ma
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States; University of Minnesota Department of Medicine, Minneapolis, MN, United States
| | - Roshan Tourani
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Gerda G Fillenbaum
- Psychiatry and Behavioral Sciences and Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Bruce M Burchett
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Daniel C Parker
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Margery A Connelly
- Laboratory Corporation of America® Holdings (Labcorp), Morrisville, NC, United States
| | - James D Otvos
- Laboratory Corporation of America® Holdings (Labcorp), Morrisville, NC, United States
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Melissa C Orenduff
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States; Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Xin Zhang
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Constantin F Aliferis
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States; University of Minnesota Consortium on Aging, Minneapolis, MN, United States; University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, United States; University of Minnesota Department of Medicine, Minneapolis, MN, United States
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5
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Sedrak MS, Gilmore NJ, Carroll JE, Muss HB, Cohen HJ, Dale W. Measuring Biologic Resilience in Older Cancer Survivors. J Clin Oncol 2021; 39:2079-2089. [PMID: 34043454 PMCID: PMC8260901 DOI: 10.1200/jco.21.00245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Judith E. Carroll
- University of California, Los Angeles, David Geffen School of Medicine, Jonsson Comprehensive Cancer Center, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Los Angeles, CA
| | - Hyman B. Muss
- Department of Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - William Dale
- City of Hope National Medical Center, Duarte, CA
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Kumar P, Liu C, Hsu JW, Chacko S, Minard C, Jahoor F, Sekhar RV. Glycine and N-acetylcysteine (GlyNAC) supplementation in older adults improves glutathione deficiency, oxidative stress, mitochondrial dysfunction, inflammation, insulin resistance, endothelial dysfunction, genotoxicity, muscle strength, and cognition: Results of a pilot clinical trial. Clin Transl Med 2021; 11:e372. [PMID: 33783984 PMCID: PMC8002905 DOI: 10.1002/ctm2.372] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Oxidative stress (OxS) and mitochondrial dysfunction are implicated as causative factors for aging. Older adults (OAs) have an increased prevalence of elevated OxS, impaired mitochondrial fuel-oxidation (MFO), elevated inflammation, endothelial dysfunction, insulin resistance, cognitive decline, muscle weakness, and sarcopenia, but contributing mechanisms are unknown, and interventions are limited/lacking. We previously reported that inducing deficiency of the antioxidant tripeptide glutathione (GSH) in young mice results in mitochondrial dysfunction, and that supplementing GlyNAC (combination of glycine and N-acetylcysteine [NAC]) in aged mice improves naturally-occurring GSH deficiency, mitochondrial impairment, OxS, and insulin resistance. This pilot trial in OA was conducted to test the effect of GlyNAC supplementation and withdrawal on intracellular GSH concentrations, OxS, MFO, inflammation, endothelial function, genotoxicity, muscle and glucose metabolism, body composition, strength, and cognition. METHODS A 36-week open-label clinical trial was conducted in eight OAs and eight young adults (YAs). After all the participants underwent an initial (pre-supplementation) study, the YAs were released from the study. OAs were studied again after GlyNAC supplementation for 24 weeks, and GlyNAC withdrawal for 12 weeks. Measurements included red-blood cell (RBC) GSH, MFO; plasma biomarkers of OxS, inflammation, endothelial function, glucose, and insulin; gait-speed, grip-strength, 6-min walk test; cognitive tests; genomic-damage; glucose-production and muscle-protein breakdown rates; and body-composition. RESULTS GlyNAC supplementation for 24 weeks in OA corrected RBC-GSH deficiency, OxS, and mitochondrial dysfunction; and improved inflammation, endothelial dysfunction, insulin-resistance, genomic-damage, cognition, strength, gait-speed, and exercise capacity; and lowered body-fat and waist-circumference. However, benefits declined after stopping GlyNAC supplementation for 12 weeks. CONCLUSIONS GlyNAC supplementation for 24-weeks in OA was well tolerated and lowered OxS, corrected intracellular GSH deficiency and mitochondrial dysfunction, decreased inflammation, insulin-resistance and endothelial dysfunction, and genomic-damage, and improved strength, gait-speed, cognition, and body composition. Supplementing GlyNAC in aging humans could be a simple and viable method to promote health and warrants additional investigation.
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Affiliation(s)
- Premranjan Kumar
- Translational Metabolism Unit, Division of Endocrinology, Diabetes and MetabolismDepartment of Medicine, Baylor College of MedicineHoustonTexas77030USA
| | - Chun Liu
- Translational Metabolism Unit, Division of Endocrinology, Diabetes and MetabolismDepartment of Medicine, Baylor College of MedicineHoustonTexas77030USA
| | - Jean W. Hsu
- USDA/ARS Children's Nutritional Research CenterHoustonTexasUSA
| | - Shaji Chacko
- USDA/ARS Children's Nutritional Research CenterHoustonTexasUSA
| | - Charles Minard
- Institute of Clinical and Translational Research, Baylor College of MedicineHoustonTexas
| | - Farook Jahoor
- USDA/ARS Children's Nutritional Research CenterHoustonTexasUSA
| | - Rajagopal V. Sekhar
- Translational Metabolism Unit, Division of Endocrinology, Diabetes and MetabolismDepartment of Medicine, Baylor College of MedicineHoustonTexas77030USA
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7
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Parker DC, Colόn-Emeric C, Huebner JL, Chou CH, Kraus VB, Pieper CF, Sloane R, Whitson HE, Orwig D, Crabtree DM, Magaziner J, Bain JR, Muehlbauer M, Ilkayeva OR, Huffman KM. Biomarkers Associated with Physical Resilience After Hip Fracture. J Gerontol A Biol Sci Med Sci 2020; 75:e166-e172. [PMID: 32386291 PMCID: PMC7518564 DOI: 10.1093/gerona/glaa119] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Clinically similar older adults demonstrate variable responses to health stressors, heterogeneity attributable to differences in physical resilience. However, molecular mechanisms underlying physical resilience are unknown. We previously derived a measure of physical resilience after hip fracture-the expected recovery differential (ERD)-that captures the difference between actual recovery and predicted recovery. Starting with biomarkers associated with physical performance, morbidity, mortality, and hip fracture, we evaluated associations with the ERD to identify biomarkers of physical resilience after hip fracture. METHODS In the Baltimore Hip Studies (N = 304) sera, we quantified biomarkers of inflammation (TNFR-I, TNFR-II, sVCAM-1, and IL-6), metabolic and mitochondrial function (non-esterified fatty acids, lactate, ketones, acylcarnitines, free amino acids, and IGF-1), and epigenetic dysregulation (circulating microRNAs). We used principal component analysis, canonical correlation, and least absolute shrinkage and selection operator regression (LASSO) to identify biomarker associations with better-than-expected recovery (greater ERD) after hip fracture. RESULTS Participants with greater ERD were more likely to be women and less disabled at baseline. The complete biomarker set explained 37% of the variance in ERD (p < .001) by canonical correlation. LASSO regression identified a biomarker subset that accounted for 27% of the total variance in the ERD and included a metabolic factor (aspartate/asparagine, C22, C5:1, lactate, glutamate/mine), TNFR-I, miR-376a-3p, and miR-16-5p. CONCLUSIONS We identified a set of biomarkers that explained 27% of the variance in ERD-a measure of physical resilience after hip fracture. These ERD-associated biomarkers may be useful in predicting physical resilience in older adults facing hip fracture and other acute health stressors.
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Affiliation(s)
- Daniel C Parker
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Cathleen Colόn-Emeric
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Address correspondence to: Cathleen Colón-Emeric, MD, MHS, Box 3003 DUMC, Durham, NC 27710. E-mail
| | - Janet L Huebner
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Ching-Heng Chou
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Virginia Byers Kraus
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina,Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Heather E Whitson
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Donna M Crabtree
- Duke Office of Clinical Research, Duke University Medical Center, Durham, North Carolina
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - James R Bain
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Michael Muehlbauer
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Olga R Ilkayeva
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Kim M Huffman
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina,Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina
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8
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Zadvorev SF, Zamytskaya AA, Piskunov DP, Pushkin AS, Yakovlev AA. Plasma D-Dimer Level as a Subclinical Marker of Thrombotic Risk in Elderly Patients with Atrial Fibrillation. ADVANCES IN GERONTOLOGY 2020. [DOI: 10.1134/s2079057020010166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stanifer JW, Landerman L, Pieper CF, Huffman KM, Kraus WE. Relations of established aging biomarkers (IL-6, D-dimer, s-VCAM) to glomerular filtration rate and mortality in community-dwelling elderly adults. Clin Kidney J 2018; 11:377-382. [PMID: 29942503 PMCID: PMC6007338 DOI: 10.1093/ckj/sfx097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/22/2017] [Indexed: 12/11/2022] Open
Abstract
Background Biomarkers improving risk prediction for elderly populations with chronic kidney disease (CKD), an independent predictor of mortality, could be particularly useful. We previously observed that interleukin-6 (IL-6), D-dimer and soluble vascular adhesion molecule (s-VCAM) were independent biomarkers of mortality in elderly individuals. Therefore, we investigated whether these established biomarkers were independently associated with both estimated glomerular filtration rate (eGFR) and mortality. Methods The Established Populations for Epidemiologic Studies of the Elderly (EPESE) is a longitudinal cohort of community-dwelling elderly individuals. We investigated the association among eGFR, the biomarkers (IL-6, D-dimer and s-VCAM) and 4-year all-cause mortality using restricted cubic splines within Cox proportional hazards models. Results Among 1907 participants in EPESE, 1342 had available creatinine and biomarker measures. Incidence of all-cause mortality was 21.6%. eGFR was associated with all-cause mortality (P < 0.01); individuals at the lowest (<30 mL/min/1.73 m2) levels had the highest mortality rates. D-dimer and s-VCAM were associated (P < 0.01) with mortality, and after adjustment for IL-6, D-dimer and s-VCAM, the mortality risk varied by eGFR level. Conclusions In community-dwelling elderly individuals, we observed an association among eGFR, 4-year mortality and IL-6, D-dimer and s-VCAM. eGFR was independently associated with mortality, and the relation between eGFR and mortality was modified by IL-6, D-dimer and s-VCAM, which was most notable in individuals with severely reduced eGFR. These findings suggest that IL-6, D-dimer and s-VCAM may be useful biomarkers for improving risk prediction, but further studies are needed examining the role of these biomarkers in elderly individuals with CKD.
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Affiliation(s)
- John W Stanifer
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Landerman
- Duke University Older Americans Independence Center; Duke University School of Medicine; Duke University; Durham, NC, USA
| | - Carl F Pieper
- Duke University Older Americans Independence Center; Duke University School of Medicine; Duke University; Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine, Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA.,Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Duke University, Durham, NC, USA.,Department of Medicine, Division of Cardiology, Duke University School of Medicine, Duke University, Durham, NC, USA
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10
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Tchalla AE, Wellenius GA, Sorond FA, Gagnon M, Iloputaife I, Travison TG, Dantoine T, Lipsitz LA. Elevated Soluble Vascular Cell Adhesion Molecule-1 Is Associated With Cerebrovascular Resistance and Cognitive Function. J Gerontol A Biol Sci Med Sci 2017; 72:560-566. [PMID: 27317684 PMCID: PMC5861880 DOI: 10.1093/gerona/glw099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated plasma soluble vascular cell adhesion molecule-1 (sVCAM-1) is a presumed marker of endothelial dysfunction, both in the brain and systemic circulation. Impairments in memory and cognition have been associated with cardiovascular diseases, but little is known about their relationships to abnormal cerebral endothelial function. METHODS We studied the cross-sectional association between sVCAM-1 and markers of cerebrovascular hemodynamics and cognitive function in 680 community-dwelling participants in the MOBILIZE Boston Study, aged 65 years and older. Cognitive function was assessed using the Hopkins Verbal Learning Memory Test and Trail Making Tests (TMTs) A and B. Global cognitive impairment was defined as Mini-Mental State Examination (MMSE) score less than 24. sVCAM-1 was measured by ELISA assay. Beat-to-beat blood flow velocity (BFV) and cerebrovascular resistance (CVR = mean arterial pressure / BFV) in the middle cerebral artery were assessed at rest by transcranial Doppler ultrasound. RESULTS sVCAM-1 concentrations were higher among participants with an MMSE score <24 versus ≥24 (1,201±417 vs 1,122±494ng/mL). In regression models adjusted for sociodemographic characteristics and health conditions, increasing levels of sVCAM-1 were linearly associated with higher resting CVR (p = .006) and lower performance on the Hopkins Verbal Learning Memory (immediate recall and delayed recall) and adjusted TMT B tests (p < .05). Higher levels of sVCAM-1 were also associated with global cognitive impairment on the MMSE (odds ratio = 3.9; 95% confidence interval: 1.4-10.9; p = .011). CONCLUSIONS In this cohort of elderly participants, we observed a cross-sectional association between elevated sVCAM-1 levels and both cognitive impairment and increased cerebrovascular resistance. Longitudinal studies are needed to determine whether elevated sVCAM-1 is a cause or consequence of cerebrovascular damage.
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Affiliation(s)
- Achille E Tchalla
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Geriatric Medicine, Limoges University, Limoges, France
| | | | - Farzaneh A Sorond
- Department of Neurology, Stroke Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Margaret Gagnon
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | | | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Thierry Dantoine
- Department of Geriatric Medicine, Limoges University, Limoges, France
| | - Lewis A Lipsitz
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Cases MG, Frugé AD, De Los Santos JF, Locher JL, Cantor AB, Smith KP, Glover TA, Cohen HJ, Daniel M, Morrow CD, Moellering DR, Demark-Wahnefried W. Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors. Contemp Clin Trials 2016; 50:201-12. [PMID: 27565830 PMCID: PMC5055381 DOI: 10.1016/j.cct.2016.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/10/2016] [Accepted: 08/22/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cancer survivors suffer from long-term adverse effects that reduce health-related quality of life (QOL) and physical functioning, creating an urgent need to develop effective, durable, and disseminable interventions. Harvest for Health, a home-based vegetable gardening intervention, holds promise for these domains. METHODS This report describes the methods and recruitment experiences from two randomized controlled feasibility trials that employ a waitlist-controlled design. Delivered in partnership with Cooperative Extension Master Gardeners, this intervention provides one-on-one mentorship of cancer survivors in planning and maintaining three seasonal vegetable gardens over 12months. The primary aim is to determine intervention feasibility and acceptability; secondary aims are to explore effects on objective and subjective measures of diet, physical activity and function, and QOL and examine participant factors associated with potential effects. One trial is conducted exclusively among 82 female breast cancer survivors residing in the Birmingham, AL metropolitan area (BBCS); another broadly throughout Alabama among 46 older cancer survivors aged >60 (ASCS). RESULTS Response rates were 32.6% (BBCS) and 52.3% (ASCS). Both trials exceeded 80% of their accrual target. Leading reasons for ineligibility were removal of >10 lymph nodes (lymphedema risk factor), lack of physician approval, and unwillingness to be randomized to the waitlist. CONCLUSION To date, recruitment and implementation of Harvest for Health appears feasible. DISCUSSION Although both studies encountered recruitment challenges, lessons learned can inform future larger-scale studies. Vegetable gardening interventions are of interest to cancer survivors and may provide opportunities to gain life skills leading to improvements in overall health and QOL.
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Affiliation(s)
- Mallory G Cases
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States.
| | - Andrew D Frugé
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States
| | - Jennifer F De Los Santos
- Department of Radiation Oncology, School of Medicine, University of Alabama at Birmingham, The Kirklin Clinic at Acton Road, 2145 Bonner Way, Birmingham, AL 35243, United States
| | - Julie L Locher
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1530 3rd Avenue South, CH19-Room 218F, Birmingham, AL 35294, United States
| | - Alan B Cantor
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Ryals Public Health Building, Room 327, Birmingham, AL 35294, United States
| | - Kerry P Smith
- Alabama Cooperative Extension System, Alabama A&M University and Auburn University, 101 Funchess Hall, Auburn University, AL 36849, United States
| | - Tony A Glover
- Alabama Cooperative Extension System, Alabama A&M University and Auburn University, 101 Funchess Hall, Auburn University, AL 36849, United States
| | - Harvey J Cohen
- Center for the Study of Aging, Duke University, Room 3502 Blue Zone, Duke University Medical Center Box 3003, Durham, NC 27710, United States
| | - Michael Daniel
- Department of Biology, College of Arts & Sciences, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States
| | - Casey D Morrow
- Department of Cell, Developmental, and Integrative Biology, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, THT 926, Birmingham, AL 35294, United States
| | - Douglas R Moellering
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States; UAB Diabetes Research Center, Bioanalytical Redox Biology Core, University of Alabama at Birmingham, 1670 University Boulevard, VH G004, Birmingham, AL 35294, United States
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Webb Building 346, Birmingham, AL 35294, United States
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Bambrick P, Tan WS, Mulcahy R, Pope GA, Cooke J. Vascular risk assessment in older adults without a history of cardiovascular disease. Exp Gerontol 2016; 79:37-45. [PMID: 26972634 DOI: 10.1016/j.exger.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 01/27/2016] [Accepted: 03/01/2016] [Indexed: 12/16/2022]
Abstract
Modern cardiovascular risk prediction tools, which have their genesis in the Framingham Heart Study, have allowed more accurate risk stratification and targeting of treatments worldwide over the last seven decades. Better cardiovascular risk factor control during this time has led to a reduction in cardiovascular mortality and, at least in part, to improved life expectancy. As a result, western societies as a whole have seen a steady increase in the proportion of older persons in their populations. Unfortunately, several studies have shown that the same tools which have contributed to this increase cannot be reliably extrapolated for use in older generations. Recent work has allowed recalibration of existing models for use in older populations but these modified tools still require external validation before they can be confidently applied in clinical practice. Another complication is emerging evidence that aggressive risk factor modification in older adults, particularly more frail individuals, may actually be harmful. This review looks at currently available cardiovascular risk prediction models and the specific challenges faced with their use in older adults, followed by analysis of recent attempts at recalibration for this cohort. We discuss the issue of frailty, looking at our evolving understanding of its constituent features and various tools for its assessment. We also review work to date on the impact of frailty on cardiovascular risk modification and outline its potentially central role in determining the most sensible approach in older patients. We summarise the most promising novel markers of cardiovascular risk which may be of use in improving risk prediction in older adults in the future. These include markers of vascular compliance (such as aortic pulse wave velocity and pulse wave analysis), of endothelial function (such as flow mediated dilation, carotid intima-media thickness and coronary artery calcium scores), and also biochemical and circulating cellular markers.
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Affiliation(s)
- P Bambrick
- Department of Medicine for the Elderly, University Hospital Waterford, Republic of Ireland; Waterford Cardiovascular Research Group, Republic of Ireland.
| | - W S Tan
- Department of Medicine for the Elderly, University Hospital Waterford, Republic of Ireland
| | - R Mulcahy
- Department of Medicine for the Elderly, University Hospital Waterford, Republic of Ireland
| | - G A Pope
- Department of Medicine for the Elderly, University Hospital Waterford, Republic of Ireland
| | - J Cooke
- Department of Medicine for the Elderly, University Hospital Waterford, Republic of Ireland; Waterford Cardiovascular Research Group, Republic of Ireland
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Abstract
BACKGROUND Data relating to cancer treatment in the older patient population are limited because older individuals have been under-represented in clinical trials. The goal of this review was to establish which factors hinder the participation of older individuals to clinical trials and to examine possible solutions. METHODS The literature relating to cancer treatment in the older patient population was reviewed. RESULTS The benefit of systemic cancer treatment may decrease with age, and risks may be increased due to reduced life expectancy and reduced tolerance of stress in the older population. Therefore, a multipronged approach is recommended for clinical studies in these patients, including phase 2 studies limited to persons 70 years of age and older, stratification by life expectancy and predicted treatment tolerance in phase 3 studies, and registration studies to establish predictive variables for treatment-related toxicity in older individuals. CONCLUSIONS A combination of prospective and registration studies may supply adequate information to study cancer treatments in the older patient population.
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Affiliation(s)
- Lodovico Balducci
- Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Peterson MJ, Thompson DK, Pieper CF, Morey MC, Kraus VB, Kraus WE, Sullivan P, Fillenbaum G, Cohen HJ. A Novel Analytic Technique to Measure Associations Between Circulating Biomarkers and Physical Performance Across the Adult Life Span. J Gerontol A Biol Sci Med Sci 2015; 71:196-202. [PMID: 25745025 DOI: 10.1093/gerona/glv007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/16/2015] [Indexed: 12/20/2022] Open
Abstract
Understanding associations between circulating biomarkers and physical performance across the adult life span could aid in better describing mechanistic pathways leading to disability. We hypothesized that high concentrations of circulating biomarkers would be associated with lower functioning across study populations representing the adult life span. The data were from four intervention and two observational studies with ages ranging 22-89 years. Biomarkers assayed included inflammatory, coagulation, and endothelial function markers. Physical performance was measured either by VO2peak (studies of young and middle-aged adults) or usual gait speed (studies of older adults). Partialled (by age, body mass index, race, and sex) and weighted common correlations were calculated between biomarkers and physical performance. Homogeneity of the associations was also assessed. Interleukin-6 (weighted r = -.22), tumor necrosis factor receptor 2 (weighted r = -.19), D-dimer (weighted r = -.16), tumor necrosis factor receptor 1 (weighted r = -.15), granulocyte colony-stimulating factor (weighted r = -.14), and tumor necrosis factor alpha (weighted r = -.10) were all significantly inversely correlated with physical performance (p < .05). All significant correlations were homogeneous across studies. In summary, we observed consistent inverse associations between six circulating biomarkers and objective measures of physical performance. These results suggest that these serum biomarkers may be broadly applicable for detection, trajectory, and treatment monitoring of physical function across the life span or possibly for midlife predictors of functionally deleterious conditions.
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Affiliation(s)
| | - Dana K Thompson
- Department of Medicine, Duke University, Durham, North Carolina
| | - Carl F Pieper
- Center for the Study of Aging and Human Development/Claude D. Pepper Older Adults Independence Center and Department of Biometry and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | | | - Virginia B Kraus
- Center for the Study of Aging and Human Development/Claude D. Pepper Older Adults Independence Center and Department of Medicine, Duke University, Durham, North Carolina
| | - William E Kraus
- Center for the Study of Aging and Human Development/Claude D. Pepper Older Adults Independence Center and Department of Medicine, Duke University, Durham, North Carolina
| | - Patrick Sullivan
- Department of Medicine, Duke University, Durham, North Carolina. Geriatric Research, Education and Clinical Center, Veteran's Affairs Medical Center, Durham, North Carolina
| | - Gerda Fillenbaum
- Center for the Study of Aging and Human Development/Claude D. Pepper Older Adults Independence Center and
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15
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Wannamethee SG, Whincup PH, Lennon L, Papacosta O, Lowe GD. Associations between fibrin D-dimer, markers of inflammation, incident self-reported mobility limitation, and all-cause mortality in older men. J Am Geriatr Soc 2015; 62:2357-62. [PMID: 25516032 PMCID: PMC4293158 DOI: 10.1111/jgs.13133] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the independent relationships between fibrin D-dimer, interleukin 6 (IL-6), C-reactive protein (CRP), and fibrinogen and incident mobility limitation and mortality. DESIGN Prospective. SETTING General practice in 24 British towns. PARTICIPANTS Men aged 60 to 79 without prevalent heart failure followed up for an average of 11.5 years (N = 3,925). MEASUREMENTS All-cause mortality (n = 1,286) and self-reported mobility disability obtained at examination in 1998 to 2000 and in a postal questionnaire 3 to 5 years later in 2003. RESULTS High D-dimer (top vs lowest tertile: adjusted odds ratio (aOR) = 1.46, 95% confidence interval = 1.02-2.05) and IL-6 (aOR = 1.43, 95% CI = 1.01-2.02) levels (but not CRP or fibrinogen) were associated with greater incident mobility limitation after adjustment for confounders and prevalent disease status. IL-6, CRP, fibrinogen, and D-dimer were significantly associated with total mortality after adjustment for confounders. Only D-dimer and IL-6 predicted total mortality independent of each other and the other biomarkers. The adjusted hazard ratio (aHR) was 1.16 (95% CI = 1.10-1.22) for a standard deviation increase in log D-dimer and 1.10 (95% CI = 1.04-1.18) for a standard deviation increase in log IL-6. D-dimer was independently related to vascular and nonvascular mortality, and IL-6 was independently related to vascular mortality. Risks of mobility limitation and mortality were greatest in those with a combination of high D-dimer and IL-6 levels. CONCLUSION D-dimer and IL-6 are associated with risk of mobility limitation and mortality in older men without heart failure. The findings suggest that coagulation leads to functional decline and mortality s that inflammation does not explain.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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16
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Hubbard JM, Cohen HJ, Muss HB. Incorporating biomarkers into cancer and aging research. J Clin Oncol 2014; 32:2611-6. [PMID: 25071114 DOI: 10.1200/jco.2014.55.4261] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The challenge in treating the older adult with cancer is accurately accounting for and adapting management to the heterogeneity in health status of the individual patient. Many oncologists recognize that chronological age alone should not be the determinant when deciding on a treatment regimen. Easily measurable markers that provide an assessment of functional age would be ideal to assess frailty, which may predispose the patient to complications from cancer treatment, including increased toxicity, functional decline, decreased quality of life, and poorer survival. Several categories of potential markers, including chronic inflammatory markers, markers of cellular senescence, and imaging to assess muscle mass to detect sarcopenia, may provide insight into the likelihood of treatment-related complications. This article discusses candidate markers and strategies to evaluate these markers in cancer treatment trials, with the aim of developing a method to assess risk of oncologic outcomes and guide management decisions for both the physician and patient.
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Affiliation(s)
- Joleen M Hubbard
- Joleen M. Hubbard, Mayo Clinic, Rochester, MN; Harvey J. Cohen, Duke University Medical Center, Durham; and Hyman B. Muss, University of North Carolina, Chapel Hill, NC.
| | - Harvey J Cohen
- Joleen M. Hubbard, Mayo Clinic, Rochester, MN; Harvey J. Cohen, Duke University Medical Center, Durham; and Hyman B. Muss, University of North Carolina, Chapel Hill, NC
| | - Hyman B Muss
- Joleen M. Hubbard, Mayo Clinic, Rochester, MN; Harvey J. Cohen, Duke University Medical Center, Durham; and Hyman B. Muss, University of North Carolina, Chapel Hill, NC
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Hubbard JM, Jatoi A. Incorporating biomarkers of frailty and senescence in cancer therapeutic trials. J Gerontol A Biol Sci Med Sci 2014; 70:722-8. [PMID: 24770389 DOI: 10.1093/gerona/glu046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/04/2014] [Indexed: 02/07/2023] Open
Abstract
As the population ages, oncologists are faced with the quandary of how to efficiently identify frail individuals that may have more difficulty tolerating and recovering from systemic therapy for cancer. Recent advances have been made in recognizing frailty via clinical geriatric assessment of older patients with cancer. These advances appear to allow for better prediction of toxicity than physician-rated performance status. Although the development of these tools is a large step forward in geriatric oncology, we still lack an understanding of how the underlying biologic processes of aging affect tolerance of cancer treatment. Determining specific biologic causes underlying frailty may allow oncologists to become even more adept at identifying patients at risk for excessive toxicity and provide the opportunity to therapeutically target these processes to help improve tolerability and survival outcomes for older patients with cancer. This article provides a background on potential biologic factors that may identify frail individuals at increased risk for toxicity related to cancer treatment. Potential methods to incorporate these factors into cancer therapeutic trials are discussed.
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Affiliation(s)
- Joleen M Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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18
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Hybels CF, George LK, Blazer DG, Pieper CF, Cohen HJ, Koenig HG. Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults. J Aging Health 2014; 26:679-697. [PMID: 24728938 DOI: 10.1177/0898264314527479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status. METHOD Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders. RESULTS More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation. DISCUSSION Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services.
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Affiliation(s)
| | | | | | | | | | - Harold G Koenig
- Duke University Medical Center, Durham, NC, USA King Abdulaziz University, Jeddah, Saudi Arabia
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19
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Hajjar RR, Atli T, Al-Mandhari Z, Oudrhiri M, Balducci L, Silbermann M. Prevalence of aging population in the Middle East and its implications on cancer incidence and care. Ann Oncol 2014; 24 Suppl 7:vii11-24. [PMID: 24001758 DOI: 10.1093/annonc/mdt268] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Middle Eastern population is aging rapidly, and as aging is the main risk factor for cancer, the incidence and prevalence of that disease are increasing among all the populations in the region. These developments represent huge challenges to national and community-based health services. At the current state of affairs, most Middle Eastern countries require the cooperation of international agencies in order to cope with such new challenges to their health systems. The focus and emphasis in facing these changing circumstances lie in the education and training of professionals, mainly physicians and nurses, at the primary, secondary and tertiary levels of health services. It is imperative that these training initiatives include clinical practice, with priority given to the creation of multidisciplinary teams both at the cancer centers and for home-based services.
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Affiliation(s)
- R R Hajjar
- Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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20
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Atkins JL, Whincup PH, Morris RW, Wannamethee SG. Low muscle mass in older men: the role of lifestyle, diet and cardiovascular risk factors. J Nutr Health Aging 2014; 18:26-33. [PMID: 24402385 DOI: 10.1007/s12603-013-0336-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore associations between low muscle mass and a wide range of lifestyle, dietary and cardiovascular risk factors in older men including metabolic risk factors, markers of inflammation, endothelial dysfunction and coagulation. DESIGN Cross-sectional study. SETTING British Regional Heart Study. PARTICIPANTS 4252 men aged 60-79 years. MEASUREMENTS PARTICIPANTS attended a physical examination in 1998-2000, and completed a general questionnaire and a food frequency questionnaire. Low muscle mass was assessed by two measures: midarm muscle circumference (MAMC) and fat-free mass index (FFMI). Associations between risk factors and low muscle mass were analysed using logistic regression. RESULTS Physical inactivity, insulin resistance, C-reactive protein, von Willebrand factor and fibrinogen were associated with significantly increased odds of low MAMC and FFMI after adjustment for body mass index, lifestyle characteristics and morbidity. Those with higher percent energy intake from carbohydrates showed decreased odds of low MAMC (OR: 0.73, 95% CI: 0.55-0.96) and FFMI (OR: 0.76, 95% CI: 0.58-0.99). Other dietary variables, smoking, alcohol intake, D-dimer, interleukin 6 and homocysteine showed no important associations with MAMC and FFMI. CONCLUSION Increasing physical activity, consuming a diet with a high proportion of energy from carbohydrates, and taking steps to prevent insulin resistance and reduce inflammation and endothelial dysfunction may help to reduce the risk of low muscle mass in older men.
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Affiliation(s)
- J L Atkins
- J.L. Atkins, Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Telephone: 020 7794 0500 Ext 34389. Fax: 0207 794 1224. E-mail:
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21
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Vascular cell adhesion molecule 1, soluble Fas and hepatocyte growth factor as predictors of mortality in nonagenarians: the Vitality 90+ study. Exp Gerontol 2013; 48:1167-72. [PMID: 23911532 DOI: 10.1016/j.exger.2013.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/30/2013] [Accepted: 07/23/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ageing is characteristically accompanied by changes in vascular endothelial markers and growth factor as well as increased cellular death. We analysed the associations of the plasma levels of vascular cell adhesion molecule-1 (VCAM-1), hepatocyte growth factor (HGF) and soluble Fas (sFAS), and their combinations, with 4-year mortality to identify new biomarkers. METHODS A total of 238 individuals, both community-dwelling and institutionalised, aged 89 91 years and participating in the Vitality 90+ study were included. Biomarkers of endothelial function (VCAM-1), growth factor (HGF) and a marker of apoptosis (sFAS) were determined from plasma using Luminex® technology. This newly-determined data was combined with earlier data, e.g., 4-year mortality and medical history. RESULTS Subjects who died during the follow-up had higher baseline plasma levels of VCAM-1, sFas, and HGF. When other known risk factors were adjusted for, subjects in the highest concentration tertile for VCAM-1 (HR 1.85; 95% CI, 1.12-3.05) and HGF (HR 2.22; 95% CI, 1.33-3.71) had higher mortality compared to those in the lowest tertile. In the adjusted analyses, when compared to subjects with none of the biomarkers in the highest concentration tertile, mortality was also higher when sFas and VCAM-1 were simultaneously (HR 2.03; 95% CI, 1.13-3.64) or all three were simultaneously (HR 3.63; 95% CI, 1.65-7.97) in the highest concentration tertile. CONCLUSIONS Our results suggest that increased concentrations of these biomarkers, separately and in combination, associate with mortality among the aged and are prognostic markers of death.
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Freitas WM, Carvalho LSF, Moura FA, Sposito AC. Atherosclerotic disease in octogenarians: A challenge for science and clinical practice. Atherosclerosis 2012; 225:281-9. [DOI: 10.1016/j.atherosclerosis.2012.06.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 06/13/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
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