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Stubbs BJ, Alvarez Azañedo G, Peralta S, Diaz SR, Gray W, Alexander L, Silverman-Martin W, Garcia TY, Blonquist TM, Upadhyay V, Turnbaugh PJ, Johnson JB, Newman JC. Rationale and protocol for a safety, tolerability and feasibility randomized, parallel arm, double-blind, placebo-controlled, pilot study of a novel ketone ester targeting frailty via immunometabolic geroscience mechanisms. PLoS One 2024; 19:e0307951. [PMID: 39292659 PMCID: PMC11410252 DOI: 10.1371/journal.pone.0307951] [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: 07/27/2023] [Accepted: 07/14/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome characterized by chronic inflammation and metabolic insufficiency that creates vulnerability to poor outcomes with aging. We hypothesize that interventions which target common underlying mechanism of aging could ameliorate frailty. Ketone bodies are metabolites produced during fasting or on a ketogenic diet that have pleiotropic effects on inflammatory and metabolic aging pathways in laboratory animal models. Ketone esters (KEs) are compounds that induce ketosis without dietary changes, but KEs have not been studied in an older adult population. Our long-term goal is to examine if KEs modulate aging biology mechanisms and clinical outcomes relevant to frailty in older adults. OBJECTIVES The primary objective of this randomized, placebo-controlled, double-blinded, parallel-group, pilot trial is to determine tolerability of 12-weeks of KE ingestion in a broad population of older adults (≥ 65 years). Secondary outcomes include safety and acute blood ketone kinetics. Exploratory outcomes include physical function, cognitive function, quality of life, aging biomarkers and inflammatory measures. METHODS Community-dwelling adults who are independent in activities of daily living, with no unstable acute medical conditions (n = 30) will be recruited. The study intervention is a KE or a taste, appearance, and calorie matched placebo beverage. Initially, acute 4-hour ketone kinetics after 12.5g or 25g of KE consumption will be assessed. After collection of baseline safety, functional, and biological measurements, subjects will randomly be allocated to consume KE 25g or placebo once daily for 12-weeks. Questionnaires will assess tolerability daily for 2-weeks, and then via phone interview at bi-monthly intervals. Safety assessments will be repeated at week 4. All measures will be repeated at week 12. CONCLUSION This study will evaluate feasibility, tolerability, and safety of KE consumption in older adults and provide exploratory data across a range of aging-related endpoints. This data will inform design of larger trials to rigorously test KE effects on aging mechanisms and clinical outcomes relevant to frailty.
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Affiliation(s)
- Brianna J. Stubbs
- Buck Institute for Research on Aging, Novato, California, United States of America
| | | | - Sawyer Peralta
- Buck Institute for Research on Aging, Novato, California, United States of America
| | - Stephanie Roa Diaz
- Buck Institute for Research on Aging, Novato, California, United States of America
| | - Wyatt Gray
- Buck Institute for Research on Aging, Novato, California, United States of America
| | - Laura Alexander
- Buck Institute for Research on Aging, Novato, California, United States of America
| | | | - Thelma Y. Garcia
- Buck Institute for Research on Aging, Novato, California, United States of America
| | - Traci M. Blonquist
- Biofortis, Mérieux NutriSciences, Addison, Illinois, United States of America
| | - Vaibhav Upadhyay
- Department of Microbiology & Immunology, UCSF, San Francisco, California, United States of America
- Independent Researcher, Greenbrae, California, United States of America
| | - Peter J. Turnbaugh
- Department of Microbiology & Immunology, UCSF, San Francisco, California, United States of America
- Division of Geriatrics, UCSF, San Francisco, California, United States of America
| | - James B. Johnson
- Department of Medicine, UCSF, San Francisco, California, United States of America
| | - John C. Newman
- Buck Institute for Research on Aging, Novato, California, United States of America
- Chan Zuckerberg Biohub-San Francisco, San Francisco, California, United States of America
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Stubbs BJ, Stephens EB, Senadheera C, Diaz SR, Peralta S, Alexander L, Silverman-Martin W, Kurtzig J, Fernando BA, Yurkovich JT, Garcia TY, Yukawa M, Morris J, Johnson JB, Newman JC. Exploratory functional and quality of life outcomes with daily consumption of the ketone ester bis-octanoyl (R)-1,3-butanediol in healthy older adults: a randomized, parallel arm, double-blind, placebo-controlled study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.17.24313811. [PMID: 39371165 PMCID: PMC11451762 DOI: 10.1101/2024.09.17.24313811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Background Ketone bodies are metabolites produced during fasting or on a ketogenic diet that have pleiotropic effects on the inflammatory and metabolic aging pathways underpinning frailty in in vivo models. Ketone esters (KEs) are compounds that induce hyperketonemia without dietary changes and that may impact physical and cognitive function in young adults. The functional effects of KEs have not been studied in older adults. Objectives Our long-term goal is to examine if KEs modulate aging biology mechanisms and clinical outcomes relevant to frailty in older adults. Here, we report the exploratory functional and quality-of-life outcome measures collected during a 12-week safety and tolerability study of KE (NCT05585762). Design Randomized, placebo-controlled, double-blinded, parallel-group, pilot trial of 12-weeks of daily KE ingestion. Setting The Clinical Research Unit at the Buck Institute for Research on Aging, California. Participants Community-dwelling older adults (≥ 65 years), independent in activities of daily living, with no unstable acute medical conditions (n = 30). Intervention Subjects were randomly allocated (1:1) to consume 25 g daily of either KE (bis-octanoyl (R)-1,3-butanediol) or a taste, appearance, and calorie-matched placebo (PLA) containing canola oil. Measurements Longitudinal change in physical function, cognitive function and quality of life were assessed as exploratory outcomes in n = 23 completers (n = 11 PLA, n = 12 KE). A composite functional outcome to describe the vigor-frailty continuum was calculated. Heart rate and activity was measured throughout the study using digital wearables. Results There were no statistically significant longitudinal differences between groups in exploratory functional, activity-based or quality of life outcomes. Conclusion Daily ingestion of 25 g of KE did not affect exploratory functional or quality-of-life end points in this pilot cohort of healthy older adults. Future work will address these endpoints as primary and secondary outcomes in a larger trial of pre-frail older adults.
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Affiliation(s)
| | | | | | | | | | | | | | - Jamie Kurtzig
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | - James T Yurkovich
- Buck Institute for Research on Aging, Novato, CA, USA
- Phenome Health, Seattle, WA, USA
| | | | - Michi Yukawa
- Veteran’s Affairs Medical Center, San Francisco, CA, USA
| | | | | | - John C Newman
- Buck Institute for Research on Aging, Novato, CA, USA
- Division of Geriatrics, University of California, San Francisco, CA, USA
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Sharma S, Prizment A, Nelson H, Zhang L, Staley C, Poynter JN, Seshadri G, Ellison A, Thyagarajan B. Association between Accelerated Biological Aging, Diet, and Gut Microbiome. Microorganisms 2024; 12:1719. [PMID: 39203561 PMCID: PMC11357197 DOI: 10.3390/microorganisms12081719] [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: 07/17/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/03/2024] Open
Abstract
Factors driving accelerated biological age (BA), an important predictor of chronic diseases, remain poorly understood. This study focuses on the impact of diet and gut microbiome on accelerated BA. Accelerated Klemera-Doubal biological age (KDM-BA) was estimated as the difference between KDM-BA and chronological age. We assessed the cross-sectional association between accelerated KDM-BA and diet/gut microbiome in 117 adult participants from the 10,000 Families Study. 16S rRNA sequencing was used to estimate the abundances of gut bacterial genera. Multivariable linear mixed models evaluated the associations between accelerated KDM-BA and diet/gut microbiome after adjusting for family relatedness, diet, age, sex, smoking status, alcohol intake, and BMI. One standard deviation (SD) increase in processed meat was associated with a 1.91-year increase in accelerated KDM-BA (p = 0.04), while one SD increase in fiber intake was associated with a 0.70-year decrease in accelerated KDM-BA (p = 0.01). Accelerated KDM-BA was positively associated with Streptococcus and negatively associated with Subdoligranulum, unclassified Bacteroidetes, and Burkholderiales. Adjustment for gut microbiome did not change the association between dietary fiber and accelerated KDM-BA, but the association with processed meat intake became nonsignificant. These cross-sectional associations between higher meat intake, lower fiber intake, and accelerated BA need validation in longitudinal studies.
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Affiliation(s)
- Shweta Sharma
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (A.P.); (G.S.); (A.E.)
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Anna Prizment
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (A.P.); (G.S.); (A.E.)
| | - Heather Nelson
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Lin Zhang
- Division of Biostatistics & Health Data Science, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Christopher Staley
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Jenny N. Poynter
- Department of Pediatrics, Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Gokul Seshadri
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (A.P.); (G.S.); (A.E.)
| | - Aidan Ellison
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (A.P.); (G.S.); (A.E.)
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (A.P.); (G.S.); (A.E.)
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Stubbs BJ, Stephens EB, Senadheera C, Peralta S, Roa-Diaz S, Alexander L, Silverman-Martin W, Garcia TY, Yukawa M, Morris J, Blonquist TM, Johnson JB, Newman JC. Daily consumption of ketone ester, bis-octanoyl (R)-1,3-butanediol, is safe and tolerable in healthy older adults in a randomized, parallel arm, double-blind, placebo-controlled, pilot study. J Nutr Health Aging 2024; 28:100329. [PMID: 39137624 DOI: 10.1016/j.jnha.2024.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Ketone bodies are endogenous metabolites produced during fasting or a ketogenic diet that have pleiotropic effects on aging pathways. Ketone esters (KEs) are compounds that induce ketosis without dietary changes, but KEs have not been studied in an older adult population. The primary objective of this trial was to assess the tolerability and safety of KE ingestion in a cohort of older adults. DESIGN Randomized, placebo-controlled, double-blinded, parallel-arm trial (NCT05585762). SETTING General community, Northern California, USA. PARTICIPANTS Community-dwelling older adults, independent in activities of daily living, with no unstable acute medical conditions (n = 30; M = 15, F = 15; age = 76 y, range 65-90 y) were randomized and n = 23 (M = 14, F = 9) completed the protocol. INTERVENTION Participants were randomly allocated to consume either KE (25 g bis-octanoyl (R)-1,3-butanediol) or a taste, appearance, and calorie-matched placebo (PLA) containing canola oil daily for 12 weeks. MEASUREMENTS Tolerability was assessed using a composite score from a daily log for 2-weeks, and then via a bi-weekly phone interview. Safety was assessed by vital signs and lab tests at screening and weeks 0, 4 and 12, along with tabulation of adverse events. RESULTS There was no difference in the prespecified primary outcome of proportion of participants reporting moderate or severe nausea, headache, or dizziness on more than one day in a two-week reporting period (KE n = 2 (14.3% [90% CI = 2.6-38.5]); PLA n = 1 (7.1% [90% CI = 0.4-29.7]). Dropouts numbered four in the PLA group and two in the KE group. A greater number of symptoms were reported in both groups during the first two weeks; symptoms were reported less frequently between 2 and 12 weeks. There were no clinically relevant changes in safety labs or vital signs in either group. CONCLUSIONS This KE was safe and well-tolerated in this study of healthy older adults. These results provide an initial foundation for use of KEs in clinical research with older adults.
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Affiliation(s)
- Brianna J Stubbs
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA.
| | - Elizabeth B Stephens
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA
| | - Chatura Senadheera
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA
| | - Sawyer Peralta
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA
| | - Stephanie Roa-Diaz
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA
| | - Laura Alexander
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA
| | | | - Thelma Y Garcia
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA
| | - Michi Yukawa
- Division of Geriatrics, UCSF, 3575 Geary Blvd, Fl 1, San Francisco, CA 94118-3212, USA; Geriatrics, San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA 94121-1563, USA
| | - Jenifer Morris
- Geriatrics, San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA 94121-1563, USA
| | - Traci M Blonquist
- Biofortis, Mérieux NutriSciences, 800-A South Rohling Rd, Addison, IL 60101-4219, USA
| | | | - John C Newman
- Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA 94945-1400, USA; Division of Geriatrics, UCSF, 3575 Geary Blvd, Fl 1, San Francisco, CA 94118-3212, USA.
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Dwaraka VB, Aronica L, Carreras-Gallo N, Robinson JL, Hennings T, Carter MM, Corley MJ, Lin A, Turner L, Smith R, Mendez TL, Went H, Ebel ER, Sonnenburg ED, Sonnenburg JL, Gardner CD. Unveiling the epigenetic impact of vegan vs. omnivorous diets on aging: insights from the Twins Nutrition Study (TwiNS). BMC Med 2024; 22:301. [PMID: 39069614 DOI: 10.1186/s12916-024-03513-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Geroscience focuses on interventions to mitigate molecular changes associated with aging. Lifestyle modifications, medications, and social factors influence the aging process, yet the complex molecular mechanisms require an in-depth exploration of the epigenetic landscape. The specific epigenetic clock and predictor effects of a vegan diet, compared to an omnivorous diet, remain underexplored despite potential impacts on aging-related outcomes. METHODS This study examined the impact of an entirely plant-based or healthy omnivorous diet over 8 weeks on blood DNA methylation in paired twins. Various measures of epigenetic age acceleration (PC GrimAge, PC PhenoAge, DunedinPACE) were assessed, along with system-specific effects (Inflammation, Heart, Hormone, Liver, and Metabolic). Methylation surrogates of clinical, metabolite, and protein markers were analyzed to observe diet-specific shifts. RESULTS Distinct responses were observed, with the vegan cohort exhibiting significant decreases in overall epigenetic age acceleration, aligning with anti-aging effects of plant-based diets. Diet-specific shifts were noted in the analysis of methylation surrogates, demonstrating the influence of diet on complex trait prediction through DNA methylation markers. An epigenome-wide analysis revealed differentially methylated loci specific to each diet, providing insights into the affected pathways. CONCLUSIONS This study suggests that a short-term vegan diet is associated with epigenetic age benefits and reduced calorie intake. The use of epigenetic biomarker proxies (EBPs) highlights their potential for assessing dietary impacts and facilitating personalized nutrition strategies for healthy aging. Future research should explore the long-term effects of vegan diets on epigenetic health and overall well-being, considering the importance of proper nutrient supplementation. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05297825.
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Affiliation(s)
- Varun B Dwaraka
- TruDiagnostic, Inc, 881 Corporate Dr, Lexington, KY, 40503, USA.
| | - Lucia Aronica
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, 3180 Porter Dr, Palo Alto, Stanford, CA, 94305, USA
| | | | - Jennifer L Robinson
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, 3180 Porter Dr, Palo Alto, Stanford, CA, 94305, USA
| | - Tayler Hennings
- Seattle Children's Research Institute, Seattle, WA, 98101, USA
| | - Matthew M Carter
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford University, Palo Alto, CA, USA
| | - Michael J Corley
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Aaron Lin
- TruDiagnostic, Inc, 881 Corporate Dr, Lexington, KY, 40503, USA
| | - Logan Turner
- TruDiagnostic, Inc, 881 Corporate Dr, Lexington, KY, 40503, USA
| | - Ryan Smith
- TruDiagnostic, Inc, 881 Corporate Dr, Lexington, KY, 40503, USA
| | - Tavis L Mendez
- TruDiagnostic, Inc, 881 Corporate Dr, Lexington, KY, 40503, USA
| | - Hannah Went
- TruDiagnostic, Inc, 881 Corporate Dr, Lexington, KY, 40503, USA
| | - Emily R Ebel
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford University, Palo Alto, CA, USA
| | - Erica D Sonnenburg
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford University, Palo Alto, CA, USA
| | - Justin L Sonnenburg
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford University, Palo Alto, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Center for Human Microbiome Studies, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, 3180 Porter Dr, Palo Alto, Stanford, CA, 94305, USA.
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Bourassa KJ, Sbarra DA. Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory. Transl Psychiatry 2024; 14:285. [PMID: 38997260 PMCID: PMC11245531 DOI: 10.1038/s41398-024-03004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
Although stress and adversity are largely universal experiences, people exposed to greater hardship are at increased risk for negative health consequences. Recent studies identify accelerated biological aging as a mechanism that could explain how trauma and adversity gives rise to poor health, and advances in this area of study coincide with technological innovations in the measurement of biological aging, particularly epigenetic profiles consistent with accelerated aging derived from DNA methylation. In this review, we provide an overview of the current literature examining how adversity might accelerate biological aging, with a specific focus on social and health behaviors. The most extensive evidence in this area suggests that health-compromising behaviors, particularly smoking, may partially explain the association between adversity and accelerated aging. Although there is relatively less published support for the role of social behaviors, emerging evidence points to the importance of social connection as a mechanism for future study. Our review highlights the need to determine the extent to which the associations from adversity to accelerated aging are consistent with causal processes. As we consider these questions, the review emphasizes methodological approaches from the causal inference literature that can help deepen our understanding of how stress and trauma might result in poor health. The use of these methodologies will help provide evidence as to which behavioral interventions might slow aging and improve health, particularly among populations that more often experience adversity and trauma.
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Affiliation(s)
- Kyle J Bourassa
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
- Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs (VA) Health Care System, Durham, NC, USA.
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
| | - David A Sbarra
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Lozada‐Martinez ID, Lozada‐Martinez LM, Anaya J. Gut microbiota in centenarians: A potential metabolic and aging regulator in the study of extreme longevity. Aging Med (Milton) 2024; 7:406-413. [PMID: 38975304 PMCID: PMC11222757 DOI: 10.1002/agm2.12336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024] Open
Abstract
Centenarians, those aged 100 years or older, are considered the most successful biological aging model in humans. This population is commonly characterized by a low prevalence of chronic diseases, with favorable maintenance of functionality and independence, thus determining a health phenotype of successful aging. There are many factors usually associated with extreme longevity: genetics, lifestyles, diet, among others. However, it is most likely a multifactorial condition where protective factors contribute individually to some extent. The gut microbiota (GM) has emerged as a potential factor associated with the establishment of a favorable health phenotype that allows for extreme longevity, as seen in centenarians. To understand the possible impact generated by the GM, its changes, and the probable causes for successful aging, the aim of this review was to synthesize evidence on the role of the GM as a potential protective factor for achieving extreme longevity, using its relationship with centenarians.
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Affiliation(s)
- Ivan David Lozada‐Martinez
- Health Research and Innovation Center at Coosalud EPSCartagenaColombia
- Universidad de la CostaBarranquillaColombia
| | | | - Juan‐Manuel Anaya
- Health Research and Innovation Center at Coosalud EPSCartagenaColombia
- Universidad de la CostaBarranquillaColombia
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Bourassa KJ, Halverson TF, Garrett ME, Hair L, Dennis M, Ashley-Koch AE, Beckham JC, Kimbrel NA. Demographic characteristics and epigenetic biological aging among post-9/11 veterans: Associations of DunedinPACE with sex, race, and age. Psychiatry Res 2024; 336:115908. [PMID: 38626626 PMCID: PMC11070289 DOI: 10.1016/j.psychres.2024.115908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/18/2024]
Abstract
Measures of epigenetic aging derived from DNA methylation (DNAm) have enabled the assessment of biological aging in new populations and cohorts. In the present study, we used an epigenetic measure of aging, DunedinPACE, to examine rates of aging across demographic groups in a sample of 2,309 United States military veterans from the VISN 6 MIRECC's Post-Deployment Mental Health Study. As assessed by DunedinPACE, female veterans were aging faster than male veterans (β = 0.39, 95 % CI [0.29, 0.48], p < .001), non-Hispanic Black veterans were aging faster than non-Hispanic White veterans (β = 0.58, 95 % CI [0.50, 0.66], p < .001), and older veterans were biologically aging faster than younger veterans (β = 0.21, 95 % CI [0.18, 0.25], p < .001). In secondary analyses, these differences in rates of aging were not explained by a variety of biopsychosocial covariates. In addition, the percentage of European genetic admixture in non-Hispanic Black veterans was not associated with DunedinPACE. Our findings suggest that female and non-Hispanic Black veterans are at greater risk of accelerated aging among post-9/11 veterans. Interventions that slow aging might provide relatively greater benefit among veterans comprising these at-risk groups.
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Affiliation(s)
- Kyle J Bourassa
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System; Geriatric Research, Education, and Clinical Center, Durham VA Health Care System; Center for the Study of Aging and Human Development, Duke University Medical Center.
| | - Tate F Halverson
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System
| | | | - Lauren Hair
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Michelle Dennis
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | | | - Jean C Beckham
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Nathan A Kimbrel
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
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9
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Stubbs BJ, Stephens EB, Senadheera C, Peralta S, Roa-Diaz S, Alexander L, Silverman-Martin W, Garcia TY, Yukawa M, Morris J, Blonquist TM, Johnson JB, Newman JC. Daily consumption of ketone ester, bis-octanoyl (R)-1,3-butanediol, is safe and tolerable in healthy older adults, a randomized, parallel arm, double-blind, placebo-controlled, pilot study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.03.24306699. [PMID: 38746215 PMCID: PMC11092707 DOI: 10.1101/2024.05.03.24306699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Objectives Ketone bodies are endogenous metabolites produced during fasting or a ketogenic diet that have pleiotropic effects on aging pathways. Ketone esters (KEs) are compounds that induce ketosis without dietary changes, but KEs have not been studied in an older adult population. The primary objective of this trial was to determine tolerability and safety of KE ingestion in older adults. Design Randomized, placebo-controlled, double-blinded, parallel-arm trial, with a 12-week intervention period ( NCT05585762 ). Setting General community, Northern California, USA. Participants Community-dwelling older adults, independent in activities of daily living, with no unstable acute medical conditions (n=30) were randomized and n=23 (M= 14, F=9) completed the protocol. Intervention Participants were randomly allocated to consume either KE (bis-octanoyl (R)-1,3-butanediol) or a taste, appearance, and calorie-matched placebo (PLA) containing canola oil. Measurements Tolerability was assessed using a composite score from a daily log for 2-weeks, and then via a bi-weekly phone interview. Safety was assessed by vital signs and lab tests at screening and weeks 0, 4 and 12, along with tabulation of adverse events. Results There was no difference in the prespecified primary outcome of proportion of participants reporting moderate or severe nausea, headache, or dizziness on more than one day in a two-week reporting period (KE n =2 (14.3% [90% CI = 2.6 - 38.5]); PLA n=1 (7.1% [90% CI = 0.4 - 29.7]). Dropouts numbered four in the PLA group and two in the KE group. A greater number of symptoms were reported in both groups during the first two weeks; symptoms were reported less frequently between 2 - 12 weeks. There were no clinically relevant changes in safety labs or vital signs in either group. Conclusions This KE was safe and well-tolerated in healthy older adults. These results provide a foundation for use of KEs in aging research. Highlights Ketones esters induce ketosis without dietary changes and may target aging biologyStudies of ketone esters were limited in duration and focused on younger adultsWe found ketone esters were safe and tolerable for 12 weeks in healthy older adults.
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Tchkonia T, Kritchevsky SB, Kuchel GA, Kirkland JL. NIA Translational Geroscience Network: An infrastructure to facilitate geroscience-guided clinical trials. J Am Geriatr Soc 2024; 72:1605-1607. [PMID: 38650350 PMCID: PMC11090706 DOI: 10.1111/jgs.18901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Tamara Tchkonia
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen B. Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - James L. Kirkland
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Le Couteur DG, Raubenheimer D, Solon-Biet S, de Cabo R, Simpson SJ. Does diet influence aging? Evidence from animal studies. J Intern Med 2024; 295:400-415. [PMID: 35701180 DOI: 10.1111/joim.13530] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nutrition profoundly influences the risk for many age-related diseases. Whether nutrition influences human aging biology directly is less clear. Studies in different animal species indicate that reducing food intake ("caloric restriction" [CR]) can increase lifespan and delay the onset of diseases and the biological hallmarks of aging. Obesity has been described as "accelerated aging" and therefore the lifespan and health benefits generated by CR in both aging and obesity may occur via similar mechanisms. Beyond calorie intake, studies based on nutritional geometry have shown that protein intake and the interaction between dietary protein and carbohydrates influence age-related health and lifespan. Studies where animals are calorically restricted by providing free access to diluted diets have had less impact on lifespan than those studies where animals are given a reduced aliquot of food each day and are fasting between meals. This has drawn attention to the role of fasting in health and aging, and exploration of the health effects of various fasting regimes. Although definitive human clinical trials of nutrition and aging would need to be unfeasibly long and unrealistically controlled, there is good evidence from animal experiments that some nutritional interventions based on CR, manipulating dietary macronutrients, and fasting can influence aging biology and lifespan.
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Affiliation(s)
- David G Le Couteur
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- ANZAC Research Institute, The Concord Hospital, Concord, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Samantha Solon-Biet
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Rafael de Cabo
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging (NIH), Baltimore, Maryland, USA
| | - Stephen J Simpson
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
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12
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Jacobson RM, Pignolo RJ, Lazaridis KN. Clinical Trials for Special Populations: Children, Older Adults, and Rare Diseases. Mayo Clin Proc 2024; 99:318-335. [PMID: 38309939 PMCID: PMC10842263 DOI: 10.1016/j.mayocp.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 02/05/2024]
Abstract
Research cannot maximize population health unless it improves health for all members of the public, including special populations such as children, older adults, and people living with rare diseases. Each of these categories require special considerations when planning and performing clinical trials, and common threads of ethical conduct of research in vulnerable populations appear throughout. In this review, definitions of each of the three categories of special population (children, older adults, and rare diseases) are discussed in terms of US research regulations, the unique challenges to conducting clinical trials for these special populations, critical ethical issues, and opportunities for innovative ways to design and operationalize clinical trials in special populations. Additional critical attention is focused on factors that influence the generalizability of study results to reduce health disparities, as well as the importance of community engagement and advocacy groups that can help to educate potential trial participants of the benefits of clinical trial participation.
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Robert J Pignolo
- Department of Medicine and Divisions of Hospital Internal Medicine and Endocrinology, Home of Medical Excellence in Geriatric Medicine and Gerontology, Department of Physiology and Biomedical Engineering, and Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Department of Internal Medicine, Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
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13
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Bourassa KJ, Garrett ME, Caspi A, Dennis M, Hall KS, Moffitt TE, Taylor GA, Ashley-Koch AE, Beckham JC, Kimbrel NA. Posttraumatic stress disorder, trauma, and accelerated biological aging among post-9/11 veterans. Transl Psychiatry 2024; 14:4. [PMID: 38184702 PMCID: PMC10771513 DOI: 10.1038/s41398-023-02704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024] Open
Abstract
People who experience trauma and develop posttraumatic stress disorder (PTSD) are at increased risk for poor health. One mechanism that could explain this risk is accelerated biological aging, which is associated with the accumulation of chronic diseases, disability, and premature mortality. Using data from 2309 post-9/11 United States military veterans who participated in the VISN 6 MIRECC's Post-Deployment Mental Health Study, we tested whether PTSD and trauma exposure were associated with accelerated rate of biological aging, assessed using a validated DNA methylation (DNAm) measure of epigenetic aging-DunedinPACE. Veterans with current PTSD were aging faster than those who did not have current PTSD, β = 0.18, 95% CI [0.11, 0.27], p < .001. This effect represented an additional 0.4 months of biological aging each year. Veterans were also aging faster if they reported more PTSD symptoms, β = 0.13, 95% CI [0.09, 0.16], p < 0.001, or higher levels of trauma exposure, β = 0.09, 95% CI [0.05, 0.13], p < 0.001. Notably, veterans with past PTSD were aging more slowly than those with current PTSD, β = -0.21, 95% CI [-0.35, -0.07], p = .003. All reported results accounted for age, gender, self-reported race/ethnicity, and education, and remained when controlling for smoking. Our findings suggest that an accelerated rate of biological aging could help explain how PTSD contributes to poor health and highlights the potential benefits of providing efficacious treatment to populations at increased risk of trauma and PTSD.
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Affiliation(s)
- Kyle J Bourassa
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA.
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA.
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, USA.
| | | | - Avshalom Caspi
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
- Department of Psychology and Neuroscience, Duke University, Durham, USA
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Center for the Study of Population Health & Aging, Duke University Population Research Institute, Durham, USA
| | - Michelle Dennis
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
| | - Terrie E Moffitt
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
- Department of Psychology and Neuroscience, Duke University, Durham, USA
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Center for the Study of Population Health & Aging, Duke University Population Research Institute, Durham, USA
| | - Gregory A Taylor
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, USA
| | | | - Jean C Beckham
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
| | - Nathan A Kimbrel
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, USA
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14
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Venn-Watson S, Schork NJ. Pentadecanoic Acid (C15:0), an Essential Fatty Acid, Shares Clinically Relevant Cell-Based Activities with Leading Longevity-Enhancing Compounds. Nutrients 2023; 15:4607. [PMID: 37960259 PMCID: PMC10649853 DOI: 10.3390/nu15214607] [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: 10/08/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Pentadecanoic acid (C15:0) is an essential odd-chain saturated fatty acid with broad activities relevant to protecting cardiometabolic, immune, and liver health. C15:0 activates AMPK and inhibits mTOR, both of which are core components of the human longevity pathway. To assess the potential for C15:0 to enhance processes associated with longevity and healthspan, we used human cell-based molecular phenotyping assays to compare C15:0 with three longevity-enhancing candidates: acarbose, metformin, and rapamycin. C15:0 (n = 36 activities in 10 of 12 cell systems) and rapamycin (n = 32 activities in 12 of 12 systems) had the most clinically relevant, dose-dependent activities. At their optimal doses, C15:0 (17 µM) and rapamycin (9 µM) shared 24 activities across 10 cell systems, including anti-inflammatory (e.g., lowered MCP-1, TNFα, IL-10, IL-17A/F), antifibrotic, and anticancer activities, which are further supported by previously published in vitro and in vivo studies. Paired with prior demonstrated abilities for C15:0 to target longevity pathways, hallmarks of aging, aging rate biomarkers, and core components of type 2 diabetes, heart disease, cancer, and nonalcoholic fatty liver disease, our results support C15:0 as an essential nutrient with activities equivalent to, or surpassing, leading longevity-enhancing candidate compounds.
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Affiliation(s)
- Stephanie Venn-Watson
- Epitracker Inc., San Diego, CA 92106, USA
- Seraphina Therapeutics, Inc., San Diego, CA 92106, USA;
| | - Nicholas J. Schork
- Seraphina Therapeutics, Inc., San Diego, CA 92106, USA;
- Translational Genomics Research Institute (TGen), City of Hope, Phoenix, AZ 85004, USA
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15
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Stubbs BJ, Alvarez-Azanedo G, Peralta S, Roa-Diaz S, Gray W, Alexander L, Silverman-Martin W, Garcia T, Blonquist TM, Upadhyay V, Turnbaugh PJ, Johnson JB, Newman JC. Rationale and protocol for a safety, tolerability and feasibility randomized, parallel group, double-blind, placebo-controlled, pilot study of a novel ketone ester targeting frailty via immunometabolic geroscience mechanisms. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.25.23297571. [PMID: 37961234 PMCID: PMC10635199 DOI: 10.1101/2023.10.25.23297571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Frailty is a geriatric syndrome characterized by chronic inflammation and metabolic insufficiency that creates vulnerability to poor outcomes with aging. We hypothesize that geroscience interventions, which target mechanisms of aging, could ameliorate frailty. Metabolites such as ketone bodies are candidate geroscience interventions, having pleiotropic effects on inflammo-metabolic aging mechanisms. Ketone esters (KEs) induce ketosis without dietary changes, but KEs have not been studied in an older adult population. Our long-term goal is to examine if KEs modulate geroscience mechanisms and clinical outcomes relevant to frailty in older adults. Objectives The primary objective of this randomized, placebo-controlled, double-blinded, parallel-group, pilot trial is to determine tolerability of 12-weeks of KE ingestion in a generalizable population of older adults (≥ 65 years). Secondary outcomes include safety and acute blood ketone kinetics. Exploratory outcomes include physical function, cognitive function, quality of life, aging biomarkers and inflammatory measures. Methods Community-dwelling adults who are independent in activities of daily living, with no unstable acute medical conditions (n=30) will be recruited. The study intervention is a KE or a taste, appearance, and calorie matched placebo beverage. Initially, acute 4-hour ketone kinetics after 12.5g or 25g of KE consumption will be assessed. After collection of baseline safety, functional, and biological measurements, subjects will randomly be allocated to consume KE 25g or placebo once daily for 12-weeks. Questionnaires will assess tolerability daily for 2-weeks, and then via phone interview at bi-monthly intervals. Safety assessments will be repeated at week 4. All measures will be repeated at week 12. Conclusion This study will evaluate feasibility, tolerability, and safety of KE consumption in older adults and provide exploratory data across a range of geroscience-related endpoints. This data will inform design of larger trials to rigorously test KE effects on geroscience mechanisms and clinical outcomes relevant to frailty.
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Affiliation(s)
| | | | | | | | - Wyatt Gray
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | | | - Thelma Garcia
- Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Vaibhav Upadhyay
- Department of Microbiology & Immunology, UCSF, San Francisco, CA, USA 94143
- Department of Medicine, UCSF, San Francisco California, USA
| | - Peter J. Turnbaugh
- Department of Microbiology & Immunology, UCSF, San Francisco, CA, USA 94143
- Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA 94158
| | | | - John C. Newman
- Buck Institute for Research on Aging, Novato, CA, USA
- Division of Geriatrics, UCSF, San Francisco, California, USA
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16
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Waziry R, Gu Y, Williams O, Hägg S. Connections between cross-tissue and intra-tissue biomarkers of aging biology in older adults. EPIGENETICS COMMUNICATIONS 2023; 3:7. [PMID: 38037563 PMCID: PMC10688599 DOI: 10.1186/s43682-023-00022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/28/2023] [Indexed: 12/02/2023]
Abstract
Background Saliva measures are generally more accessible than blood, especially in vulnerable populations. However, connections between aging biology biomarkers in different body tissues remain unknown. Methods The present study included individuals (N = 2406) who consented for saliva and blood draw in the Health and Retirement Telomere length study in 2008 and the Venous blood study in 2016 who had complete data for both tissues. We assessed biological aging based on telomere length in saliva and DNA methylation and physiology measures in blood. DNA methylation clocks combine information from CpGs to produce the aging measures representative of epigenetic aging in humans. We analyzed DNA methylation clocks proposed by Horvath (353 CpG sites), Hannum (71 CpG sites), Levine or PhenoAge, (513 CpG sites), GrimAge, (epigenetic surrogate markers for select plasma proteins), Horvath skin and blood (391 CpG sites), Lin (99 CpG sites), Weidner (3 CpG sites), and VidalBralo (8 CpG sites). Physiology measures (referred to as phenotypic age) included albumin, creatinine, glucose, [log] C-reactive protein, lymphocyte percent, mean cell volume, red blood cell distribution width, alkaline phosphatase, and white blood cell count. The phenotypic age algorithm is based on parametrization of Gompertz proportional hazard models. Average telomere length was assayed using quantitative PCR (qPCR) by comparing the telomere sequence copy number in each patient's sample (T) to a single-copy gene copy number (S). The resulting T/S ratio was proportional to telomere length, mean. Within individual, relationships between aging biology measures in blood and saliva and variations according to sex were assessed. Results Saliva-based telomere length showed inverse associations with both physiology-based and DNA methylation-based aging biology biomarkers in blood. Longer saliva-based telomere length was associated with 1 to 4 years slower biological aging based on blood-based biomarkers with the highest magnitude being Weidner (β = - 3.97, P = 0.005), GrimAge (β = - 3.33, P < 0.001), and Lin (β = - 3.45, P = 0.008) biomarkers of DNA methylation. Conclusions There are strong connections between aging biology biomarkers in saliva and blood in older adults. Changes in telomere length vary with changes in DNA methylation and physiology biomarkers of aging biology. We observed variations in the relationship between each body system represented by physiology biomarkers and biological aging, particularly at the DNA methylation level. These observations provide novel opportunities for integration of both blood-based and saliva-based biomarkers in clinical care of vulnerable and clinically difficult to reach populations where either or both tissues would be accessible for clinical monitoring purposes.
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Affiliation(s)
- R. Waziry
- Department of Neurology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Y. Gu
- Department of Neurology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- The Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY, USA
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- The Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - O. Williams
- Department of Neurology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - S. Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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17
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Rolland Y, Sierra F, Ferrucci L, Barzilai N, De Cabo R, Mannick J, Oliva A, Evans W, Angioni D, De Souto Barreto P, Raffin J, Vellas B, Kirkland JL. Challenges in developing Geroscience trials. Nat Commun 2023; 14:5038. [PMID: 37598227 PMCID: PMC10439920 DOI: 10.1038/s41467-023-39786-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/29/2023] [Indexed: 08/21/2023] Open
Abstract
Geroscience is becoming a major hope for preventing age-related diseases and loss of function by targeting biological mechanisms of aging. This unprecedented paradigm shift requires optimizing the design of future clinical studies related to aging in humans. Researchers will face a number of challenges, including ideal populations to study, which lifestyle and Gerotherapeutic interventions to test initially, selecting key primary and secondary outcomes of such clinical trials, and which age-related biomarkers are most valuable for both selecting interventions and predicting or monitoring clinical responses ("Gerodiagnostics"). This article reports the main results of a Task Force of experts in Geroscience.
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Affiliation(s)
- Yves Rolland
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France.
| | | | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Nir Barzilai
- Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rafael De Cabo
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | | | | | - William Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Davide Angioni
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France
| | - Jeremy Raffin
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, IHU HealthAge, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- CERPOP UMR 1295, University of Toulouse III, Inserm, UPS, Toulouse, France
| | - James L Kirkland
- Noaber Foundation Professor of Aging Research, Mayo Clinic, Principal Investigator, NIH R33 Translational Geroscience Network, President, American Federation for Aging Research, Rochester, NY, USA
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18
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Forman DE, Kuchel GA, Newman JC, Kirkland JL, Volpi E, Taffet GE, Barzilai N, Pandey A, Kitzman DW, Libby P, Ferrucci L. Impact of Geroscience on Therapeutic Strategies for Older Adults With Cardiovascular Disease: JACC Scientific Statement. J Am Coll Cardiol 2023; 82:631-647. [PMID: 37389519 PMCID: PMC10414756 DOI: 10.1016/j.jacc.2023.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
Geroscience posits that cardiovascular disease (CVD) and other chronic diseases result from progressive erosion of the effectiveness of homeostatic mechanisms that oppose age-related accumulation of molecular damage. This hypothetical common root to chronic diseases explains why patients with CVD are often affected by multimorbidity and frailty and why older age negatively affects CVD prognosis and treatment response. Gerotherapeutics enhance resilience mechanisms that counter age-related molecular damage to prevent chronic diseases, frailty, and disability, thereby extending healthspan. Here, we describe the main resilience mechanisms of mammalian aging, with a focus on how they can affect CVD pathophysiology. We next present novel gerotherapeutic approaches, some of which are already used in management of CVD, and explore their potential to transform care and management of CVD. The geroscience paradigm is gaining traction broadly in medical specialties, with potential to mitigate premature aging, reduce health care disparities, and improve population healthspan.
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Affiliation(s)
- Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology) University of Pittsburgh, Pittsburgh, Pennsylvania, USA; GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, UConn Health, Farmington, Connecticut, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato California, USA; Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - James L Kirkland
- Division of General Internal Medicine, Department of Medicine and Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - George E Taffet
- Department of Medicine (Geriatrics and Cardiovascular Sciences), Baylor College of Medicine, Houston, Texas, USA
| | - Nir Barzilai
- Einstein Institute for Aging Research, Bronx, New York, USA; Einstein-NSC and Glenn Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dalane W Kitzman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Libby
- Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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19
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Waziry R, Ryan CP, Corcoran DL, Huffman KM, Kobor MS, Kothari M, Graf GH, Kraus VB, Kraus WE, Lin DTS, Pieper CF, Ramaker ME, Bhapkar M, Das SK, Ferrucci L, Hastings WJ, Kebbe M, Parker DC, Racette SB, Shalev I, Schilling B, Belsky DW. Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial. NATURE AGING 2023; 3:248-257. [PMID: 37118425 PMCID: PMC10148951 DOI: 10.1038/s43587-022-00357-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2022] [Indexed: 04/30/2023]
Abstract
The geroscience hypothesis proposes that therapy to slow or reverse molecular changes that occur with aging can delay or prevent multiple chronic diseases and extend healthy lifespan1-3. Caloric restriction (CR), defined as lessening caloric intake without depriving essential nutrients4, results in changes in molecular processes that have been associated with aging, including DNA methylation (DNAm)5-7, and is established to increase healthy lifespan in multiple species8,9. Here we report the results of a post hoc analysis of the influence of CR on DNAm measures of aging in blood samples from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial, a randomized controlled trial in which n = 220 adults without obesity were randomized to 25% CR or ad libitum control diet for 2 yr (ref. 10). We found that CALERIE intervention slowed the pace of aging, as measured by the DunedinPACE DNAm algorithm, but did not lead to significant changes in biological age estimates measured by various DNAm clocks including PhenoAge and GrimAge. Treatment effect sizes were small. Nevertheless, modest slowing of the pace of aging can have profound effects on population health11-13. The finding that CR modified DunedinPACE in a randomized controlled trial supports the geroscience hypothesis, building on evidence from small and uncontrolled studies14-16 and contrasting with reports that biological aging may not be modifiable17. Ultimately, a conclusive test of the geroscience hypothesis will require trials with long-term follow-up to establish effects of intervention on primary healthy-aging endpoints, including incidence of chronic disease and mortality18-20.
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Affiliation(s)
- R Waziry
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - C P Ryan
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - D L Corcoran
- Department of Genetics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - K M Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M S Kobor
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Kothari
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - G H Graf
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - V B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - W E Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D T S Lin
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - C F Pieper
- Center on Aging and Development, Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - M E Ramaker
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M Bhapkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S K Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - W J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - M Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - D C Parker
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - S B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - B Schilling
- Buck Institute for Research on Aging, Novato, CA, USA
| | - D W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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20
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Kumar P, Liu C, Suliburk J, Hsu JW, Muthupillai R, Jahoor F, Minard CG, Taffet GE, Sekhar RV. Supplementing Glycine and N-Acetylcysteine (GlyNAC) in Older Adults Improves Glutathione Deficiency, Oxidative Stress, Mitochondrial Dysfunction, Inflammation, Physical Function, and Aging Hallmarks: A Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2023; 78:75-89. [PMID: 35975308 PMCID: PMC9879756 DOI: 10.1093/gerona/glac135] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Elevated oxidative stress (OxS), mitochondrial dysfunction, and hallmarks of aging are identified as key contributors to aging, but improving/reversing these defects in older adults (OA) is challenging. In prior studies, we identified that deficiency of the intracellular antioxidant glutathione (GSH) could play a role and reported that supplementing GlyNAC (combination of glycine and N-acetylcysteine [NAC]) in aged mice improved GSH deficiency, OxS, mitochondrial fatty-acid oxidation (MFO), and insulin resistance (IR). To test whether GlyNAC supplementation in OA could improve GSH deficiency, OxS, mitochondrial dysfunction, IR, physical function, and aging hallmarks, we conducted a placebo-controlled randomized clinical trial. METHODS Twenty-four OA and 12 young adults (YA) were studied. OA was randomized to receive either GlyNAC (N = 12) or isonitrogenous alanine placebo (N = 12) for 16-weeks; YA (N = 12) received GlyNAC for 2-weeks. Participants were studied before, after 2-weeks, and after 16-weeks of supplementation to assess GSH concentrations, OxS, MFO, molecular regulators of energy metabolism, inflammation, endothelial function, IR, aging hallmarks, gait speed, muscle strength, 6-minute walk test, body composition, and blood pressure. RESULTS Compared to YA, OA had GSH deficiency, OxS, mitochondrial dysfunction (with defective molecular regulation), inflammation, endothelial dysfunction, IR, multiple aging hallmarks, impaired physical function, increased waist circumference, and systolic blood pressure. GlyNAC (and not placebo) supplementation in OA improved/corrected these defects. CONCLUSION GlyNAC supplementation in OA for 16-weeks was safe and well-tolerated. By combining the benefits of glycine, NAC and GSH, GlyNAC is an effective nutritional supplement that improves and reverses multiple age-associated abnormalities to promote health in aging humans. Clinical Trials Registration Number: NCT01870193.
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Affiliation(s)
- Premranjan Kumar
- Translational Metabolism Unit, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine
- Baylor College of Medicine, Houston, TX, USA
| | - Chun Liu
- Translational Metabolism Unit, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine
- Baylor College of Medicine, Houston, TX, USA
| | - James Suliburk
- Department of Surgery
- Baylor College of Medicine, Houston, TX, USA
| | - Jean W Hsu
- Baylor College of Medicine, Houston, TX, USA
- Baylor-St. Luke’s Medical Center
| | - Raja Muthupillai
- Baylor-St. Luke’s Medical Center
- Baylor College of Medicine, Houston, TX, USA
| | - Farook Jahoor
- USDA/ARS Children’s Nutrition Research Center
- Baylor College of Medicine, Houston, TX, USA
| | - Charles G Minard
- Institute of Clinical and Translational Research
- Baylor College of Medicine, Houston, TX, USA
| | - George E Taffet
- Section of Geriatrics, Department of Medicine
- Baylor College of Medicine, Houston, TX, USA
| | - Rajagopal V Sekhar
- Translational Metabolism Unit, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine
- Baylor College of Medicine, Houston, TX, USA
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21
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Mace RA, Greenberg J, Stauder M, Reynolds G, Vranceanu AM. My Healthy Brain: a multimodal lifestyle program to promote brain health. Aging Ment Health 2022; 26:980-991. [PMID: 33784902 DOI: 10.1080/13607863.2021.1904828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Promoting brain health depends on sustaining healthy behaviors across the lifespan. Yet, public adoption of lifestyle behaviors and knowledge of cognitive decline (CD) prevention remains poor. Our multidisciplinary team developed My Healthy Brain (MHB) to promote a healthy lifestyle (e.g. diet, exercise, alcohol, sleep) and build cognitive reserve (e.g. memory compensatory strategies). Our objective was to demonstrate early proof-of-concept for MHB by exploring the feasibility, acceptability, and improvement in primary lifestyle outcomes as well as secondary outcomes of self-determination and subjective wellbeing. MATERIALS AND METHODS Older adults with subjective (self-report only) or objective (confirmed by cognitive testing) CD, referred by neurologists to modify lifestyle risk factors (e.g. sedentary), participated in a non-randomized open pilot of MHB (N = 24). Participants completed the 8-week MHB group (90 min each) and pre-post outcome measures. RESULTS MHB met all a-priori set benchmarks, including good feasibility of recruitment (71% of patients screened) and enrollment (75% completed baseline), and good acceptability of treatment (75% completed 6 of 8 sessions and post-testing). Program satisfaction was excellent (100% of participants) and no adverse events were reported. We also observed improvements in primary lifestyle outcomes as well as secondary outcomes of self-determination and subjective well-being. DISCUSSION While MHB demonstrated preliminary feasibility and the potential to modify lifestyle risk factors for CD, the program can be improved. Future work will explore the integration of mindfulness skills with behavioral principles to bolster multidomain lifestyle change, and the live video delivery format to bypass barriers to participation.
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Affiliation(s)
- Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Matthew Stauder
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Gretchen Reynolds
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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22
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Bourassa KJ, Moffitt TE, Ambler A, Hariri AR, Harrington H, Houts RM, Ireland D, Knodt A, Poulton R, Ramrakha S, Caspi A. Association of Treatable Health Conditions During Adolescence With Accelerated Aging at Midlife. JAMA Pediatr 2022; 176:392-399. [PMID: 35188538 PMCID: PMC8861897 DOI: 10.1001/jamapediatrics.2021.6417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Biological aging is a distinct construct from health; however, people who age quickly are more likely to experience poor health. Identifying pediatric health conditions associated with accelerated aging could help develop treatment approaches to slow midlife aging and prevent poor health in later life. OBJECTIVE To examine the association between 4 treatable health conditions in adolescence and accelerated aging at midlife. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from participants in the Dunedin Study, a longitudinal investigation of health and behavior among a birth cohort born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand, and followed up until age 45 years. Participants underwent an assessment at age 45 years and had data for at least 1 adolescent health condition (asthma, smoking, obesity, and psychological disorders) and outcome measure (pace of aging, gait speed, brain age, and facial age). Data analysis was performed from February 11 to September 27, 2021. EXPOSURES Asthma, cigarette smoking, obesity, and psychological disorders were assessed at age 11, 13, and 15 years. MAIN OUTCOMES AND MEASURES The outcome was a midlife aging factor composite score comprising 4 measures of biological aging: pace of aging, gait speed, brain age (specifically, BrainAGE score), and facial age. RESULTS A total of 910 participants (459 men [50.4%]) met the inclusion criteria, including an assessment at age 45 years. Participants who had smoked daily (0.61 [95% CI, 0.43-0.79] SD units), had obesity (0.82 [95% CI, 0.59-1.06] SD units), or had a psychological disorder diagnosis (0.43 [95% CI, 0.29-0.56] SD units) during adolescence were biologically older at midlife compared with participants without these conditions. Participants with asthma were not biologically older at midlife (0.02 [95% CI, -0.14 to 0.19] SD units) compared with those without asthma. These results remained unchanged after adjusting for childhood risk factors such as poor health, socioeconomic disadvantage, and adverse experiences. CONCLUSIONS AND RELEVANCE This study found that adolescent smoking, obesity, and psychological disorder diagnoses were associated with older biological age at midlife. These health conditions could be treated during adolescence to reduce the risk of accelerated biological aging later in life.
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Affiliation(s)
- Kyle J. Bourassa
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Geriatric Research, Education, and Clinical Center, Veterans Affairs Durham Healthcare System, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Terrie E. Moffitt
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Institute of Psychiatry, King’s College London, London, United Kingdom,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
| | - Antony Ambler
- Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Ahmad R. Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Renate M. Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - David Ireland
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Annchen Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Richie Poulton
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Avshalom Caspi
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Institute of Psychiatry, King’s College London, London, United Kingdom,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
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23
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Lynch DH, Spangler HB, Franz JR, Krupenevich RL, Kim H, Nissman D, Zhang J, Li YY, Sumner S, Batsis JA. Multimodal Diagnostic Approaches to Advance Precision Medicine in Sarcopenia and Frailty. Nutrients 2022; 14:1384. [PMID: 35405997 PMCID: PMC9003228 DOI: 10.3390/nu14071384] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia, defined as the loss of muscle mass, strength, and function with aging, is a geriatric syndrome with important implications for patients and healthcare systems. Sarcopenia increases the risk of clinical decompensation when faced with physiological stressors and increases vulnerability, termed frailty. Sarcopenia develops due to inflammatory, hormonal, and myocellular changes in response to physiological and pathological aging, which promote progressive gains in fat mass and loss of lean mass and muscle strength. Progression of these pathophysiological changes can lead to sarcopenic obesity and physical frailty. These syndromes independently increase the risk of adverse patient outcomes including hospitalizations, long-term care placement, mortality, and decreased quality of life. This risk increases substantially when these syndromes co-exist. While there is evidence suggesting that the progression of sarcopenia, sarcopenic obesity, and frailty can be slowed or reversed, the adoption of broad-based screening or interventions has been slow to implement. Factors contributing to slow implementation include the lack of cost-effective, timely bedside diagnostics and interventions that target fundamental biological processes. This paper describes how clinical, radiographic, and biological data can be used to evaluate older adults with sarcopenia and sarcopenic obesity and to further the understanding of the mechanisms leading to declines in physical function and frailty.
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Affiliation(s)
- David H. Lynch
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Hillary B. Spangler
- Division of Medicine and Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Rebecca L. Krupenevich
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Hoon Kim
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Daniel Nissman
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; (D.N.); (J.Z.)
| | - Janet Zhang
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; (D.N.); (J.Z.)
| | - Yuan-Yuan Li
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
| | - Susan Sumner
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
| | - John A. Batsis
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC 27599, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
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24
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A toolkit for quantification of biological age from blood chemistry and organ function test data: BioAge. GeroScience 2021; 43:2795-2808. [PMID: 34725754 DOI: 10.1007/s11357-021-00480-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022] Open
Abstract
Methods to quantify biological aging are emerging as new measurement tools for epidemiology and population science and have been proposed as surrogate measures for healthy lifespan extension in geroscience clinical trials. Publicly available software packages to compute biological aging measurements from DNA methylation data have accelerated dissemination of these measures and generated rapid gains in knowledge about how different measures perform in a range of datasets. Biological age measures derived from blood chemistry data were introduced at the same time as the DNA methylation measures and, in multiple studies, demonstrate superior performance to these measures in prediction of healthy lifespan. However, their dissemination has been slow by comparison, resulting in a significant gap in knowledge. We developed a software package to help address this knowledge gap. The BioAge R package, available for download at GitHub ( http://github.com/dayoonkwon/BioAge ), implements three published methods to quantify biological aging based on analysis of chronological age and mortality risk: Klemera-Doubal biological age, PhenoAge, and homeostatic dysregulation. The package allows users to parametrize measurement algorithms using custom sets of biomarkers, to compare the resulting measurements to published versions of the Klemera-Doubal method and PhenoAge algorithms, and to score the measurements in new datasets. We applied BioAge to safety lab data from the CALERIE™ randomized controlled trial, the first-ever human trial of long-term calorie restriction in healthy, non-obese adults, to test effects of intervention on biological aging. Results contribute evidence that CALERIE intervention slowed biological aging. BioAge is a toolkit to facilitate measurement of biological age for geroscience.
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25
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Bauer SR, Walter LC, Ensrud KE, Suskind AM, Newman JC, Ricke WA, Liu TT, McVary KT, Covinsky K. Assessment of Frailty and Association With Progression of Benign Prostatic Hyperplasia Symptoms and Serious Adverse Events Among Men Using Drug Therapy. JAMA Netw Open 2021; 4:e2134427. [PMID: 34817584 PMCID: PMC8613596 DOI: 10.1001/jamanetworkopen.2021.34427] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Benign prostatic hyperplasia (BPH) in older men can cause lower urinary tract symptoms (LUTS), which are increasingly managed with medications. Frailty may contribute to both symptom progression and serious adverse events (SAEs), shifting the balance of benefits and harms of drug therapy. OBJECTIVE To assess the association between a deficit accumulation frailty index and clinical BPH progression or SAE. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Medical Therapy of Prostatic Symptoms trial, which compared placebo, doxazosin, finasteride, and combination therapy in men with moderate-to-severe LUTS, reduced urinary flow rate, and no prior BPH interventions, hypotension, or elevated prostate-specific antigen. Enrollment was from 1995 to 1998, and follow-up was through 2001. Data were assessed in February 2021. EXPOSURES A frailty index (score range, 0-1) using 68 potential deficits collected at baseline was used to categorized men as robust (score ≤0.1), prefrail (score 0.1 to <0.25), or frail (score ≥0.25). MAIN OUTCOMES AND MEASURES Primary outcomes were time to clinical BPH progression and time to SAE, as defined in the parent trial. Adjusted hazard ratios (AHRs) were estimated using Cox proportional hazards regressions adjusted for demographic variables, treatment group, measures of obstruction, and comorbidities. RESULTS Among 3047 men (mean [SD] age, 62.6 [7.3] years; range, 50-89 years) in this analysis, 745 (24%) were robust, 1824 (60%) were prefrail, and 478 (16%) were frail at baseline. Compared with robust men, frail men were older (age ≥75 years, 12 men [2%] vs 62 men [13%]), less likely to be White (646 men [87%] vs 344 men [72%]), less likely to be married (599 men [80%] vs 342 men [72%]), and less likely to have 16 years or more of education (471 men [63%] vs 150 men [31%]). During mean (SD) follow-up of 4.0 (1.5) years, the incidence rate of clinical BPH progression was 2.2 events per 100 person-years among robust men, 2.9 events per 100 person-years among prefrail men (AHR, 1.36; 95% CI, 1.02-1.83), and 4.0 events per 100 person-years among frail men (AHR, 1.82; 95% CI, 1.24-2.67; linear P = .005). Larger point estimates were seen among men who received doxazosin or combination therapy, although the test for interaction between frailty index and treatment group did not reach statistical significance (P for interaction = .06). Risk of SAE was higher among prefrail and frail men (prefrail vs robust AHR, 1.81; 95% CI, 1.48-2.23; frail vs robust AHR, 2.86; 95% CI, 2.21-3.69; linear P < .001); this association was similar across treatment groups (P for interaction = .76). CONCLUSIONS AND RELEVANCE These findings suggest that frailty is independently associated with greater risk of both clinical BPH progression and SAEs. Older frail men with BPH considering initiation of drug therapy should be counseled regarding their higher risk of progression despite combination therapy and their likelihood of experiencing SAEs regardless of treatment choice.
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Affiliation(s)
- Scott R. Bauer
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
- Department of Urology, University of California, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Louise C. Walter
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Kristine E. Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Anne M. Suskind
- Department of Urology, University of California, San Francisco
| | - John C. Newman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Buck Institute for Research on Aging, Novato, California
| | - William A. Ricke
- George M. O’Brien Center of Research Excellence, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Teresa T. Liu
- George M. O’Brien Center of Research Excellence, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kevin T. McVary
- Department of Urology and Center for Male Health, Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| | - Kenneth Covinsky
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
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26
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Hilmer SN. Bridging geriatric medicine, clinical pharmacology and ageing biology to understand and improve outcomes of medicines in old age and frailty. Ageing Res Rev 2021; 71:101457. [PMID: 34481922 DOI: 10.1016/j.arr.2021.101457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah N Hilmer
- Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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27
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Macaulay TR, Pa J, Kutch JJ, Lane CJ, Duncan D, Yan L, Schroeder ET. 12 weeks of strength training improves fluid cognition in older adults: A nonrandomized pilot trial. PLoS One 2021; 16:e0255018. [PMID: 34293060 PMCID: PMC8297768 DOI: 10.1371/journal.pone.0255018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Resistance training (RT) is a promising strategy to slow or prevent fluid cognitive decline during aging. However, the effects of strength-specific RT programs have received little attention. The purpose of this single-group proof of concept clinical trial was to determine whether a 12-week strength training (ST) program could improve fluid cognition in healthy older adults 60 to 80 years of age, and to explore concomitant physiological and psychological changes. Methods Twenty participants (69.1 ± 5.8 years, 14 women) completed this study with no drop-outs or severe adverse events. Baseline assessments were completed before an initial 12-week control period, then participants were re-tested at pre-intervention and after the 12-week ST intervention. The NIH Toolbox Cognition Battery and standard physical and psychological measures were administered at all three time points. During the 36 sessions of periodized ST (3 sessions per week), participants were supervised by an exercise specialist and challenged via autoregulatory load progression. Results Test-retest reliability over the control period was good for fluid cognition and excellent for crystallized cognition. Fluid composite scores significantly increased from pre- to post-intervention (8.2 ± 6.1%, p < 0.01, d = 1.27), while crystallized composite scores did not (-0.5 ± 2.8%, p = 0.46, d = -0.34). Performance on individual fluid instruments, including executive function, attention, working memory, and processing speed, also significantly improved. Surprisingly, changes in fluid composite scores had small negative correlations with changes in muscular strength and sleep quality, but a small positive correlation with changes in muscular power. Conclusions Thus, improvements in fluid cognition can be safely achieved in older adults using a 12-week high-intensity ST program, but further controlled studies are needed to confirm these findings. Furthermore, the relationship with other widespread physiological and psychological benefits remains unclear.
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Affiliation(s)
- Timothy R Macaulay
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States of America
| | - Judy Pa
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States of America
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Dominique Duncan
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Lirong Yan
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - E Todd Schroeder
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California, United States of America
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28
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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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29
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Hastings WJ, Almeida DM, Shalev I. Conceptual and analytical overlap between allostatic load and systemic biological aging measures: Analyses from the National Survey of Midlife Development in the United States. J Gerontol A Biol Sci Med Sci 2021; 77:1179-1188. [PMID: 34180993 DOI: 10.1093/gerona/glab187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Indices quantifying allostatic load (AL) and biological aging (BA) have independently received widespread use in epidemiological literature. However, little attention has been paid to their conceptual and quantitative overlap. By reviewing literature utilizing measures of AL and BA, and conducting comparative analysis, we highlight similarities and differences in biological markers employed and approach toward scale construction. Further, we outline opportunities where both types of indices might be improved by adopting methodological features of the other. METHODS Using data from the National Survey of Midlife Development in the United States (N=2,055, age=26-86), we constructed three AL indices: one common literature standard, and two alternative formulations informed by previous work with measures of BA. The performance of AL indices was juxtaposed against two commonly employed BA indices: Klemera-Doubal Method Biological Age and Homeostatic Dysregulation. RESULTS All indices correlated with chronological age. Participants with higher AL and older BA performed worse on tests of physical and subjective functioning. Further, participants with increased life-course risk exposure exhibited higher AL and BA. Notably, alternative AL formulations tended to exhibit effect-sizes equivalent to or larger than those observed for BA measures, and displayed superior mortality prediction. CONCLUSIONS In addition to their conceptual similarity, AL and BA indices also exhibit significant analytical similarity. Further, BA measures are robust to construction using a panel of biomarkers not observed in previous iterations, including carotenoids indexing antioxidant capacity. In turn, AL indices could benefit by adopting the methodological rigor formalized within BA composites, such as applying biomarker down-selection criteria.
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Affiliation(s)
- Waylon J Hastings
- Department of Biobehavioral Health, The Pennsylvania State University, University Park PA, USA
| | - David M Almeida
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park PA, USA
| | - Idan Shalev
- Department of Biobehavioral Health, The Pennsylvania State University, University Park PA, USA
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Sanders JL, Putman RK, Dupuis J, Xu H, Murabito JM, Araki T, Nishino M, Benjamin EJ, Levy DL, Ramachandran VS, Washko GR, Curtis JL, Freeman CM, Bowler RP, Hatabu H, O’Connor GT, Hunninghake GM. The Association of Aging Biomarkers, Interstitial Lung Abnormalities, and Mortality. Am J Respir Crit Care Med 2021; 203:1149-1157. [PMID: 33080140 PMCID: PMC8314902 DOI: 10.1164/rccm.202007-2993oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/20/2020] [Indexed: 12/28/2022] Open
Abstract
Rationale: The association between aging and idiopathic pulmonary fibrosis has been established. The associations between aging-related biomarkers and interstitial lung abnormalities (ILA) have not been comprehensively evaluated.Objectives: To evaluate the associations among aging biomarkers, ILA, and all-cause mortality.Methods: In the FHS (Framingham Heart Study), we evaluated associations among plasma biomarkers (IL-6, CRP [C-reactive protein], TNFR [tumor necrosis factor α receptor II], GDF15 [growth differentiation factor 15], cystatin-C, HGBA1C [Hb A1C], insulin, IGF1 [insulin-like growth factor 1], and IGFBP1 [IGF binding protein 1] and IGFBP3]), ILA, and mortality. Causal inference analysis was used to determine whether biomarkers mediated age. GDF15 results were replicated in the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) Study.Measurements and Main Results: In the FHS, there were higher odds of ILA per increase in natural log-transformed GDF15 (odds ratio [95% confidence interval], 3.4 [1.8-6.4]; P = 0.0002), TNFR (3.1 [1.6-5.8]; P = 0.004), IL-6 (1.8 [1.4-2.4]; P < 0.0001), and CRP (1.7 [1.3-2.0]; P < 0.0001). In the FHS, after adjustment for multiple comparisons, no biomarker was associated with increased mortality, but the associations of GDF15 (hazard ratio, 2.0 [1.1-3.5]; P = 0.02), TNFR (1.8 [1.0-3.3]; P = 0.05), and IGFBP1 (1.3 [1.1-1.7]; P = 0.01) approached significance. In the COPDGene Study, higher natural log-transformed GDF15 was associated with ILA (odds ratio, 8.1 [3.1-21.4]; P < 0.0001) and mortality (hazard ratio, 1.6 [1.1-2.2]; P = 0.01). Causal inference analysis showed that the association of age with ILA was mediated by IL-6 (P < 0.0001) and TNFR (P = 0.002) and was likely mediated by GDF15 (P = 0.008) in the FHS and was mediated by GDF15 (P = 0.001) in the COPDGene Study.Conclusions: Some aging-related biomarkers are associated with ILA. GDF15, in particular, may explain some of the associations among age, ILA, and mortality.
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Affiliation(s)
| | | | - Josée Dupuis
- Department of Biostatistics, School of Public Health
| | - Hanfei Xu
- Department of Biostatistics, School of Public Health
| | - Joanne M. Murabito
- Department of Medicine, and
- Framingham Heart Study, Framingham, Massachusetts
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Emelia J. Benjamin
- Department of Medicine, and
- Framingham Heart Study, Framingham, Massachusetts
| | - Daniel L. Levy
- Department of Medicine, and
- Framingham Heart Study, Framingham, Massachusetts
| | | | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Medical Service and
| | - Christine M. Freeman
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Research Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health–Health Sciences Center, University of Colorado at Denver, Denver, Colorado
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital–Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - George T. O’Connor
- Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gary M. Hunninghake
- Division of Pulmonary and Critical Care Medicine and
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital–Harvard Medical School, Harvard University, Boston, Massachusetts; and
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31
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Blagosklonny MV. The goal of geroscience is life extension. Oncotarget 2021; 12:131-144. [PMID: 33613842 PMCID: PMC7869575 DOI: 10.18632/oncotarget.27882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
Although numerous drugs seemingly extend healthspan in mice, only a few extend lifespan in mice and only one does it consistently. Some of them, alone or in combination, can be used in humans, without further clinical trials.
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Cesari M, Cherubini A, Guralnik JM, Beresniak A, Rodriguez-Mañas L, Inzitari M, Walston J. Early detection of accelerated aging and cellular decline (AACD): A consensus statement. Exp Gerontol 2021; 146:111242. [PMID: 33484892 DOI: 10.1016/j.exger.2021.111242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
The cellular hallmarks of accelerated aging and their clinical expression may be grouped using the terms 'accelerated aging and cellular decline' (AACD) and/or 'age-associated cellular decline'. This construct is designed to capture the biological background predisposing the development of age-related conditions. By classifying risk factors, early indicators, and clinical differentiators of AACD through expert consensus, this study aimed to identify the signs, symptoms, and markers indicative of AACD. In doing so, this work paves the way for future implementation of the AACD concept in the clinical and research settings. An interdisciplinary panel of experts with clinical and research expertise was selected to participate in a virtual workshop to discuss AACD. A modified nominal group technique was used to establish consensus among the group. An extended group of international experts critically reviewed an early draft of the manuscript, and their feedback was then incorporated into the model. Experts identified 13 factors predisposing to or clinically manifesting AACD. Among these, chronic diseases, obesity, and unfavorable genetic background were considered as the most important. There was a consensus that a gradual and nonspecific development often characterizes AACD, making its clinical detection potentially challenging. In addition, signs and symptoms might have multifactorial causes and overlapping origins, such as genetic and epigenetic predispositions. As a result, an initial checklist was outlined, listing clinical factors of special relevance (e.g., fatigue, low quality of sleep, and low mood) to represent early manifestations of the organism's exhaustion, which are also frequently neglected in the clinical setting. Differentiating AACD from other conditions is essential. The use of a combination of biomarkers was proposed as a viable method in a two-step process of differentiation: 1) identification of early AACD clinical indicators, followed by 2) symptom and biomarker confirmation with a focus on system domains (to be potentially targeted by future specific interventions). Although the AACD construct is not yet ready for routine use in clinical practice, its operationalization may support the early identification of age-related conditions (when this might still be amenable to reversion) and also encourage preventative interventions. Further investigation is needed to establish specific biomarkers that confirm independent risk factors for AACD and provide a more definitive structure to the concept of AACD (and age-associated cellular decline).
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Affiliation(s)
- Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Via Camaldoli 64, 20100 Milano, Italy.
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, POR, Ancona, IRCCS INRCA, via della Montagnola 81, 60100, Ancona, Italy.
| | - Jack M Guralnik
- University of Maryland School of Medicine, Howard Hall, 660 W. Redwood Street, HH 132A, Baltimore, MD 21201, USA.
| | - Ariel Beresniak
- Data Mining International, International SA, World Trade Centre II CP856, 29 Route de Pre-Bois, CH-1215, Geneva 15, Switzerland.
| | - Leocadio Rodriguez-Mañas
- Geriatrics Department, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, 28905, Getafe, Madrid, Spain.
| | - Marco Inzitari
- REFiT Bcn research group, Parc Sanitari Pere Virgili and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Jeremy Walston
- Department of Medicine, Division of Geriatric Medicine and Gerontology, John Hopkins University, 5501 Hopkins Bayview Circle, Suite 1A, 62, Baltimore, MD, 21224, USA.
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Bourassa KJ, Caspi A, Harrington H, Houts R, Poulton R, Ramrakha S, Moffitt TE. Intimate partner violence and lower relationship quality are associated with faster biological aging. Psychol Aging 2020; 35:1127-1139. [PMID: 33211513 PMCID: PMC7712579 DOI: 10.1037/pag0000581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The characteristics of people's relationships have relevance to health-high quality romantic relationships are associated with improved health whereas intimate partner violence is associated with poorer health. Recently, increased attention has been focused on the biological processes underpinning these associations. A geroscience approach-examining whether close relationship characteristics are associated with biological aging-would complement previous research focused on individual disease pathways. This study used participants from the Dunedin Study (N = 974) to investigate relationship characteristics and biological aging across almost 20 years, from age 26 to 45. Being involved in romantic relationships was associated with slower biological aging, β = -0.12, p < .001. This difference represented 2.9 years of aging over the two decades. Greater relationship quality was also associated with slower biological aging, β = -0.19, p < .001, whereas higher levels of partner violence were associated with faster biological aging, β = 0.25, p < .001. A 1 SD difference in these characteristics was associated with a difference of 1.0 and 1.3 years of aging over the two decades, respectively. Secondary analyses suggested that experiencing violence from a partner was more strongly associated with biological aging than perpetrating violence, and that the experience of physical violence was more strongly associated with aging than psychological violence. These findings suggest that the characteristics of romantic relationships have relevance for biological aging in midlife. Interventions designed to increase relationship quality and decrease partner violence could reduce future morbidity and early mortality by slowing people's biological aging. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Epel ES. The geroscience agenda: Toxic stress, hormetic stress, and the rate of aging. Ageing Res Rev 2020; 63:101167. [PMID: 32979553 PMCID: PMC7520385 DOI: 10.1016/j.arr.2020.101167] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Geroscience offers a counterpoint to the challenged pursuit of curing diseases of aging, by focusing on slowing the biological aging process for extended healthspan earlier in life. Remarkable progress has led this field toward animal trials and the next challenge lies with translation to humans. There is an emerging number of small human trials that can take advantage of new models integrating behavioral and social factors. Understanding dynamic aging mechanisms, given the powerful social determinants of aging (Crimmins, 2020) and human variability and environmental contexts (Moffitt, 2020), will be critical. Behavioral and social factors are intrinsic to aging. Toxic stressors broadly defined can lead to stress-acceleration of aging, either directly impacting aging processes or by shaping poor behavioral health, and underlie the socioeconomic disparities of aging. In contrast, hormetic stressors, acute intermittent stressors of moderate intensity, can produce stress resilience, the ability for quick recovery and possibly rejuvenation of cells and tissues. Although health research usually examines static biomarkers, aging is reflected in dynamic ability to recover from challenges pointing to new interventions and targets for examining mechanisms. A fuller model incorporating stress resilience provides innovative biobehavioral interventions, both for bolstering response to challenges, such as COVID-19, and for improving healthspan.
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Affiliation(s)
- Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, & Center for Health and Community, University of California, 3333 California St, Ste 465, San Francisco, CA, 94122, United States.
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35
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TSAI YC, CHENG LH, LIU YW, JENG OJ, LEE YK. Gerobiotics: probiotics targeting fundamental aging processes. BIOSCIENCE OF MICROBIOTA, FOOD AND HEALTH 2020; 40:1-11. [PMID: 33520563 PMCID: PMC7817508 DOI: 10.12938/bmfh.2020-026] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Abstract
Aging is recognized as a common risk factor for many chronic diseases and functional decline. The newly emerging field of geroscience is an interdisciplinary field that aims to understand the molecular and cellular mechanisms of aging. Several fundamental biological processes have been proposed as hallmarks of aging. The proposition of the geroscience hypothesis is that targeting holistically these highly integrated hallmarks could be an effective approach to preventing the pathogenesis of age-related diseases jointly, thereby improving the health span of most individuals. There is a growing awareness concerning the benefits of the prophylactic use of probiotics in maintaining health and improving quality of life in the elderly population. In view of the rapid progress in geroscience research, a new emphasis on geroscience-based probiotics is in high demand, and such probiotics require extensive preclinical and clinical research to support their functional efficacy. Here we propose a new term, "gerobiotics", to define those probiotic strains and their derived postbiotics and para-probiotics that are able to beneficially attenuate the fundamental mechanisms of aging, reduce physiological aging processes, and thereby expand the health span of the host. We provide a thorough discussion of why the coining of a new term is warranted instead of just referring to these probiotics as anti-aging probiotics or with other similar terms. In this review, we highlight the needs and importance of the new field of gerobiotics, past and currently on-going research and development in the field, biomarkers for potential targets, and recommended steps for the development of gerobiotic products. Use of gerobiotics could be a promising intervention strategy to improve health span and longevity of humans in the future.
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Affiliation(s)
- Ying-Chieh TSAI
- Institute of Biochemistry and Molecular Biology, National
Yang-Ming University, Taipei 11221, Taiwan
| | - Li-Hao CHENG
- Bened Biomedical Co., Ltd., Taipei 10448, Taiwan
| | - Yen-Wenn LIU
- Institute of Biochemistry and Molecular Biology, National
Yang-Ming University, Taipei 11221, Taiwan
| | | | - Yuan-Kun LEE
- Department of Microbiology & Immunology, National
University of Singapore, Singapore 117597, Singapore
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36
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Liu Z. Development and Validation of 2 Composite Aging Measures Using Routine Clinical Biomarkers in the Chinese Population: Analyses From 2 Prospective Cohort Studies. J Gerontol A Biol Sci Med Sci 2020; 76:1627-1632. [PMID: 32946548 PMCID: PMC8521780 DOI: 10.1093/gerona/glaa238] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to: (i) develop 2 composite aging measures in the Chinese population using 2 recent advanced algorithms (the Klemera and Doubal method and Mahalanobis distance); and (ii) validate the 2 measures by examining their associations with mortality and disease counts. METHODS Based on data from the China Nutrition and Health Survey (CHNS) 2009 wave (N = 8119, aged 20-79 years, 53.5% women), a nationwide prospective cohort study of the Chinese population, we developed Klemera and Doubal method-biological age (KDM-BA) and physiological dysregulation (PD, derived from Mahalanobis distance) using 12 biomarkers. For the validation analysis, we used Cox proportional hazard regression models (for mortality) and linear, Poisson, and logistic regression models (for disease counts) to examine the associations. We replicated the validation analysis in the China Health and Retirement Longitudinal Study (CHARLS, N = 9304, aged 45-99 years, 53.4% women). RESULTS Both aging measures were predictive of mortality after accounting for age and gender (KDM-BA, per 1-year, hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.08, 1.19; PD, per 1-SD, HR = 1.50, 95% CI = 1.33, 1.69). With few exceptions, these mortality predictions were robust across stratifications by age, gender, education, and health behaviors. The 2 aging measures were associated with disease counts both cross-sectionally and longitudinally. These results were generally replicable in CHARLS although 4 biomarkers were not available. CONCLUSIONS We successfully developed and validated 2 composite aging measures-KDM-BA and PD, which have great potentials for applications in early identifications and preventions of aging and aging-related diseases in China.
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Affiliation(s)
- Zuyun Liu
- Center for Clinical Big Data and Analytics, Second Affiliated Hospital and Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China,Department of Pathology, Yale School of Medicine, New Haven, Connecticut,Address correspondence to: Zuyun Liu, PhD, Department of Big Data in Health Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China. E-mail:
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37
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Ermogenous C, Green C, Jackson T, Ferguson M, Lord JM. Treating age-related multimorbidity: the drug discovery challenge. Drug Discov Today 2020; 25:1403-1415. [DOI: 10.1016/j.drudis.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
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38
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Belsky DW, Caspi A, Arseneault L, Baccarelli A, Corcoran DL, Gao X, Hannon E, Harrington HL, Rasmussen LJH, Houts R, Huffman K, Kraus WE, Kwon D, Mill J, Pieper CF, Prinz JA, Poulton R, Schwartz J, Sugden K, Vokonas P, Williams BS, Moffitt TE. Quantification of the pace of biological aging in humans through a blood test, the DunedinPoAm DNA methylation algorithm. eLife 2020; 9:e54870. [PMID: 32367804 PMCID: PMC7282814 DOI: 10.7554/elife.54870] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
Biological aging is the gradual, progressive decline in system integrity that occurs with advancing chronological age, causing morbidity and disability. Measurements of the pace of aging are needed as surrogate endpoints in trials of therapies designed to prevent disease by slowing biological aging. We report a blood-DNA-methylation measure that is sensitive to variation in pace of biological aging among individuals born the same year. We first modeled change-over-time in 18 biomarkers tracking organ-system integrity across 12 years of follow-up in n = 954 members of the Dunedin Study born in 1972-1973. Rates of change in each biomarker over ages 26-38 years were composited to form a measure of aging-related decline, termed Pace-of-Aging. Elastic-net regression was used to develop a DNA-methylation predictor of Pace-of-Aging, called DunedinPoAm for Dunedin(P)ace(o)f(A)ging(m)ethylation. Validation analysis in cohort studies and the CALERIE trial provide proof-of-principle for DunedinPoAm as a single-time-point measure of a person's pace of biological aging.
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Affiliation(s)
- Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public HealthNew YorkUnited States
- Butler Columbia Aging Center, Columbia University Mailman School of Public HealthNew YorkUnited States
| | - Avshalom Caspi
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College LondonLondonUnited Kingdom
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurhamUnited States
- Center for Genomic and Computational Biology, Duke UniversityDurhamUnited States
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College LondonLondonUnited Kingdom
| | - Andrea Baccarelli
- Laboratory of Precision Environmental Health, Mailman School of Public Health, Columbia UniversityNew YorkUnited States
| | - David L Corcoran
- Center for Genomic and Computational Biology, Duke UniversityDurhamUnited States
| | - Xu Gao
- Laboratory of Precision Environmental Health, Mailman School of Public Health, Columbia UniversityNew YorkUnited States
| | - Eiliss Hannon
- University of Exeter Medical School, College of Medicine and HealthExeterUnited Kingdom
| | - Hona Lee Harrington
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
| | - Line JH Rasmussen
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
- Clinical Research Centre, Copenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
| | - Kim Huffman
- Duke Molecular Physiology Institute, Duke UniversityDurhamUnited States
- Duke University Center for the Study of Aging, Duke UniversityDurhamUnited States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke UniversityDurhamUnited States
- Duke University Center for the Study of Aging, Duke UniversityDurhamUnited States
| | - Dayoon Kwon
- Butler Columbia Aging Center, Columbia University Mailman School of Public HealthNew YorkUnited States
| | - Jonathan Mill
- University of Exeter Medical School, College of Medicine and HealthExeterUnited Kingdom
| | - Carl F Pieper
- Duke University Center for the Study of Aging, Duke UniversityDurhamUnited States
- Department of Biostatistics, Duke University School of MedicineDurhamUnited States
| | - Joseph A Prinz
- Center for Genomic and Computational Biology, Duke UniversityDurhamUnited States
| | - Richie Poulton
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of OtagoOtagoNew Zealand
| | - Joel Schwartz
- Department of Environmental Health Sciences, Harvard TH Chan School of Public HealthBostonUnited States
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Department of Medicine, Boston University School of MedicineBostonUnited States
| | - Benjamin S Williams
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
| | - Terrie E Moffitt
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College LondonLondonUnited Kingdom
- Department of Psychology and Neuroscience, Duke UniversityDurhamUnited States
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurhamUnited States
- Center for Genomic and Computational Biology, Duke UniversityDurhamUnited States
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Pignolo RJ, Passos JF, Khosla S, Tchkonia T, Kirkland JL. Reducing Senescent Cell Burden in Aging and Disease. Trends Mol Med 2020; 26:630-638. [PMID: 32589933 DOI: 10.1016/j.molmed.2020.03.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
Cellular senescence is a primary aging process and tumor suppressive mechanism characterized by irreversible growth arrest, apoptosis resistance, production of a senescence-associated secretory phenotype (SASP), mitochondrial dysfunction, and alterations in DNA and chromatin. In preclinical aging models, accumulation of senescent cells is associated with multiple chronic diseases and disorders, geriatric syndromes, multimorbidity, and accelerated aging phenotypes. In animals, genetic and pharmacologic reduction of senescent cell burden results in the prevention, delay, and/or alleviation of a variety of aging-related diseases and sequelae. Early clinical trials have thus far focused on safety and target engagement of senolytic agents that clear senescent cells. We hypothesize that these pharmacologic interventions may have transformative effects on geriatric medicine.
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Affiliation(s)
- Robert J Pignolo
- Mayo Clinic Departments of Medicine, Physiology and Biomedical Engineering, and the Kogod Center on Aging, Rochester, MN, USA.
| | - João F Passos
- Mayo Clinic Departments of Medicine, Physiology and Biomedical Engineering, and the Kogod Center on Aging, Rochester, MN, USA
| | - Sundeep Khosla
- Mayo Clinic Departments of Medicine, Physiology and Biomedical Engineering, and the Kogod Center on Aging, Rochester, MN, USA
| | - Tamara Tchkonia
- Mayo Clinic Departments of Medicine, Physiology and Biomedical Engineering, and the Kogod Center on Aging, Rochester, MN, USA
| | - James L Kirkland
- Mayo Clinic Departments of Medicine, Physiology and Biomedical Engineering, and the Kogod Center on Aging, Rochester, MN, USA
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40
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Wissler Gerdes EO, Zhu Y, Tchkonia T, Kirkland JL. Discovery, development, and future application of senolytics: theories and predictions. FEBS J 2020; 287:2418-2427. [PMID: 32112672 PMCID: PMC7302972 DOI: 10.1111/febs.15264] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/26/2020] [Indexed: 12/25/2022]
Abstract
Senescent cells accumulate with aging and at etiological sites of multiple diseases, including those accounting for most morbidity, mortality, and health costs. Senescent cells do not replicate, can release factors that cause tissue dysfunction, and yet remain viable. The discovery of senolytic drugs, agents that selectively eliminate senescent cells, created a new route for alleviating age‐related dysfunction and diseases. As anticipated for agents targeting fundamental aging mechanisms that are ‘root cause’ contributors to multiple disorders, potential applications of senolytics are protean. We review the discovery of senolytics, strategies for translation into clinical application, and promising early signals from clinical trials.
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Affiliation(s)
| | - Yi Zhu
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Tamar Tchkonia
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
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41
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Ford GA, Lord JM, Ferguson MAJ, Bountra C, Le Couteur DG. Organizational Innovation for Developing New Medicines That Target Aging and Age-Related Conditions. J Gerontol A Biol Sci Med Sci 2020; 75:87-88. [PMID: 30838376 DOI: 10.1093/gerona/glz062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Gary A Ford
- Radcliffe Department of Medicine, Oxford University and Oxford Academic Health Science Network, UK
| | - Janet M Lord
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, UK
| | | | - Chas Bountra
- Structural Genomics Consortium, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - David G Le Couteur
- Charles Perkins Centre, Centre for Education and Research on Ageing and ANZAC Research Institute, University of Sydney and Concord Hospital, Australia
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Upadhya B, Haykowsky MJ, Kitzman DW. Therapy for heart failure with preserved ejection fraction: current status, unique challenges, and future directions. Heart Fail Rev 2019; 23:609-629. [PMID: 29876843 DOI: 10.1007/s10741-018-9714-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF. Among elderly women, HFpEF comprises more than 80% of incident HF cases. Adverse outcomes-exercise intolerance, poor quality of life, frequent hospitalizations, and reduced survival-approach those of classic HF with reduced EF (HFrEF). However, despite its importance, our understanding of the pathophysiology of HFpEF is incomplete, and despite intensive efforts, optimal therapy remains uncertain, as most trials to date have been negative. This is in stark contrast to management of HFrEF, where dozens of positive trials have established a broad array of effective, guidelines-based therapies that definitively improve a range of clinically meaningful outcomes. In addition to providing an overview of current management status, we examine evolving data that may help explain this paradox, overcome past challenges, provide a roadmap for future success, and that underpin a wave of new trials that will test novel approaches based on these insights.
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Affiliation(s)
- Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA
| | - Mark J Haykowsky
- College of Nursing and Health Innovation, University of Texas Arlington, Arlington, TX, USA
| | - Dalane W Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.
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Eaton AD, Walmsley SL, Craig SL, Rourke SB, Sota T, McCullagh JW, Fallon BA. Protocol for a pilot randomised controlled trial evaluating feasibility and acceptability of cognitive remediation group therapy compared with mutual aid group therapy for people ageing with HIV-associated neurocognitive disorder (HAND) in Toronto, Canada. BMJ Open 2019; 9:e033183. [PMID: 31676660 PMCID: PMC6830703 DOI: 10.1136/bmjopen-2019-033183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION HIV-associated neurocognitive disorder (HAND) may affect 30%-50% of people ageing with HIV. HAND may increase stress and anxiety, and impede coping. Psychosocial group therapy may ameliorate HAND's symptoms, yet the ideal intervention is unclear. This protocol outlines a pilot randomised controlled trial (RCT)-designed using community-based participatory research-to pilot cognitive remediation group therapy (CRGT) against an active comparator. METHODS AND ANALYSIS This is a pilot, parallel design, two-arm RCT that will recruit participants diagnosed with the mild neurocognitive disorder form of HAND from a neurobehavioural research unit at a tertiary care hospital in Toronto, Canada. Eligibility criteria include age ≥40 years, known HIV status for 5+ years, English fluency, able to consent and able to attend 8 weeks of group therapy. Eligible participants will be randomised to one of two treatment arms, each consisting of eight-session group interventions delivered once weekly at 3 hours per session. Arm 1 (novel) is CRGT, combining mindfulness-based stress reduction with brain training activities. Arm 2 (active control) is mutual aid group therapy. The primary outcomes are feasibility, measured by proportions of recruitment and completion, and acceptability, determined by a satisfaction questionnaire. The secondary outcome is intervention fidelity, where content analysis will be used to assess facilitator session reports. A between-group analysis will be conducted on exploratory outcomes of stress, anxiety, coping and use of intervention activities that will be collected at three time points. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Boards of St. Michael's Hospital and the University of Toronto. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. This study could provide insight into design (eg, recruitment, measures) and intervention considerations (eg, structure, content) for a larger trial to lessen the burden of cognitive decline among people ageing with HIV. TRIAL REGISTRATION NUMBER NCT03483740; Pre-results.
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Affiliation(s)
- Andrew David Eaton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Teresa Sota
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Barbara A Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Palmer AK, Gustafson B, Kirkland JL, Smith U. Cellular senescence: at the nexus between ageing and diabetes. Diabetologia 2019; 62:1835-1841. [PMID: 31451866 PMCID: PMC6731336 DOI: 10.1007/s00125-019-4934-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
Ageing and diabetes lead to similar organ dysfunction that is driven by parallel molecular mechanisms, one of which is cellular senescence. The abundance of senescent cells in various tissues increases with age, obesity and diabetes. Senescent cells have been directly implicated in the generation of insulin resistance. Recently, drugs that preferentially target senescent cells, known as senolytics, have been described and recently entered clinical trials. In this review, we explore the biological links between ageing and diabetes, specifically focusing on cellular senescence. We summarise the current data on cellular senescence in key target tissues associated with the development and clinical phenotypes of type 2 diabetes and discuss the therapeutic potential of targeting cellular senescence in diabetes.
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Affiliation(s)
- Allyson K Palmer
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Birgit Gustafson
- Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and University of Gothenburg, 413 45, Gothenburg, Sweden
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, 200 1st St SW, Rochester, MN, USA.
| | - Ulf Smith
- Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and University of Gothenburg, 413 45, Gothenburg, Sweden.
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Hickson LJ, Langhi Prata LGP, Bobart SA, Evans TK, Giorgadze N, Hashmi SK, Herrmann SM, Jensen MD, Jia Q, Jordan KL, Kellogg TA, Khosla S, Koerber DM, Lagnado AB, Lawson DK, LeBrasseur NK, Lerman LO, McDonald KM, McKenzie TJ, Passos JF, Pignolo RJ, Pirtskhalava T, Saadiq IM, Schaefer KK, Textor SC, Victorelli SG, Volkman TL, Xue A, Wentworth MA, Wissler Gerdes EO, Zhu Y, Tchkonia T, Kirkland JL. Senolytics decrease senescent cells in humans: Preliminary report from a clinical trial of Dasatinib plus Quercetin in individuals with diabetic kidney disease. EBioMedicine 2019; 47:446-456. [PMID: 31542391 PMCID: PMC6796530 DOI: 10.1016/j.ebiom.2019.08.069] [Citation(s) in RCA: 703] [Impact Index Per Article: 140.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/16/2019] [Accepted: 08/29/2019] [Indexed: 01/01/2023] Open
Abstract
Background Senescent cells, which can release factors that cause inflammation and dysfunction, the senescence-associated secretory phenotype (SASP), accumulate with ageing and at etiological sites in multiple chronic diseases. Senolytics, including the combination of Dasatinib and Quercetin (D + Q), selectively eliminate senescent cells by transiently disabling pro-survival networks that defend them against their own apoptotic environment. In the first clinical trial of senolytics, D + Q improved physical function in patients with idiopathic pulmonary fibrosis (IPF), a fatal senescence-associated disease, but to date, no peer-reviewed study has directly demonstrated that senolytics decrease senescent cells in humans. Methods In an open label Phase 1 pilot study, we administered 3 days of oral D 100 mg and Q 1000 mg to subjects with diabetic kidney disease (N = 9; 68·7 ± 3·1 years old; 2 female; BMI:33·9 ± 2·3 kg/m2; eGFR:27·0 ± 2·1 mL/min/1·73m2). Adipose tissue, skin biopsies, and blood were collected before and 11 days after completing senolytic treatment. Senescent cell and macrophage/Langerhans cell markers and circulating SASP factors were assayed. Findings D + Q reduced adipose tissue senescent cell burden within 11 days, with decreases in p16INK4A-and p21CIP1-expressing cells, cells with senescence-associated β-galactosidase activity, and adipocyte progenitors with limited replicative potential. Adipose tissue macrophages, which are attracted, anchored, and activated by senescent cells, and crown-like structures were decreased. Skin epidermal p16INK4A+ and p21CIP1+ cells were reduced, as were circulating SASP factors, including IL-1α, IL-6, and MMPs-9 and −12. Interpretation “Hit-and-run” treatment with senolytics, which in the case of D + Q have elimination half-lives <11 h, significantly decreases senescent cell burden in humans. Fund NIH and Foundations. ClinicalTrials.gov Identifier: NCT02848131. Senescence, Frailty, and Mesenchymal Stem Cell Functionality in Chronic Kidney Disease: Effect of Senolytic Agents.
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Affiliation(s)
- LaTonya J Hickson
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, United States of America; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Larissa G P Langhi Prata
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Shane A Bobart
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Tamara K Evans
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Medicine Clinical Trials Unit, Department of Medicine, Mayo Clinic, United States of America
| | - Nino Giorgadze
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Shahrukh K Hashmi
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Division of Hematology, Department of Medicine, Mayo Clinic, United States of America
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Michael D Jensen
- Division of Endocrinology, Department of Medicine, Mayo Clinic, United States of America
| | - Qingyi Jia
- Division of Endocrinology, Department of Medicine, Mayo Clinic, United States of America
| | - Kyra L Jordan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, United States of America
| | - Sundeep Khosla
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Division of Endocrinology, Department of Medicine, Mayo Clinic, United States of America
| | - Daniel M Koerber
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Anthony B Lagnado
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, United States of America
| | - Donna K Lawson
- Division of Hospital Medicine, Department of Medicine, Mayo Clinic, United States of America
| | - Nathan K LeBrasseur
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Physiology, Mayo Clinic, United States of America; Department of Physical Medicine and Rehabilitation, Mayo Clinic, United States of America
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Kathleen M McDonald
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Office of Research Regulatory Support, Mayo Clinic, United States of America
| | | | - João F Passos
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, United States of America
| | - Robert J Pignolo
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, United States of America; Division of Endocrinology, Department of Medicine, Mayo Clinic, United States of America; Division of Hospital Medicine, Department of Medicine, Mayo Clinic, United States of America; Department of Physiology, Mayo Clinic, United States of America
| | - Tamar Pirtskhalava
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Ishran M Saadiq
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Kalli K Schaefer
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Stephen C Textor
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, United States of America
| | - Stella G Victorelli
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, United States of America
| | - Tammie L Volkman
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Medicine Clinical Trials Unit, Department of Medicine, Mayo Clinic, United States of America
| | - Ailing Xue
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Mark A Wentworth
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Office of Research Regulatory Support, Mayo Clinic, United States of America
| | - Erin O Wissler Gerdes
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Department of Medicine Clinical Trials Unit, Department of Medicine, Mayo Clinic, United States of America
| | - Yi Zhu
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America
| | - Tamara Tchkonia
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America.
| | - James L Kirkland
- Cellular Senescence and Translation and Pharmacology Programs, Robert and Arlene Kogod Center on Aging, Mayo Clinic, United States of America; Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, United States of America; Division of Hospital Medicine, Department of Medicine, Mayo Clinic, United States of America; Division of General Internal Medicine, Department of Medicine, Mayo Clinic, United States of America.
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Gijzel SMW, Whitson HE, van de Leemput IA, Scheffer M, van Asselt D, Rector JL, Olde Rikkert MGM, Melis RJF. Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults. J Am Geriatr Soc 2019; 67:2650-2657. [PMID: 31498881 PMCID: PMC6916426 DOI: 10.1111/jgs.16149] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022]
Abstract
Background Geriatricians are often confronted with unexpected health outcomes in older adults with complex multimorbidity. Aging researchers have recently called for a focus on physical resilience as a new approach to explaining such outcomes. Physical resilience, defined as the ability to resist functional decline or recover health following a stressor, is an emerging construct. Methods Based on an outline of the state‐of‐the‐art in research on the measurement of physical resilience, this article describes what tests to predict resilience can already be used in clinical practice and which innovations are to be expected soon. Results An older adult's recovery potential is currently predicted by static tests of physiological reserves. Although geriatric medicine typically adopts a multidisciplinary view of the patient and implicitly performs resilience management to a certain extent, clinical management of older adults can benefit from explicitly applying the dynamical concept of resilience. Two crucial leads for advancing our capacity to measure and manage the resilience of individual patients are advocated: first, performing multiple repeated measurements around a stressor can provide insight about the patient's dynamic responses to stressors; and, second, linking psychological and physiological subsystems, as proposed by network studies on resilience, can provide insight into dynamic interactions involved in a resilient response. Conclusion A big challenge still lies ahead in translating the dynamical concept of resilience into clinical tools and guidelines. As a first step in bridging this gap, this article outlines what opportunities clinicians and researchers can already exploit to improve prediction, understanding, and management of resilience of older adults. J Am Geriatr Soc 67:2650–2657, 2019
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Affiliation(s)
- Sanne M W Gijzel
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Environmental Sciences, Wageningen University, Wageningen, The Netherlands
| | - Heather E Whitson
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Geriatrics Research Education and Clinical Center, Durham Veteran Affairs (VA) Medical Center, Durham, North Carolina
| | | | - Marten Scheffer
- Department of Environmental Sciences, Wageningen University, Wageningen, The Netherlands
| | - Dieneke van Asselt
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jerrald L Rector
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - René J F Melis
- Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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48
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Hastings WJ, Shalev I, Belsky DW. Comparability of biological aging measures in the National Health and Nutrition Examination Study, 1999-2002. Psychoneuroendocrinology 2019; 106:171-178. [PMID: 30999227 PMCID: PMC6599717 DOI: 10.1016/j.psyneuen.2019.03.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/20/2019] [Accepted: 03/14/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Biological processes of aging are thought to be modifiable causes of many different chronic diseases. Measures of biological aging could provide sensitive endpoints for studies of risk factors hypothesized to shorten healthy lifespan and/or interventions that extend it. But uncertainty remains about how to measure biological aging and if proposed measures assess the same thing. METHOD We tested four proposed measures of biological aging that could be quantified with available data from the National Health and Nutrition Examination Survey (NHANES), Klemera-Doubal method (KDM) Biological Age, homeostatic dysregulation, Levine Method (LM) Biological Age, and leukocyte telomere length. RESULTS We analyzed data collected during 1999-2002, when all four biological aging meausres could be taken. Participants' KDM biological ages, homeostatic dysregulation levels, LM biological ages, and telomere length were all correlated with their chronological ages. KDM Biological Age, homeostatic dysregulation, and LM Biological Age were all correlated with one another, but these measures were uncorrelated with telomere length. Participants' with more advanced biological aging performed worse on tests of physical, cognitive, and perceptual functioning and reported more limitations to their daily activities and more pain, and rated themselves as being in worse health. In parallel, participants with risk factors for shorter healthy lifespan exhibited more advanced biological aging. In both sets of analyses, effect-sizes tended to be larger for KDM Biological Age, homeostatic dysregulation, and LM Biological Age as compared to telomere length. DISCUSSION The cellular-level aging biomarker telomere length may measure different aspects of the aging process as compared to the patient-level physiological composite measures KDM Biological Age, homeostatic dysregulation, and LM Biological Age. Studies aiming to test if risk factors accelerate aging or if interventions may slow aging should not treat proposed measures of aging as interchangeable.
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Affiliation(s)
- Waylon J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, United States
| | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, United States
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States; Robert N. Butler Columbia Aging Center, Columbia University, United States.
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49
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From discoveries in ageing research to therapeutics for healthy ageing. Nature 2019; 571:183-192. [PMID: 31292558 DOI: 10.1038/s41586-019-1365-2] [Citation(s) in RCA: 707] [Impact Index Per Article: 141.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/03/2019] [Indexed: 12/12/2022]
Abstract
For several decades, understanding ageing and the processes that limit lifespan have challenged biologists. Thirty years ago, the biology of ageing gained unprecedented scientific credibility through the identification of gene variants that extend the lifespan of multicellular model organisms. Here we summarize the milestones that mark this scientific triumph, discuss different ageing pathways and processes, and suggest that ageing research is entering a new era that has unique medical, commercial and societal implications. We argue that this era marks an inflection point, not only in ageing research but also for all biological research that affects the human healthspan.
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Newman JC, Sokoloski JL, Robbins PD, Niedernhofer LJ, Reed MJ, Wei J, Austad SN, Barzilai N, Cohen HJ, Kuchel GA, Kirkland JL, Pignolo RJ. Creating the Next Generation of Translational Geroscientists. J Am Geriatr Soc 2019; 67:1934-1939. [PMID: 31287934 PMCID: PMC6771814 DOI: 10.1111/jgs.16055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/05/2019] [Accepted: 05/18/2019] [Indexed: 12/26/2022]
Abstract
Advances in understanding fundamental processes of aging have led to a variety of investigational therapies to delay or prevent age-related diseases and conditions. These geroscience therapeutics hold the promise of revolutionizing medical care of older adults by treating the complex syndromes of aging and preserving health and independence. A crucial bottleneck is the study of geroscience therapeutics in early-stage, first-in-human, or proof-of-concept clinical trials. There is a limited pool of clinical investigators with the combination of knowledge and skills at the interface of clinical research, care of older adults, and aging biology needed to successfully design, fund, and implement geroscience trials. Current training pipelines are insufficient to meet the need. The sixth retreat of the National Institute on Aging R24 Geroscience Network brought together basic scientists, gerontologists, clinicians, and clinical researchers from the United States and Europe to discuss how to identify, recruit, and train investigators who can perform early-stage clinical trials in geroscience. We present herein the group's consensus on necessary subject domains and competencies, identification of candidate learners, credentialing learners, and the efficient and rapid implementation of training programs. Foundations and funding agencies have crucial roles to play in catalyzing the development of these programs. Geriatrician investigators are indispensable but cannot meet the need alone. Translational geroscience training programs can create a cadre of groundbreaking investigators from a variety of backgrounds and foster institutional cultures supportive of multidisciplinary translational aging research to turn innovative ideas into transformative therapeutics that can improve the health and independence of older adults. J Am Geriatr Soc 67:1934-1939, 2019.
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Affiliation(s)
- John C Newman
- Buck Institute for Research on Aging, and, University of California San Francisco Division of Geriatrics, Novato, California
| | - Julie L Sokoloski
- Robert and Arlene Kogod Center on Aging and the Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul D Robbins
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Institute on the Biology of Aging and Metabolism, Minneapolis, Minnesota
| | - Laura J Niedernhofer
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Institute on the Biology of Aging and Metabolism, Minneapolis, Minnesota
| | - May J Reed
- Division of Gerontology, Department of Medicine, University of Washington, Seattle, Washington
| | - Jeanne Wei
- Department of Geriatrics, College of Medicine-University of Arkansas Medical Sciences, Little Rock, Arkansas
| | - Steven N Austad
- Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.,Department of Genetics, Albert Einstein College of Medicine, Bronx, New York.,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, New York
| | | | - George A Kuchel
- UConn Center on Aging, University of Connecticut, Farmington, Connecticut
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging and the Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert J Pignolo
- Robert and Arlene Kogod Center on Aging and the Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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