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James LM, Tsilibary EP, Wanberg EJ, Georgopoulos AP. Negative Association of Cognitive Performance With Blood Serum Neurotoxicity and Its Modulation by Human Herpes Virus 5 (HHV5) Seropositivity in Healthy Women. Neurosci Insights 2024; 19:26331055241258436. [PMID: 38827247 PMCID: PMC11143810 DOI: 10.1177/26331055241258436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/04/2024] Open
Abstract
Identification of early influences on cognitive decline is of paramount importance in order to stem the impacts of decrements in cognitive functioning and to potentially intervene. Thus, here we focused on 132 healthy adult women (age range 26-98 years) to (a) determine whether factors circulating in serum may exert neurotoxic effects in vitro, (b) evaluate associations between serum neurotoxicity and cognitive performance, and (c) assess the influence of human herpes virus (HHV) seroprevalence and other factors on apoptosis and cognitive performance. The results documented that the addition of serum from healthy adult women to neural cell cultures resulted in apoptosis, indicating the presence of circulating neurotoxic factors in the serum. Furthermore, apoptosis increased with age, and was associated with decreased cognitive performance. Stepwise regression evaluating the influence of 6 HHVs on apoptosis and cognitive function revealed that only HHV5 (cytomegalovirus; CMV) seropositivity was significantly associated with apoptosis and cognitive decline, controlling for age. These findings document neurotoxic effects of serum from healthy women across the adult lifespan and suggest a unique detrimental influence associated with CMV seropositivity.
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Affiliation(s)
- Lisa M James
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Effie-Photini Tsilibary
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erik J Wanberg
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- The Healthy Brain Aging Group, Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
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2
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Abidi MZ, Umbleja T, Overton ET, Burdo T, Flynn JM, Lu MT, Taron J, Schnittman SR, Fitch KV, Zanni MV, Fichtenbaum CJ, Malvestutto C, Aberg JA, Fulda ES, Eckard AR, Manne-Goehler J, Tuan JJ, Ribaudo HJ, Douglas PS, Grinspoon SK, Brown TT, Erlandson KM. Cytomegalovirus IgG is Associated With Physical Function But Not Muscle Density in People With HIV. J Acquir Immune Defic Syndr 2024; 95:470-478. [PMID: 38180893 PMCID: PMC10947880 DOI: 10.1097/qai.0000000000003377] [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: 07/03/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) seropositivity is associated with poor outcomes, including physical function impairment, in people without HIV. We examined associations between CMV IgG titer and physical function in virologically suppressed people with HIV (PWH). METHODS REPRIEVE is a double-blind randomized trial evaluating pitavastatin for primary prevention of atherosclerotic cardiovascular disease in PWH. This analysis focused on participants enrolled in a substudy with additional biomarker testing, imaging [coronary CT angiography], and physical function measures at entry. CMV IgG was measured using quantitative enzyme immunoassay, physical function by Short Physical Performance Battery, and muscle density and area by CT. Associations between CMV IgG (risk factor) and outcomes were evaluated using the partial Spearman correlation and linear and log-binomial regression. RESULTS Among 717 participants, 82% male, the median CMV IgG was 2716 (Q1, Q3: 807, 6672) IU/mL, all above the limit of quantification. Among 631 participants with imaging, there was no association between CMV IgG and CT-based muscle density or area, controlling for age (r = -0.03 and r = -0.01, respectively; P ≥ 0.38). Among 161 participants with physical function data, higher CMV IgG was associated with poorer overall modified Short Physical Performance Battery score ( P = 0.02), adjusted for age, nadir CD4, and high-sensitivity C-reactive protein. CONCLUSIONS Higher CMV IgG titer was associated with poorer physical function, not explained by previous immune compromise, inflammation, or muscle density or area. Further mechanistic studies are needed to understand this association and whether CMV-specific therapy can affect physical function in PWH.
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Affiliation(s)
- Maheen Z. Abidi
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Tricia Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jacqueline M. Flynn
- Department of Microbiology, Immunology, and Inflammation and Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Medical Center – University of Freiburg, Germany
| | - Samuel R. Schnittman
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, OH, USA
| | - Judith A. Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelynne S. Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison Ross Eckard
- Departments of Pediatrics and Medicine, Divisions of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica J. Tuan
- Division of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, U.S.A
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
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3
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Watanabe M, Davidson L, Smith P, Castellucio PF, Jergovic M, Uhrlaub JL, Smithey MJ, Fantry LE, Dechambre B, Wilson RC, Knox KC, Ren J, Stowe RP, Weinstock G, Twigg H, Nikolich JŽ. Anti-cytomegalovirus antibody levels stratify human immune profiles across the lifespan. GeroScience 2024:10.1007/s11357-024-01124-0. [PMID: 38512581 DOI: 10.1007/s11357-024-01124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
Human cytomegalovirus (hCMV) is a ubiquitous latent persistent herpesvirus infecting 60-90% of the population worldwide. hCMV carriage in immunocompetent people is asymptomatic; thus, hCMV can be considered a component of normative aging. However, hCMV powerfully modulates many features of the immune, and likely other, systems and organs. Questions remain as to how hCMV carriage affects the human host. We used anti-CMV antibody titers as a stratifying criterion to examine the impact of "intensity" of hCMV infection as a potential biomarker of aging, inflammation, and immune homeostasis in a cohort of 247 participants stratified into younger (21-40 years) and older (> 65 years of age) groups. We showed that anti-CMV antibody titers increased with age and directly correlated to increased levels of soluble tumor necrosis factor (sTNFR) I in younger but not older participants. CD8 + cell numbers were reduced in the older group due to the loss in CD8 + T naïve (Tn) cells. In CMV carriers and, in particular, in anti-CMV Ab-high participants, this loss was mitigated or reversed by an increase in the numbers of CD8 + T effector memory (Tem) and T effector memory reexpressing CD45RA (Temra) cells. Analysis of CD38, HLA-DR, and CD57 expression revealed subset (CD4 or CD8)-specific changes that correlated with anti-CMV Ab levels. In addition, anti-CMV Ab levels predicted anti-CMV CD8 T cell responsiveness to different CMV open reading frames (ORFs) selectively in older participants, which correlated to the transcriptional order of expression of specific CMV ORFs. Implications of these results for the potential predictive value of anti-CMV Ab titers during aging are discussed.
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Affiliation(s)
- Makiko Watanabe
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Arizona Center On Aging, University of Arizona College of Medicine-Tucson, 1501 N. Campbell Ave, P.O. Box 245221, Tucson, AZ, 85724, USA
| | - Lisa Davidson
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Arizona Center On Aging, University of Arizona College of Medicine-Tucson, 1501 N. Campbell Ave, P.O. Box 245221, Tucson, AZ, 85724, USA
| | - Patricia Smith
- Division of Pulmonary Medicine, Department of Medicine, Indiana University College of Medicine, Bloomington, IN, USA
| | - Peter F Castellucio
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mladen Jergovic
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Arizona Center On Aging, University of Arizona College of Medicine-Tucson, 1501 N. Campbell Ave, P.O. Box 245221, Tucson, AZ, 85724, USA
| | - Jennifer L Uhrlaub
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Arizona Center On Aging, University of Arizona College of Medicine-Tucson, 1501 N. Campbell Ave, P.O. Box 245221, Tucson, AZ, 85724, USA
| | - Megan J Smithey
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Arizona Center On Aging, University of Arizona College of Medicine-Tucson, 1501 N. Campbell Ave, P.O. Box 245221, Tucson, AZ, 85724, USA
| | - Lori E Fantry
- Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Brett Dechambre
- Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Arizona Department of Health Services, Phoenix, AZ, USA
| | - Rachel C Wilson
- Division of Pulmonary Medicine, Department of Medicine, Indiana University College of Medicine, Bloomington, IN, USA
| | - Kenneth C Knox
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Jie Ren
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Homer Twigg
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Janko Ž Nikolich
- Department of Immunobiology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA.
- Arizona Center On Aging, University of Arizona College of Medicine-Tucson, 1501 N. Campbell Ave, P.O. Box 245221, Tucson, AZ, 85724, USA.
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Rengo C, Valletta A, Liccardo D, Spagnuolo G, Corbi G, De Luca F, Lauria MR, Perrotta A, Rengo G, Ferrara N, Rengo S, Valletta R, Cannavo A. Healthy aging: when periodontal health matters. JOURNAL OF GERONTOLOGY AND GERIATRICS 2023. [DOI: 10.36150/2499-6564-n580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Bleve A, Motta F, Durante B, Pandolfo C, Selmi C, Sica A. Immunosenescence, Inflammaging, and Frailty: Role of Myeloid Cells in Age-Related Diseases. Clin Rev Allergy Immunol 2023; 64:123-144. [PMID: 35031957 PMCID: PMC8760106 DOI: 10.1007/s12016-021-08909-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/20/2022]
Abstract
The immune system is the central regulator of tissue homeostasis, ensuring tissue regeneration and protection against both pathogens and the neoformation of cancer cells. Its proper functioning requires homeostatic properties, which are maintained by an adequate balance of myeloid and lymphoid responses. Aging progressively undermines this ability and compromises the correct activation of immune responses, as well as the resolution of the inflammatory response. A subclinical syndrome of "homeostatic frailty" appears as a distinctive trait of the elderly, which predisposes to immune debilitation and chronic low-grade inflammation (inflammaging), causing the uncontrolled development of chronic and degenerative diseases. The innate immune compartment, in particular, undergoes to a sequela of age-dependent functional alterations, encompassing steps of myeloid progenitor differentiation and altered responses to endogenous and exogenous threats. Here, we will review the age-dependent evolution of myeloid populations, as well as their impact on frailty and diseases of the elderly.
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Affiliation(s)
- Augusto Bleve
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Largo Donegani, via Bovio 6, 2 - 28100, Novara, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, via Manzoni 56, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Barbara Durante
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Largo Donegani, via Bovio 6, 2 - 28100, Novara, Italy
| | - Chiara Pandolfo
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Largo Donegani, via Bovio 6, 2 - 28100, Novara, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, via Manzoni 56, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
| | - Antonio Sica
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Largo Donegani, via Bovio 6, 2 - 28100, Novara, Italy.
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
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6
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Assessment of the Interferon-Lambda-3 Polymorphism in the Antibody Response to COVID-19 in Older Adults Seropositive for CMV. Vaccines (Basel) 2023; 11:vaccines11020480. [PMID: 36851357 PMCID: PMC9963200 DOI: 10.3390/vaccines11020480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Here, we investigated the impact of IFN-lambda-3 polymorphism on specific IgG responses for COVID-19 in older adults seropositive for CMV. METHODS Blood samples of 25 older adults of both sexes were obtained at three different times: during a micro-outbreak (MO) of SARS-CoV-2 in 2020; eight months after (CURE); and 30 days after the administration of the second dose of ChadOx-1 vaccine (VAC). The specific IgG for both SARS-CoV-2 and CMV antigens, neutralizing antibodies against SARS-CoV-2, and also the polymorphism profile for IFN-lambda-3 (rs12979860 C > T) were assessed. RESULTS Higher levels of specific IgG for SARS-CoV-2 antigens were found in the MO and VAC than in the CURE time-point. Volunteers with specific neutralizing antibodies against SARS-CoV-2 showed better specific IgG responses for SARS-CoV-2 and lower specific IgG levels for CMV than volunteers without specific neutralizing antibodies. Significant negative correlations between the specific IgG levels for SARS-CoV-2 and CMV were found at the MO time-point, as well as in the group of individuals homozygous for allele 1 (C/C) in the MO time-point and heterozygotes (C/T) in the CURE time-point. CONCLUSION Our results suggested that both CMV seropositivity and the homozygosis for allele 1 (C/C) in IFN-lambda-3 gene can negatively impact the antibody response to COVID-19 infection and vaccination in older adults.
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7
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Are Skeletal Muscle Changes during Prolonged Space Flights Similar to Those Experienced by Frail and Sarcopenic Older Adults? LIFE (BASEL, SWITZERLAND) 2022; 12:life12122139. [PMID: 36556504 PMCID: PMC9781047 DOI: 10.3390/life12122139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Microgravity exposure causes several physiological and psychosocial alterations that challenge astronauts' health during space flight. Notably, many of these changes are mostly related to physical inactivity influencing different functional systems and organ biology, in particular the musculoskeletal system, dramatically resulting in aging-like phenotypes, such as those occurring in older persons on Earth. In this sense, sarcopenia, a syndrome characterized by the loss in muscle mass and strength due to skeletal muscle unloading, is undoubtedly one of the most critical aging-like adverse effects of microgravity and a prevalent problem in the geriatric population, still awaiting effective countermeasures. Therefore, there is an urgent demand to identify clinically relevant biological markers and to underline molecular mechanisms behind these effects that are still poorly understood. From this perspective, a lesson from Geroscience may help tailor interventions to counteract the adverse effects of microgravity. For instance, decades of studies in the field have demonstrated that in the older people, the clinical picture of sarcopenia remarkably overlaps (from a clinical and biological point of view) with that of frailty, primarily when referred to the physical function domain. Based on this premise, here we provide a deeper understanding of the biological mechanisms of sarcopenia and frailty, which in aging are often considered together, and how these converge with those observed in astronauts after space flight.
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Cunha LL, Valsecchi VADS, Ward LS. Investigating population-level immunosenescence: From bench to bedside. Front Immunol 2022; 13:949928. [PMID: 36059504 PMCID: PMC9428264 DOI: 10.3389/fimmu.2022.949928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
The immune response is remodeled with aging in a process called immunosenescence. Some immunologists conceive immunosenescence as an adaptation of immunity to the aged immune-environment rather than a merely collapsed reactivity of immune cells against microbes and tumor cells. Others believe on an uninterrupted activation of the innate immune system with aging, leading to a low grade, sterile and chronic proinflammatory state called inflammaging. For instance, it is possible that chronic infection by cytomegalovirus leads to persistent production of viral load. This phenomenon offers periodic stimuli to the immune system that ultimately contribute to the remodeling of the immune response. If investigating immunosenescence at the cellular level is already a difficult task, considering the population level is much more complex. However, by studying immunosenescence at the population level, we can extract valuable results with viable applications. While studies with animal models allow scientists to deepen their understanding of the mechanisms of immunosenescence, studying large populations can bring practical innovations to medicine and the health system. Many researchers and funders have dedicated themselves to producing methods for the evaluation of immunosenescence on a large scale, aiming to elucidate new mechanisms by which diseases are established in the elderly. The description of how the immune response is remodeled with aging emerges as a new tool to identify the subset of subjects in which unhealthy aging is a matter of time, to help better individualize clinical management and select patients who may benefit. of early interventions. This review focuses on functional assays as valuable methods for measuring the remodeling of the immune response with aging and discuss their clinical impact. We also recall fundamental concepts for understanding the aging process of the immune response. In addition, we highlight future prospects for immunosenescence research.
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Affiliation(s)
- Lucas Leite Cunha
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Federal University of São Paulo, São Paulo, Brazil
- Discipline of Internal Medicine and Laboratory Medicine, Federal University of São Paulo, São Paulo, Brazil
- *Correspondence: Lucas Leite Cunha,
| | - Victor Alexandre dos Santos Valsecchi
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Federal University of São Paulo, São Paulo, Brazil
- Discipline of Internal Medicine and Laboratory Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
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Effect of Cytomegalovirus on the Immune System: Implications for Aging and Mental Health. Curr Top Behav Neurosci 2022; 61:181-214. [PMID: 35871707 DOI: 10.1007/7854_2022_376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Human cytomegalovirus (HCMV) is a major modulator of the immune system leading to long-term changes in T-lymphocytes, macrophages, and natural killer (NK) cells among others. Perhaps because of this immunomodulatory capacity, HCMV infection has been linked with a host of deleterious effects including accelerated immune aging (premature mortality, increased expression of immunosenescence-linked markers, telomere shortening, speeding-up of epigenetic "clocks"), decreased vaccine immunogenicity, and greater vulnerability to infectious diseases (e.g., tuberculosis) or infectious disease-associated pathology (e.g., HIV). Perhaps not surprisingly given the long co-evolution between HCMV and humans, the virus has also been associated with beneficial effects, such as increased vaccine responsiveness, heterologous protection against infections, and protection against relapse in the context of leukemia. Here, we provide an overview of this literature. Ultimately, we focus on one other deleterious effect of HCMV, namely the emerging literature suggesting that HCMV plays a pathophysiological role in psychiatric illness, particularly depression and schizophrenia. We discuss this literature through the lens of psychological stress and inflammation, two well-established risk factors for psychiatric illness that are also known to predispose to reactivation of HCMV.
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10
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Oursler KK, Marconi VC, Briggs BC, Sorkin JD, Ryan AS. Telehealth Exercise Intervention in Older Adults With HIV: Protocol of a Multisite Randomized Trial. J Assoc Nurses AIDS Care 2022; 33:168-177. [PMID: 33481463 PMCID: PMC8289938 DOI: 10.1097/jnc.0000000000000235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT People with HIV (PWH) have reduced cardiorespiratory fitness, but a high intensity, easily disseminated exercise program has not yet been successfully developed in older PWH. The purpose of this article is to describe a synchronous telehealth exercise intervention in older PWH, delivered from one medical center to two other centers. Eighty older PWH (≥50 years) on antiretroviral therapy will be randomized to exercise or delayed entry control groups. Functional circuit exercise training, which does not entail stationary equipment, will be provided by real-time videoconferencing, 3 times weekly for 12 weeks, to small groups. Continuous remote telemonitoring of heart rate will ensure high exercise intensity. We hypothesize that telehealth exercise will be feasible and increase cardiorespiratory fitness and reduce sarcopenia and frailty. Findings will provide new insight to target successful aging in older PWH and can also be widely disseminated to PWH of any age or other patient populations.
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Affiliation(s)
- Krisann K. Oursler
- Geriatric Research and Education, Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Vincent C. Marconi
- Infectious Diseases Research Program, Atlanta Veterans Affairs Medical Center, Emory University School of Medicine and Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Brandon C. Briggs
- Salem Veterans Affairs Medical Center, Concordia University Chicago, Chicago, Illinois, USA
| | - John D. Sorkin
- Biostatistics and Informatics, Veterans Affairs Maryland Health Care System, Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alice S. Ryan
- Rehabilitation Research & Development, Veterans Affairs Maryland Health Care System, Baltimore Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Peixoto SV, Torres KCL, Teixeira-Carvalho A, Martins-Filho OA, Lima-Costa MF. [Seroprevalence and factors associated with chronic infections among community-dwelling elderly individuals]. CIENCIA & SAUDE COLETIVA 2021; 26:5109-5121. [PMID: 34787203 DOI: 10.1590/1413-812320212611.3.37062019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/21/2020] [Indexed: 08/30/2023] Open
Abstract
Chronic infections can contribute to the aging process, but this issue is less studied in Latin America. The aim was to assess the prevalence and factors associated with cytomegalovirus (CMV), Herpes Simplex 1 (HSV-1), Chlamydia pneumoniae and Helicobacter pylori among the elderly. A total of 1,320 individuals participated from the baseline of the Elderly Cohort of Bambuí. IgG antibodies against infections and explanatory variables (sociodemographic factors, health behaviors and health conditions) were evaluated. Poisson regression models with robust variance were used. Seroprevalence rates were 99.4% for CMV, 96.7% for HSV-1, 56% for C. pneumoniae and 70.5% for H. pylori. Elderly men, women, smokers, diabetics, the disabled and those with high levels of IL-6 had a higher prevalence of CMV. HSV-1 was less frequent among women. The prevalence of C. pneumoniae was higher at ages >75 and among diabetics; it was lower among women and individuals with less schooling. H. pylori was less frequent among women and those with detectable levels of IL-1β, but more common among smokers. The findings show a high prevalence of chronic infection and a different epidemiologic profile for each pathogen, making it possible to detect groups that are vulnerable to these infections.
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Affiliation(s)
- Sérgio Viana Peixoto
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte MG Brasil. .,Departamento de Gestão em Saúde, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Karen Cecília Lima Torres
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz Minas. Belo Horizonte MG Brasil
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz Minas. Belo Horizonte MG Brasil
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz Minas. Belo Horizonte MG Brasil
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Duchowny KA, Noppert GA. The Association Between Cytomegalovirus and Disability by Race/Ethnicity and Sex: Results From the Health and Retirement Study. Am J Epidemiol 2021; 190:2314-2322. [PMID: 34017977 PMCID: PMC8799899 DOI: 10.1093/aje/kwab152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023] Open
Abstract
Recent studies have documented a decline in the overall prevalence of disability in the United States; however, racial/ethnic and sex disparities continue to persist. Cytomegalovirus (CMV) infection, a socially patterned exposure, may be a key mechanism in understanding these previously documented disparities. Using data from a nationally representative study, the 2016 Health and Retirement Study, we employed Poisson log-binomial models to estimate the prevalence of disability in a comparison of CMV-seropositive and -seronegative adults and investigated effect modification by race/ethnicity and sex. Among the 9,029 participants (55% women; mean age = 67.4 years), 63% were CMV-seropositive and 15% were disabled. CMV seropositivity was highest among non-Hispanic Black (88%) and Hispanic (92%) adults as compared with non-Hispanic White adults (57%). We found evidence for effect modification in the association between CMV and disability by sex but not race/ethnicity. While the 95% confidence intervals in the fully adjusted models included the null value, in comparison with seronegative women, our results suggest a greater prevalence of disability among CMV-seropositive women (prevalence ratio = 1.16, 95% confidence interval: 0.97, 1.38) but not among men (prevalence ratio = 0.85, 95% confidence interval: 0.69, 1.06). Results provide initial support for the hypothesis that CMV may be an important determinant of sex disparities in disability.
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Affiliation(s)
- Kate A Duchowny
- Correspondence to Dr. Kate A. Duchowny, Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, Second Floor, San Francisco, CA 94158 (e-mail: )
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13
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Felismino ES, Santos JMB, Rossi M, Santos CAF, Durigon EL, Oliveira DBL, Thomazelli LM, Monteiro FR, Sperandio A, Apostólico JS, França CN, Amaral JB, Amirato GR, Vieira RP, Vaisberg M, Bachi ALL. Better Response to Influenza Virus Vaccination in Physically Trained Older Adults Is Associated With Reductions of Cytomegalovirus-Specific Immunoglobulins as Well as Improvements in the Inflammatory and CD8 + T-Cell Profiles. Front Immunol 2021; 12:713763. [PMID: 34712226 PMCID: PMC8546344 DOI: 10.3389/fimmu.2021.713763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/21/2021] [Indexed: 12/26/2022] Open
Abstract
Chronic cytomegalovirus (CMV) infection is a trigger factor for the development of immunosenescence and negatively impacts the immune response to influenza virus vaccination (IVV) in older adults. However, the role of physical exercise training in this context is unknown. Thus, the aim of this study was to investigate whether the regular practice of combined exercise training can improve the specific antibody response to IVV in CMV-seropositive older adults. Eighty older adults were distributed into two groups—non-practitioners (NP, n = 31, age = 74.06 ± 6.4 years) and practitioners of combined exercise training (CET, n = 49, age = 71.7 ± 5.8 years)—for at least 12 months. Both volunteer groups were submitted to IVV and blood samples were collected before (pre) and 30 days after (post) the vaccination. Concerning the specific antibody response to IVV, higher serum levels of specific immunoglobulin A (IgA) were found in the CET group post- than pre-vaccination (p < 0.01), whereas higher levels of specific immunoglobulin M (IgM) were observed both in the NP (p < 0.05) and CET (p < 0.001) groups post-vaccination as compared to the pre-vaccination values. Serum levels of specific immunoglobulin G (IgG) for IVV and CMV, as well as interleukin 6 (IL-6) and IL-10, were similar between the time points evaluated. However, the IL-10/IL-6 ratio post-vaccination was higher (p < 0.05) in the CET group than that before vaccination. Negative correlations were observed between the specific IgG levels for IVV and CMV only in the CET group, both pre- and post-vaccination. In addition, negative correlations were found between IL-10 and specific IgG for CMV in all volunteer groups pre- and post-vaccination, whereas a positive correlation between IL-10 and specific-IgG for IVV pre- and post-vaccination was observed in the CET group. In addition, with the hemagglutination inhibition (HAI) assay, it was found that 32.2% of the NP group and 32.6% of the CET group were responders to IVV and displayed reductions in the CMV serostatus (p < 0.05 and p < 0.001, respectively) and increases in naive and effector CD8+ T cells post-vaccination (p < 0.01). However, only the responders from the CET group showed significant reductions in the ratio of effector to naive CD8+ T cells (p < 0.05) and increased IL-10 levels post-vaccination (p < 0.001). In summary, this study demonstrates that the improvement in the response to IVV in CMV-seropositive older adults was related to an anti-inflammatory status and enhancement of naive CD8+ T cells, particularly associated with regular practice of CET.
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Affiliation(s)
- Eduardo S Felismino
- Post-Graduation Program in Health Science, University of Santo Amaro, São Paulo, Brazil
| | - Juliana M B Santos
- Post-Graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo, Santos, Brazil
| | - Marcelo Rossi
- Ear, Nose and Throat (ENT) Lab, Department of Otorhinolaryngology, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos A F Santos
- Department of Medicine, Geriatry, Paulista School of Medicine (EPM), São Paulo, Brazil
| | - Edison L Durigon
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Science of University of São Paulo, São Paulo, Brazil.,Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - Danielle B L Oliveira
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Science of University of São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luciano M Thomazelli
- Laboratory of Clinical and Molecular Virology, Department of Microbiology, Institute of Biomedical Science of University of São Paulo, São Paulo, Brazil
| | - Fernanda R Monteiro
- Ear, Nose and Throat (ENT) Lab, Department of Otorhinolaryngology, Federal University of São Paulo, São Paulo, Brazil.,Method Faculty of São Paulo, São Paulo, Brazil
| | | | - Juliana S Apostólico
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Carolina N França
- Post-Graduation Program in Health Science, University of Santo Amaro, São Paulo, Brazil
| | - Jonatas B Amaral
- Ear, Nose and Throat (ENT) Lab, Department of Otorhinolaryngology, Federal University of São Paulo, São Paulo, Brazil
| | - Gislene R Amirato
- Ear, Nose and Throat (ENT) Lab, Department of Otorhinolaryngology, Federal University of São Paulo, São Paulo, Brazil
| | - Rodolfo P Vieira
- Post-Graduation Program in Sciences of Human Movement and Rehabilitation, Federal University of São Paulo, Santos, Brazil.,Post-Graduation Program in Bioengineering, Universidade Brasil, São Paulo, Brazil.,Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Sao Jose dos Campos, Brazil
| | - Mauro Vaisberg
- Ear, Nose and Throat (ENT) Lab, Department of Otorhinolaryngology, Federal University of São Paulo, São Paulo, Brazil
| | - André L L Bachi
- Post-Graduation Program in Health Science, University of Santo Amaro, São Paulo, Brazil.,Ear, Nose and Throat (ENT) Lab, Department of Otorhinolaryngology, Federal University of São Paulo, São Paulo, Brazil.,Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Sao Jose dos Campos, Brazil
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14
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Noppert GA, Stebbins RC, Dowd JB, Hummer RA, Aiello AE. Life Course Socioeconomic Disadvantage and the Aging Immune System: Findings From the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:1195-1205. [PMID: 32880643 DOI: 10.1093/geronb/gbaa144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Previous research has documented a consistent association between current socioeconomic status (SES) and cytomegalovirus (CMV). Early life is likely a critical period for CMV exposure and immune development, but less is known about early-life socioeconomic factors and CMV, particularly in older age populations. Using data from the Health and Retirement Study, we investigated the association between life course socioeconomic disadvantage and immune response to CMV among older adults. METHODS Using ordered logit models, we estimated associations between several measures of socioeconomic disadvantage and the odds of being in a higher CMV Immunoglobulin G (IgG) response category in a sample of 8,168 respondents aged older than 50 years. RESULTS We found a significant association between educational attainment and CMV IgG response. Those with less than a high school education had 2.00 (95% confidence interval [CI]: 1.67-2.40) times the odds of being in a higher CMV category compared to those with a college degree or greater. In addition, we also observed a significant association with parental education and CMV response. Individuals with parents having 8 years or less of schooling had 2.32 (95% CI: 2.00-2.70) times the odds of higher CMV response compared to those whose parents had greater than high school education. DISCUSSION CMV IgG levels in older adults are associated with both early-life and adult SES. Life course socioeconomic disadvantage may contribute to disparities in immunological aging.
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Affiliation(s)
- Grace A Noppert
- Carolina Population Center, University of North Carolina at Chapel Hill
| | | | - Jennifer B Dowd
- Department of Global Health and Social Medicine, King's College London, UK.,CUNY Graduate School of Public Health and Health Policy, City University of New York
| | - Robert A Hummer
- Carolina Population Center, University of North Carolina at Chapel Hill.,Department of Sociology, University of North Carolina at Chapel Hill
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill.,Department of Epidemiology, University of North Carolina at Chapel Hill
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15
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Navarro-Martínez R, Cauli O. Lymphocytes as a Biomarker of Frailty Syndrome: A Scoping Review. Diseases 2021; 9:diseases9030053. [PMID: 34287298 PMCID: PMC8293122 DOI: 10.3390/diseases9030053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Frailty is a geriatric syndrome characterized by a decrease in physiological reserve and reduced resistance to stress, as a result of an accumulation of multiple deficits in physiological systems. Frailty increases the vulnerability to adverse events and is associated with the aging process. Several studies show an association between frailty syndrome and altered blood lymphocyte levels, which is therefore potentially useful for monitoring interventions to improve or delay frailty. The main objective of this review is to provide an analysis of the current evidence related to changes in lymphocyte counts and their associations with frailty syndrome. To that end, the literature published in this field until March 2021 was in several databases: PubMed, SCOPUS, and Cochrane. Eighteen studies analyzed the association between lymphocyte counts, lymphocyte subtypes, and frailty syndrome. Eighteen studies were analyzed, and most of them reported associations. Interestingly, the association between frailty syndrome and lower lymphocytes counts appears in different clinical conditions. Further studies are needed to determine the sensitivity of lymphocyte counts and lymphocyte subtypes in the diagnosis and monitoring of frailty syndrome, and for this measure to be used as a biomarker of frailty status.
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Affiliation(s)
- Rut Navarro-Martínez
- Haematology Department, Hospital General Universitario, 46014 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Haematology Department, Hospital General Universitario, 46014 Valencia, Spain;
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-96-386-41-82
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16
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Roberts Lavigne LC, Tian J, Hladek M, LaFave SE, Szanton SL, Samuel LJ. Residential Street Block Disorder and Biological Markers of Aging in Older Adults: The National Health and Aging Trends Study. J Gerontol A Biol Sci Med Sci 2021; 76:1969-1976. [PMID: 34115871 DOI: 10.1093/gerona/glab166] [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: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Residential environments are associated with older adult health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among older adults. METHODS We included community-dwelling Medicare beneficiaries aged 67 and older with 2017 biomarker data from the nationally representative National Health and Aging Trends Study (n=4,357). Street block disorder in 2016 was measured using interviewer report of any trash/glass/litter, graffiti, or vacant buildings on participants' blocks. Propensity score models were used to create balanced groups with regard to multiple 2015 participant characteristics, including demographic, socioeconomic, residence, and early life characteristics. Linear regressions modeled street block disorder as a predictor of four aging biomarkers, hemoglobin A1C, high-sensitivity C-reactive protein, interleukin-6, and cytomegalovirus antibodies, before and after applying propensity score weighting. RESULTS Adjusting for participant sociodemographic characteristics and applying propensity score weights, living on a block with any disorder was associated with 2% higher mean hemoglobin A1C levels (95% CI: 0.002-0.03), 13% higher C-reactive protein (95% CI: 0.03-0.23), 10% higher interleukin-6 (95% CI: 0.02-0.19), and 19% more cytomegalovirus antibodies (95% CI: 0.09-0.29) compared to living on a block with no disorder. CONCLUSIONS Street block disorder predicted subsequent aging biomarkers after applying a propensity score approach to account for confounding among a national sample of older adults. Targeting street-level residential contexts for intervention may reduce risk for poor health in older adults.
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Affiliation(s)
| | - Jing Tian
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Melissa Hladek
- John Hopkins School of Nursing, Baltimore, MD, United States
| | - Sarah E LaFave
- John Hopkins School of Nursing, Baltimore, MD, United States
| | - Sarah L Szanton
- John Hopkins School of Nursing, Baltimore, MD, United States
| | - Laura J Samuel
- John Hopkins School of Nursing, Baltimore, MD, United States
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17
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Zucchelli A, Bologna E, Marengoni A. Why data on frailty and SARS-CoV-2 infection are basic to progress. Aging Clin Exp Res 2021; 33:1429-1432. [PMID: 33797742 PMCID: PMC8017512 DOI: 10.1007/s40520-021-01846-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022]
Abstract
Several studies showed that frailty was a predictor of in-hospital death in older adults with COVID-19. The mechanisms through which frailty increases the severity of COVID-19 are several, including immunosenescense and dysregulated inflammation. Whether individuals affected by frailty exhibit a higher susceptibility to SARS-CoV-2 infection remains an open question. Here we report the case series of 40 older persons that in February 2020, before the first case of COVID-19 was detected in Italy, went together on a winter holiday. Back home, 7 of them developed influenza-like symptoms and one was hospitalized due to COVID-19 pneumonia. Between May and July, the seniors were offered the possibility to be tested for SARS-CoV-2 antibody positivity. Twenty-seven of them accepted: 13 had a positive serological test whereas no active infection was found. Comparing the characteristics of those who tested positive and the others, we found that the former group was frailer, exhibiting higher Clinical Frailty Scale scores.
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Affiliation(s)
- A Zucchelli
- Department of Information Engineering, Università degli Studi di Brescia, vle Branze 38, 25123, Brescia, Italy.
| | - E Bologna
- Fondazione Piera, Pietro e Giovanni Ferrero, Alba, Italy
| | - A Marengoni
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
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18
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Schnittman SR, Hunt PW. Clinical consequences of asymptomatic cytomegalovirus in treated human immunodeficency virus infection. Curr Opin HIV AIDS 2021; 16:168-176. [PMID: 33833209 PMCID: PMC8238090 DOI: 10.1097/coh.0000000000000678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Despite antiretroviral therapy (ART)-mediated viral suppression, people with human immunodeficiency virus (HIV) (PWH) have increased morbidity and mortality. Immune activation and inflammation persist on ART and predict these complications. Over 90% of PWH have cytomegalovirus (CMV) co-infection, and CMV is considered a plausible contributor to this persistent immune activation. RECENT FINDINGS A detailed understanding of the link between CMV and multimorbidity is needed, particularly as research moves toward identifying potential targeted therapeutics to attenuate inflammation-mediated morbidity and mortality in treated HIV. We review the literature on the association between CMV and immune activation as well as multiple end-organ complications including cardiovascular disease, venous thromboembolic disease, metabolic complications, gastrointestinal dysfunction, central nervous system involvement, birth sex-related differences, and the relation to the HIV reservoir. We conclude with a discussion of ongoing therapeutic efforts to target CMV. SUMMARY As CMV is a plausible driver of multiple comorbidities through persistent immune activation in treated HIV, future research is needed and planned to address its causal role as well as to test novel therapeutics in this setting.
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Affiliation(s)
- Samuel R Schnittman
- Department of Medicine, University of California, San Francisco, California, USA
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19
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Schoevaerdts D, Sibille FX, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res 2021; 33:689-701. [PMID: 31656032 DOI: 10.1007/s40520-019-01375-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
The incidence of infections increases with age and results in a higher risk of morbidity and mortality. This rise is not mainly related to chronological age per se but has been linked mostly to individual factors such as immunosenescence; the presence of comorbidities; the occurrence of geriatric syndromes such as poor nutrition, polypharmacy, and cognitive disorders; and the presence of functional impairment concomitant with environmental, healthcare-related and microbiological factors such as the increasing risk of multidrug-resistant microorganisms. The geriatric concept of frailty introduces a new approach for considering the risk of infection; this concept highlights the importance of functional status and is a more comprehensive and multicomponent approach that may help to reverse the vulnerability to stress. The aim of this article is to provide some typical hallmarks of infections among older adults in comparison to younger individuals. The main differences among the older population that are presented are an increased prevalence of infections and potential risk factors, a higher risk of carrying multidrug-resistant microorganisms, an increase in barriers to a prompt diagnosis related to atypical presentations and challenges with diagnostic tools, a higher risk of under- and over-diagnosis, a worse prognosis with a higher risk of acute and chronic complications and a particular need for better communication among all healthcare sectors as they are closely linked together.
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Affiliation(s)
- Didier Schoevaerdts
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium.
| | - François-Xavier Sibille
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium
| | - Gaetan Gavazzi
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium
- Service Gériatrie Clinique, Centre Hospitalo-Universitaire Grenoble-Alpes, Avenue Central 621, 38400, Saint-Martin-d'Hères, France
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20
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Lu Y, Tan CTY, Gwee X, Yap KB, Fulop T, Pan F, Larbi A, Ng TP. Pathogen Burden, Blood Biomarkers and Functional Ageing in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:1864-1873. [PMID: 33640984 DOI: 10.1093/gerona/glab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lifelong accumulation of latent or persistent or repeated infections may be a contributing factor to the deterioration of physical and cognitive function associated with functional ageing, but the evidence is limited and the biological underpinnings are unclear. METHODS We profiled the seropositivity for common viral, bacterial and plasmodial pathogens of local importance in community-living older adults in two studies involving 745 older adults (mean age 67.0, SD: 7.7 years), and 142 older adults (mean age 72.7, SD: 8.3 years). Pathogen load was related to different sets of age-related physical and cognitive measures of functional ageing and the frailty index, and plasma levels of biomarkers of inflammation, innate and adaptive immunity, and other physiological functions. RESULTS High pathogen load was associated with impaired gait speed (GS), (p<0.015), functional mobility (POMA) (p<0.029), cognitive function (MMSE) (p<<0.05), and increased frailty index (FI) (p<<0.05). High pathogen load was significantly associated with C3a complement activity (p<0.001), matrix metalloproteinase-7, macrophage inflammatory protein-1α (p<0.05), and monocyte chemoattractant protein 2 (p=0.028). Blood biomarkers did not fully explain the observed association between pathogen load and functional ageing measures. CONCLUSIONS The present study provides novel evidence linking lifelong cumulated numbers of latent, persistent or repeated infection to functional ageing, plausibly via inflammatory and immune and other biological factors.
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Affiliation(s)
- Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Shandong University, China
| | - Crystal Tze Ying Tan
- Biology of Ageing Laboratory, Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Xinyi Gwee
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Bee Yap
- Geriatric Medicine and Palliative Medicine Department, Ng Teng Fong General Hospital
| | - Tamas Fulop
- Geriatrics Division, Department of Medicine, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Fang Pan
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Shandong University, China
| | - Anis Larbi
- Biology of Ageing Laboratory, Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore.,Geriatrics Division, Department of Medicine, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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21
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Chen S, Pawelec G, Trompet S, Goldeck D, Mortensen LH, Slagboom PE, Christensen K, Gussekloo J, Kearney P, Buckley BM, Ford I, Jukema JW, Westendorp RGJ, Maier AB. Associations of Cytomegalovirus Infection With All-Cause and Cardiovascular Mortality in Multiple Observational Cohort Studies of Older Adults. J Infect Dis 2021; 223:238-246. [PMID: 32909605 PMCID: PMC7857154 DOI: 10.1093/infdis/jiaa480] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Whether latent cytomegalovirus (CMV) infection in older adults has any substantial health consequences is unclear. Here, we sought associations between CMV-seropositivity and IgG titer with all-cause and cardiovascular mortality in 5 longitudinal cohorts. METHODS Leiden Longevity Study, Prospective Study of Pravastatin in the Elderly at Risk, Longitudinal Study of Aging Danish Twins, and Leiden 85-plus Study were assessed at median (2.8-11.4 years) follow-up . Cox regression and random effects meta-analysis were used to estimate mortality risk dependent on CMV serostatus and/or IgG antibody titer, in quartiles after adjusting for confounders. RESULTS CMV-seropositivity was seen in 47%-79% of 10 122 white community-dwelling adults aged 59-93 years. Of these, 3519 had died on follow-up (579 from cardiovascular disease). CMV seropositivity was not associated with all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], .97-1.14) or cardiovascular mortality (HR, 0.97; 95% CI, .83-1.13). Subjects in the highest CMV IgG quartile group had increased all-cause mortality relative to CMV-seronegatives (HR, 1.16; 95% CI, 1.04-1.29) but this association lost significance after adjustment for confounders (HR, 1.13; 95% CI, .99-1.29). The lack of increased mortality risk was confirmed in subanalyses. CONCLUSIONS CMV infection is not associated with all-cause or cardiovascular mortality in white community-dwelling older adults.
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Affiliation(s)
- Sijia Chen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
| | - Graham Pawelec
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - David Goldeck
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Fairfax Centre, Kidlington, United Kingdom
| | | | - P Eline Slagboom
- Section of Molecular Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Patricia Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Brendan M Buckley
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
- Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije University, Amsterdam, the Netherlands
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22
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Leng SX, Kittleson MM. Beyond the eyeball test: Impact and potential mechanisms of frailty in heart transplant candidates. J Heart Lung Transplant 2021; 40:95-98. [PMID: 33419640 DOI: 10.1016/j.healun.2020.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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González-Quijada S, del Álamo-Martínez de Lagos M, Álvarez-Llabrés M, Pérez-González L. Cytomegalovirus antibody levels and mortality among hospitalised elderly patients. Ann Med 2020; 52:497-505. [PMID: 32803995 PMCID: PMC7877968 DOI: 10.1080/07853890.2020.1811888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The impact of cytomegalovirus infection in elderly subjects remains unclear. This study examined the relationship between humoral immune response to cytomegalovirus (CMV) and all-cause mortality in a cohort of elderly hospitalised patients. METHODS Data were obtained from a random sample of 715 patients (≥65 years old) admitted for any cause in a third level hospital. Serum IgG antibody against CMV was determined by enzyme-linked immunosorbent (ELISA) assay. RESULTS A total of 480 deaths occurred in seropositive patients (n = 671) during a follow-up of 7.6 years (mean, 4.6); of which 112 patients died in-hospital or within 30 days after discharge (short-term mortality). For patients with CMV IgG antibody levels in the highest quartile compared with lower quartile, fully adjusted models showed that mortality was 1.40 times (95% CI 1.05-1.86) and 2.20 times (95% CI 1.15-4.21) higher, respectively. The exclusion of patients with cardiovascular disease (angina, myocardial infarction, heart failure, peripheral artery disease, or stroke) increases the risk of long-term (HR 2.22, 95% CI 1.36-3.62) and short-term mortality (OR 3.18, 95% CI 1.40-7.24). CONCLUSIONS Increased IgG antibody levels against CMV are associated with increased short and long-term mortality in elderly hospitalised patients, especially in patients without cardiovascular disease. Key Messages The outcome of elderly hospitalised patients in relation to CMV is unknown. We demonstrate an association between increased anti-CMV IgG levels and mortality. This association is greater in elderly patients without cardiovascular disease.
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Blanco JR, Negredo E, Bernal E, Blanco J. Impact of HIV infection on aging and immune status. Expert Rev Anti Infect Ther 2020; 19:719-731. [PMID: 33167724 DOI: 10.1080/14787210.2021.1848546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Thanks to antiretroviral therapy (ART), persons living with HIV (PLWH), have a longer life expectancy. However, immune activation and inflammation remain elevated, even after viral suppression, and contribute to morbidity and mortality in these individuals.Areas covered: We review aspects related to immune activation and inflammation in PLWH, their consequences, and the potential strategies to reduce immune activation in HIV-infected individuals on ART.Expert opinion: When addressing a problem, it is necessary to thoroughly understand the topic. This is the main limitation faced when dealing with immune activation and inflammation in PLWH since there is no consensus on the ideal markers to evaluate immune activation or inflammation. To date, the different interventions that have addressed this problem by targeting specific mediators have not been able to significantly reduce immune activation or its consequences. Given that there is currently no curative intervention for HIV infection, more studies are necessary to understand the mechanism underlying immune activation and help to identify potential therapeutic targets that contribute to improving the life expectancy of HIV-infected individuals.
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Affiliation(s)
- Jose-Ramon Blanco
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Pedro- Centro De Investigación Biomédica De La Rioja (CIBIR), La Rioja, Spain
| | - Eugenia Negredo
- Lluita Contra La Sida Foundation, Germans Trias I Pujol University Hospital, Badalona, Spain. Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (Uvic - UCC), Catalonia, Spain
| | - Enrique Bernal
- Unidad De Enfermedades Infecciosas, Hospital General Universitario Reina Sofía, Universidad De Murcia, Murcia, Spain
| | - Juliá Blanco
- AIDS Research Institute-IrsiCaixa, Badalona, Barcelona, Spain.,Universitat De Vic-Central De Catalunya (UVIC-UCC), Vic, Spain
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25
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Pathogenic load and frailty in older adults: Singapore longitudinal ageing study. Aging (Albany NY) 2020; 12:22139-22151. [PMID: 33159019 PMCID: PMC7695406 DOI: 10.18632/aging.104076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/05/2020] [Indexed: 01/10/2023]
Abstract
Human evidence for the role of continuous antigenic stimulation from persistent latent infections in frailty is limited. We conducted a nested case-control study (99 deceased and 43 survivors) of participants aged 55 and above in a longitudinal ageing cohort followed up from 2003 to 2017. Using blood samples and baseline data collected in 2003-2004, we examined the association of pathogenic load (PL) count of seropositivity to 10 microbes (viruses, bacteria and mycoplasma) with cumulated deficit-frailty index (CD-FI) and the physical frailty (PF) phenotype, and mortality. Controlling for age, sex, education, smoking and alcohol histories, high PL (7-9) versus low PL (3-6) was associated with an estimated increase of 0.035 points in the CD-FI (Cohen’s D=0.035 / 0.086, or 0.41). High PL was associated with 8.5 times odds of being physically frail (p=0.001), 2.8 times odds of being weak (p=0.010), 3.4 times odds of being slow (p=0.024), and mortality hazard ratio of 1.53 (p=0.046). There were no significant associations for specific pathogens, except marginal associations for Epstein-Barr virus and Chikungunya. Conclusion: A high pathogenic load of latent infections was associated with increased risks of frailty and mortality.
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26
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Samson LD, van den Berg SP, Engelfriet P, Boots AM, Hendriks M, de Rond LG, de Zeeuw-Brouwer ML, Verschuren WM, Borghans JA, Buisman AM, van Baarle D. Limited effect of duration of CMV infection on adaptive immunity and frailty: insights from a 27-year-long longitudinal study. Clin Transl Immunology 2020; 9:e1193. [PMID: 33133599 PMCID: PMC7586993 DOI: 10.1002/cti2.1193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives Cytomegalovirus infection is thought to affect the immune system and to impact general health during ageing. Higher CMV‐specific antibody levels in the elderly are generally assumed to reflect experienced viral reactivation during life. Furthermore, high levels of terminally differentiated and CMV‐specific T cells are hallmarks of CMV infection, which are thought to expand over time, a process also referred to as memory inflation. Methods We studied CMV‐specific antibody levels over ~ 27 years in 268 individuals (aged 60–89 years at study endpoint), and to link duration of CMV infection to T‐cell numbers, CMV‐specific T‐cell functions, frailty and cardiovascular disease at study endpoint. Results In our study, 136/268 individuals were long‐term CMV seropositive and 19 seroconverted during follow‐up (seroconversion rate: 0.56%/year). CMV‐specific antibody levels increased slightly over time. However, we did not find an association between duration of CMV infection and CMV‐specific antibody levels at study endpoint. No clear association between duration of CMV infection and the size and function of the memory T‐cell pool was observed. Elevated CMV‐specific antibody levels were associated with the prevalence of cardiovascular disease but not with frailty. Age at CMV seroconversion was positively associated with CMV‐specific antibody levels, memory CD4+ T‐cell numbers and frailty. Conclusion Cytomegalovirus‐specific memory T cells develop shortly after CMV seroconversion but do not seem to further increase over time. Age‐related effects other than duration of CMV infection seem to contribute to CMV‐induced changes in the immune system. Although CMV‐specific immunity is not evidently linked to frailty, it tends to associate with higher prevalence of cardiovascular disease.
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Affiliation(s)
- Leonard Daniël Samson
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands.,Centre for Nutrition, Prevention and Health Services National Institute for Public Health and the Environment Bilthoven The Netherlands.,Department of Rheumatology and Clinical Immunology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Sara Ph van den Berg
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands.,Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Peter Engelfriet
- Centre for Nutrition, Prevention and Health Services National Institute for Public Health and the Environment Bilthoven The Netherlands
| | - Annemieke Mh Boots
- Department of Rheumatology and Clinical Immunology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Marion Hendriks
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands
| | - Lia Gh de Rond
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands
| | - Mary-Lène de Zeeuw-Brouwer
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands
| | - Wm Monique Verschuren
- Centre for Nutrition, Prevention and Health Services National Institute for Public Health and the Environment Bilthoven The Netherlands.,Julius Center for Health Sciences and Primary Care University Medical Center Utrecht The Netherlands
| | - José Am Borghans
- Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Anne-Marie Buisman
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands
| | - Debbie van Baarle
- Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven The Netherlands.,Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
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27
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Is inflammageing influenced by the microbiota in the aged gut? A systematic review. Exp Gerontol 2020; 141:111079. [DOI: 10.1016/j.exger.2020.111079] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/02/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022]
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Abstract
Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%-17.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and disease-related variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy.
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Affiliation(s)
- Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center– IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Antonio Sica
- Humanitas Clinical and Research Center - IRCCS - Laboratory of Molecular Immunology, Milan, Italy
- Department of Pharmaceutical Sciences, University of Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center– IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
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29
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Marcos-Pérez D, Sánchez-Flores M, Proietti S, Bonassi S, Costa S, Teixeira JP, Fernández-Tajes J, Pásaro E, Laffon B, Valdiglesias V. Association of inflammatory mediators with frailty status in older adults: results from a systematic review and meta-analysis. GeroScience 2020; 42:1451-1473. [PMID: 32803650 DOI: 10.1007/s11357-020-00247-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
Frailty is a geriatric syndrome defined as a status of extreme vulnerability to stressors, leading to a higher risk of negative health-related outcomes. "Inflammaging", an age-related state of low-grade chronic inflammation, is characterized by an increased concentration of pro-inflammatory cytokines and acute phase proteins. Inflammaging has been postulated as an underlying mechanism of frailty, and several studies tested the relationship between frailty and concentration of inflammatory mediators. The aim of this systematic review and meta-analysis was to test whether inflammatory mediators are overproduced in frail older adults. Among the 758 articles identified in the literature search, 50 were included in the systematic review, and 39 in the three meta-analyses, i.e., C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor α. To reduce heterogeneity, meta-analyses were restricted to studies identifying frailty by the Fried et al. [1] [J. Gerontol. A. Biol. Sci. Med. Sci. 56, M146-56] phenotypic criteria. Quantitative analyses measuring the association between frailty and biomarker concentrations showed significant differences when frail subjects were compared to non-frail and pre-frail subjects for CRP and IL6. This work established strong association between inflammatory biomarkers and frailty, confirming the role of age-related chronic inflammation in frailty development.
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Affiliation(s)
- Diego Marcos-Pérez
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain
| | - María Sánchez-Flores
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain.,Environmental Health Department, National Health Institute, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal
| | - Stefania Proietti
- Scientific Direction, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166, Rome, Italy.,Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - Solange Costa
- Environmental Health Department, National Health Institute, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal
| | - Joao Paulo Teixeira
- Environmental Health Department, National Health Institute, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal
| | - Juan Fernández-Tajes
- Wellcome Centre for Human Genetics, McCarthy's group, University of Oxford, Roosevelt Drive, Headington, Oxford, OX3 7BN, UK.,Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12, SE-214 28, Malmö, Sweden
| | - Eduardo Pásaro
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain.,Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain
| | - Blanca Laffon
- Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología, Facultad de Ciencias de la Educación, Campus Elviña s/n, 15071, A Coruña, Spain. .,Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain.
| | - Vanessa Valdiglesias
- Instituto de Investigación Biomédica de A Coruña (INIBIC), AE CICA-INIBIC, Oza, 15071, A Coruña, Spain.,EPIUnit -Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no 135, 4050-600, Porto, Portugal.,Universidade da Coruña, Grupo DICOMOSA, Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Biología, Facultad de Ciencias, Campus A Zapateira s/n, 15071, A Coruña, Spain
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30
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Kadambari S, Klenerman P, Pollard AJ. Why the elderly appear to be more severely affected by COVID-19: The potential role of immunosenescence and CMV. Rev Med Virol 2020; 30:e2144. [PMID: 32671966 PMCID: PMC7404358 DOI: 10.1002/rmv.2144] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/21/2022]
Abstract
The significantly higher mortality rates seen in the elderly compared with young children during the coronavirus disease 2019 (Covid‐19) pandemic is likely to be driven in part by an impaired immune response in older individuals. Cytomegalovirus (CMV) seroprevalence approaches 80% in the elderly. CMV has been shown to accelerate immune ageing by affecting peripheral blood T cell phenotypes and increasing inflammatory mediated cytokines such as IL‐6. The elderly with pre‐existing but clinically silent CMV infection may therefore be particularly susceptible to severe Covid‐19 disease and succumb to a cytokine storm which may have been promoted by CMV. Here, we evaluate the potential role of CMV in those with severe Covid‐19 disease and consider how this relationship can be investigated in current research studies.
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Affiliation(s)
- Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
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31
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Wilson SJ, Woody A, Padin AC, Lin J, Malarkey WB, Kiecolt-Glaser JK. Loneliness and Telomere Length: Immune and Parasympathetic Function in Associations With Accelerated Aging. Ann Behav Med 2020; 53:541-550. [PMID: 30107521 DOI: 10.1093/abm/kay064] [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] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Lonely people's heightened risks for chronic health conditions and early mortality may emerge in part through cellular aging. Lonelier people have more severe sympathetic responses to acute stress, increasing their risk for herpesvirus reactivation, a possible path to shorter telomeres. Parasympathetic function may modulate this risk. PURPOSE The current study aimed to examine the associations among loneliness, herpesvirus reactivation, and telomere length, with parasympathetic activity as a moderator, in healthy middle-aged and older adults. METHODS A sample of 113 healthy men and women of ages 40-85 provided blood samples that were assayed for telomere length, as well as the latent herpesviruses cytomegalovirus (CMV) and Epstein-Barr virus (EBV). They also provided heart rate variability (HRV), a measure of parasympathetic activity, and reported on their feelings of loneliness. RESULTS Lonelier people with lower HRV (i.e., lower parasympathetic activity) had greater CMV reactivation and shorter telomeres compared with their less lonely counterparts, above and beyond demographics, health behaviors, resting heart rate, and social network size. However, loneliness was not associated with viral reactivation or telomere length among those with higher HRV. In turn, greater CMV and EBV reactivation was associated with shorter telomeres. CONCLUSIONS Taken together, these data implicate parasympathetic function in novel links between loneliness and accelerated cellular aging.
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Affiliation(s)
- Stephanie J Wilson
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Medical Center Drive, Columbus, OH, USA
| | - Alex Woody
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Medical Center Drive, Columbus, OH, USA
| | - Avelina C Padin
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Medical Center Drive, Columbus, OH, USA.,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Medical Center Drive, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Medical Center Drive, Columbus, OH, USA.,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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32
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Piggott DA, Tuddenham S. The gut microbiome and frailty. Transl Res 2020; 221:23-43. [PMID: 32360945 PMCID: PMC8487348 DOI: 10.1016/j.trsl.2020.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
The human microbiome is constituted by an extensive network of organisms that lie at the host/environment interface and transduce signals that play vital roles in human health and disease across the lifespan. Frailty is a critical aging-related syndrome marked by diminished physiological reserve and heightened vulnerability to stress, predictive of major adverse clinical outcomes including death. While recent studies suggest the microbiome may impact key pathways critical to frailty pathophysiology, direct evaluation of the microbiome-frailty relationship remains limited. In this article, we review the complex interplay of biological, behavioral, and environmental factors that may influence shifts in gut microbiome composition and function in aging populations and the putative implications of such shifts for progression to frailty. We discuss HIV infection as a key prototype for elucidating the complex pathways via which the microbiome may precipitate frailty. Finally, we review considerations for future research efforts.
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Affiliation(s)
- Damani A Piggott
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland.
| | - Susan Tuddenham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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33
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Samson LD, H Boots AM, Ferreira JA, J Picavet HS, de Rond LGH, de Zeeuw-Brouwer ML, Monique Verschuren WM, Buisman AM, Engelfriet P. In-depth immune cellular profiling reveals sex-specific associations with frailty. IMMUNITY & AGEING 2020; 17:20. [PMID: 32582361 PMCID: PMC7310472 DOI: 10.1186/s12979-020-00191-z] [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: 03/02/2020] [Accepted: 06/11/2020] [Indexed: 01/12/2023]
Abstract
Background With advancing age, the composition of leukocyte subpopulations in peripheral blood is known to change, but how this change differs between men and women and how it relates to frailty is poorly understood. Our aim in this exploratory study was to investigate whether frailty is associated with changes in immune cell subpopulations and whether this differs between men and women. Therefore, we performed in-depth immune cellular profiling by enumerating a total of 37 subpopulations of T cells, B cells, NK cells, monocytes, and neutrophils in peripheral blood of 289 elderly people between 60-87 years of age. Associations between frailty and each immune cell subpopulation were tested separately in men and women and were adjusted for age and CMV serostatus. In addition, a random forest algorithm was used to predict a participant’s frailty score based on enumeration of immune cell subpopulations. Results In the association study, frailty was found to be associated with increased numbers of neutrophils in both men and in women. Frailer women, but not men, showed higher numbers of total and CD16- monocytes, and lower numbers of both CD56+ T cells and late differentiated CD4+ TemRA cells. The random forest algorithm confirmed all the findings of the association studies in men and women. In men, the predictive accuracy of the algorithm was too low (5.5%) to warrant additional conclusions on top of the ones derived from the association study. In women however, the predictive accuracy was higher (23.1%), additionally revealing that total T cell numbers and total lymphocyte numbers also contribute in predicting frailty. Conclusions In-depth immune cellular profiling revealed consistent associations of frailty with elevated numbers of myeloid cell subpopulations in both men and women. Furthermore, additional associations were found between frailty and lower numbers of some T cell subpopulations, in women only. Thus, our study indicates sex-specific associations of immune subpopulations with frailty. We hope that our study will prompt further investigation into the sex-specific immune mechanisms associated with the development of frailty.
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Affiliation(s)
- Leonard Daniël Samson
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands.,Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, 9727 Netherlands
| | - A Mieke H Boots
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, 9727 Netherlands
| | - José A Ferreira
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands
| | - H Susan J Picavet
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands
| | - Lia G H de Rond
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands
| | | | - W M Monique Verschuren
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3553 Netherlands
| | - Anne-Marie Buisman
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands
| | - Peter Engelfriet
- National Institute of Public Health and the Environment, Bilthoven, 3722 BA Netherlands
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34
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Noppert GA, Aiello AE, O'Rand AM, Cohen HJ. Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index. J Racial Ethn Health Disparities 2020; 7:99-108. [PMID: 31642044 PMCID: PMC6980710 DOI: 10.1007/s40615-019-00638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/02/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disparities in adult morbidity and mortality may be rooted in patterns of biological dysfunction in early life. We sought to examine the association between pathogen burden and a cumulative deficits index (CDI), conceptualized as a pre-clinical marker of an unhealthy biomarker profile, specifically focusing on patterns across levels of social disadvantage. METHODS Using the data from the National Health and Nutrition Examination Survey 2003-2004 wave (aged 20-49 years), we examined the association of pathogen burden, composed of seven pathogens, with the CDI. The CDI comprised 28 biomarkers corresponding to available clinical laboratory measures. Models were stratified by race/ethnicity and education level. RESULTS The CDI ranged from 0.04 to 0.78. Nearly half of Blacks were classified in the high burden pathogen class compared with 8% of Whites. Among both Mexican Americans and other Hispanic groups, the largest proportion of individuals were classified in the common pathogens class. Among educational classes, 19% of those with less than a high school education were classified in the high burden class compared with 7% of those with at least a college education. Blacks in the high burden pathogen class had a CDI 0.05 greater than those in the low burden class (P < 0.05). Whites in the high burden class had a CDI only 0.03 greater than those in the low burden class (P < 0.01). DISCUSSION Our findings suggest there are significant social disparities in the distribution of pathogen burden across race/ethnic groups, and the effects of pathogen burden may be more significant for socially disadvantaged individuals.
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Affiliation(s)
- Grace A Noppert
- Carolina Population Center, University of North Carolina, 123 West Franklin St, Chapel Hill, NC, 27516, USA.
- Duke University Population Research Institute, Duke University, Durham, NC, USA.
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.
| | - A E Aiello
- Carolina Population Center, University of North Carolina, 123 West Franklin St, Chapel Hill, NC, 27516, USA
- Department of Epidemiology Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - A M O'Rand
- Duke University Population Research Institute, Duke University, Durham, NC, USA
| | - H J Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
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Barrera-Vázquez OS, Gomez-Verjan JC. The Unexplored World of Human Virome, Mycobiome, and Archaeome in Aging. J Gerontol A Biol Sci Med Sci 2019; 75:1834-1837. [DOI: 10.1093/gerona/glz274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
In the last decades, improvements in different aspects of sanitation, medical care, and nutrition, among others, have permitted an increase in the average lifespan of human population around the world. These advances have stimulated an increased interest in the study of the aging process and age-sensitive characteristics, such as the microbial community that colonizes the human body (microbiome). The human microbiome is composed of bacteria (bacteriome), archaea (archaeome), fungi (mycobiome), and viruses (virome). To date, research has mainly been centered on the composition of the bacteriome, with other members remain poorly studied. Interestingly, changes in the composition of the microbiome have been implicated in aging and age-related diseases. Therefore, in the present perspective, we suggest expanding the scope to research to include the role and the possible associations that the other members of the microbiome could have in the aging organism. An expanded view of the microbiome would increase our knowledge of the physiology of aging and may be particularly valuable for the treatment and diagnosis of age-related diseases.
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Aging, sex, inflammation, frailty, and CMV and HIV infections. Cell Immunol 2019; 348:104024. [PMID: 31843200 DOI: 10.1016/j.cellimm.2019.104024] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022]
Abstract
Aging is characterized by significant immune remodeling at both cellular and molecular levels, also known as immunosenescence. Older adults often manifest a chronic low-grade inflammatory phenotype. These age-related immune system changes have increasingly been recognized not only to lead to immune functional decline and increased vulnerability to infections, but also to play an important role in many chronic conditions such as frailty in older adults. In addition to sex as an important biological factor, chronic viral infections including that by human immunodeficiency virus (HIV) and cytomegalovirus (CMV) are all known to have major impact on the aging immune system. This article provides an overview of our current understanding of aging immunity, sex, inflammation, frailty, and HIV and CMV infections.
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Margolick JB, Bream JH, Nilles TL, Li H, Langan SJ, Deng S, Wang R, Wada N, Leng SX. Relationship Between T-Cell Responses to CMV, Markers of Inflammation, and Frailty in HIV-uninfected and HIV-infected Men in the Multicenter AIDS Cohort Study. J Infect Dis 2019. [PMID: 29529309 DOI: 10.1093/infdis/jiy005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Both aging and treated human immunodeficiency virus (HIV)-infected populations exhibit low-level chronic immune activation of unknown etiology, which correlates with morbidity and mortality. Cytomegalovirus (CMV) infection is common in both populations, but its relation to immune activation is unknown. Methods T cells from men who have sex with men (22 virologically suppressed HIV+, 20 HIV-) were stimulated with peptides spanning 19 CMV open reading frames, and intracellular cytokine responses were assessed. Soluble and cellular inflammatory markers were assessed by multiplex electrochemiluminescence and flow cytometry, respectively. Frailty was assessed by the Fried criteria. Results All men had responses to CMV. Proportions of CMV-responsive T cells correlated strongly (r ≥ 0.6 or ≤ -0.6; P < .05) with immunologic markers, depending on donor HIV and frailty status. Markers significantly correlated in some groups after adjustment for multiple comparisons included interferon-γ, tumor necrosis factor-α, interleukin-6, and several chemokines in serum, and the proportion of activated T cells. The magnitude of the CD4 IL-2 response significantly predicted onset of frailty in HIV- nonfrail men, but not in HIV+ nonfrail men. Conclusions T-cell responses to CMV may strongly influence chronic immune activation in HIV-uninfected and virologically suppressed HIV-infected men, and may predict frailty in HIV-uninfected men.
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Affiliation(s)
- Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
| | - Tricia L Nilles
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryl
| | - Susan J Langan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
| | - Shane Deng
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryl
| | - Ruibin Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nikolas Wada
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryl
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Abstract
PURPOSE OF REVIEW As a consequence of antiretroviral therapy, the proportion of older HIV-infected adults is increasing, with a concomitant shift in burden of illness to age-related syndromes and disease. Frailty is an age-related syndrome of increased vulnerability to stress, predictive of major adverse clinical outcomes among HIV-infected and uninfected persons alike. Understanding frailty pathogenesis is critical to developing interventions to improve health outcomes in HIV. Here, we review the current evidence for the relationship between inflammation and frailty in HIV, and the potential for novel, inflammation-targeted interventions. RECENT FINDINGS Dysregulated inflammation has been consistently associated with frailty in elderly HIV-uninfected persons. Dysregulated inflammation is also central to HIV pathophysiology and several recent studies have demonstrated the important association of inflammation with frailty in HIV. Some evidence suggests that anti-inflammatory therapies may be effective in ameliorating the adverse impact of frailty among aging HIV-infected adults, though further investigation is necessary. Inflammation has been implicated in frailty in HIV infection, and improved understanding of the role that inflammation plays in frailty pathogenesis is key to the development of effective therapies to slow or prevent frailty in the vulnerable HIV-infected population.
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Galitska G, Biolatti M, Griffante G, Gugliesi F, Pasquero S, Dell'Oste V, Landolfo S. Catch me if you can: the arms race between human cytomegalovirus and the innate immune system. Future Virol 2019. [DOI: 10.2217/fvl-2018-0189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Human cytomegalovirus (HCMV), a common opportunistic pathogen of significant clinical importance, targets immunocompromised individuals of the human population worldwide. The absence of a licensed vaccine and the low efficacy of currently available drugs remain a barrier to combating the global infection. The HCMV's ability to modulate and escape innate immune responses remains a critical step in the ongoing search for potential drug targets. Here, we describe the complex interplay between HCMV and the host immune system, focusing on different evasion strategies that the virus has employed to subvert innate immune responses. We especially highlight the mechanisms and role of host antiviral restriction factors and provide insights into viral modulation of pro-inflammatory NF-κB and interferon signaling pathways.
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Affiliation(s)
- Ganna Galitska
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
| | - Matteo Biolatti
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
| | - Gloria Griffante
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
| | - Francesca Gugliesi
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
| | - Selina Pasquero
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
| | - Valentina Dell'Oste
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
| | - Santo Landolfo
- Department of Public Health & Pediatric Sciences, University of Turin, Turin, Italy
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T-cell immunity against cytomegalovirus in HIV infection and aging: relationships with inflammation, immune activation, and frailty. Med Microbiol Immunol 2019; 208:289-294. [PMID: 30900090 DOI: 10.1007/s00430-019-00591-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022]
Abstract
Both aging and treated human immunodeficiency virus (HIV) infection are characterized by low-level chronic inflammation and immune activation which contribute to the development of age-related diseases, frailty, and early mortality. Chronic cytomegalovirus (CMV) infection is highly prevalent in older adults and HIV-infected populations. A number of studies have shown that CMV induces broad and strong T-cell responses in CMV-seropositive older adults and HIV-infected individuals. CMV infection rarely develops into clinical disease in immunocompetent individuals. However, a large body of literature has shown adverse effects of chronic CMV infection on the health and longevity of these populations. It has been hypothesized that chronic CMV infection may be a driver of chronic inflammation and immune activation, and may further contribute to the development of frailty. Thus, there is a need to better understand the extent of the impact of chronic CMV infection on T-cell immunity and health in aging and HIV infection. In this review, we will address important considerations and challenges in the assessment of chronic CMV infection and CMV-specific T-cell responses. We will then review recent data on relationships between T-cell responses to CMV and levels of inflammatory markers and immune activation, as well as the onset of frailty.
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Chen Y, Liu S, Leng SX. Chronic Low-grade Inflammatory Phenotype (CLIP) and Senescent Immune Dysregulation. Clin Ther 2019; 41:400-409. [PMID: 30833113 DOI: 10.1016/j.clinthera.2019.02.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim was to provide an overview of chronic low-grade inflammatory phenotype (CLIP) and evidence for its role in the pathogenesis of frailty and other chronic conditions as well as potential causative factors and interventions. METHODS We reviewed evidence from published clinical and laboratory studies and summarized the opinions of experts from published reviews. FINDINGS CLIP is a low-grade, systemic, unresolved, and smoldering chronic inflammatory state clearly indicated by a 2- to 4-fold increase in serum levels of inflammatory mediators, such as interleukin-6 and C-reactive protein. It involves many other cellular and molecular inflammatory mediators. CLIP typically occurs during aging, also known as "inflammaging," and is an integral part of the spectrum of immunosenescence. Causative factors likely include persistent viral infections, particularly chronic cytomegalovirus infection, cellular senescence, failure to eliminate degraded materials and waste products, dysregulated microbiota and gut permeability, obesity, and others. Substantial evidence supports CLIP as a powerful contributing factor to frailty and many other chronic conditions and adverse health outcomes. Many of the inflammatory mediators and their regulatory mechanisms in CLIP may serve as potential targets for therapeutic intervention. However, development of new interventional strategies for CLIP and its associated chronic conditions should take the complexity of the inflammatory network into consideration. Nonpharmacologic interventions, such as caloric restriction and exercise, may have significant impact on CLIP and its causative factors, leading to substantial health benefits. Metformin and resveratrol have anti-inflammatory property and may serve as a promising therapeutic agent for treatment of CLIP and frailty. IMPLICATIONS CLIP is a chronic inflammatory pathophysiologic process that plays an important role in the pathogenesis of frailty and many other chronic conditions. Improving our understanding of this phenotype may provide opportunities to identify potential targets of effective prevention and therapeutic strategies for frailty and other CLIP-associated conditions.
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Affiliation(s)
- Yiyin Chen
- Division of Geriatrics, Xiangya Second Hospital of Central South University, Changsha, Hunan Province, China
| | - Sally Liu
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Infectious complications and NK cell depletion following daratumumab treatment of Multiple Myeloma. PLoS One 2019; 14:e0211927. [PMID: 30759167 PMCID: PMC6374018 DOI: 10.1371/journal.pone.0211927] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/17/2019] [Indexed: 12/16/2022] Open
Abstract
Treatment with Daratumumab (Dara), a monoclonal anti-CD38 antibody of IgG1 subtype, is effective in patients with multiple myeloma (MM). However, Dara also impairs the cellular immunity, which in turn may lead to higher susceptibility to infections. The exact link between immune impairment and infectious complications is unclear. In this study, we report that nine out of 23 patients (39%) with progressive MM had infectious complications after Dara treatment. Five of these patients had viral infections, two developed with bacterial infections and two with both bacterial and viral infections. Two of the viral infections were exogenous, i.e. acute respiratory syncytial virus (RSV) and human metapneumovirus (hMPV), while five consisted of reactivations, i.e. one herpes simplex (HSV), 1 varicella-zoster (VZV) and three cytomegalovirus (CMV). Infections were solely seen in patients with partial response or worse. Assessment of circulating lymphocytes indicated a selective depletion of NK cells and viral reactivation after Dara treatment, however this finding does not exclude the multiple components of viral immune-surveillance that may get disabled during this monoclonal treatment in this patient cohort. These results suggest that the use of antiviral and antibacterial prophylaxis and screening of the patients should be considered.
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Zhang X, Dou Q, Zhang W, Wang C, Xie X, Yang Y, Zeng Y. Frailty as a Predictor of All-Cause Mortality Among Older Nursing Home Residents: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 20:657-663.e4. [PMID: 30639171 DOI: 10.1016/j.jamda.2018.11.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We performed a meta-analysis based on prospective cohort studies to synthesize the pooled risk effect and to determine whether frailty is a predictor of all-cause mortality. DESIGN Systematic review and meta-analysis. SETTING PubMed, EMBASE, and the Cochrane Library were systematically searched in October 2018. A random effects model was applied to combine the results according to the heterogeneity of the included studies. PARTICIPANTS Older nursing home residents. MEASUREMENTS Mortality risk due to frailty. RESULTS Fourteen studies (9076 participants) were included in this meta-analysis. Pooled results demonstrated that nursing home residents with frailty were at an increased risk of mortality [pooled hazards ratio (HR) = 1.88, 95% confidence interval (CI) = 1.57, 2.25, I2 = 47.8%, P < .001] compared to those without frailty. Results of subgroup analyses showed that frailty was significantly associated with the risk of mortality among older nursing home residents when using FRAIL-NH (pooled HR = 2.10, 95% CI = 1.60-2.77, P < .001) and Frailty Index (pooled HR = 1.74, 95% CI = 1.40-2.18, P < .001) to define frail people, whereas when using the diagnosis criteria of CSHA-CFS for frailty, the pooled HR was 2.82 (95% CI = 0.79-10.10, P = .111). In addition, the subgroup analysis for length of follow-up showed that studies with a follow-up period of 1 year or more (pooled HR = 1.83, 95% CI = 1.52, 2.21, P < .001) reported a significantly higher rate of mortality among individuals with frailty, compared to those without frailty. Similar results were also found in studies with a follow-up period of less than 1 year (pooled HR = 2.67, 95% CI = 1.43, 5.00, P = .002). CONCLUSIONS AND IMPLICATIONS Frailty is a significant predictor of all-cause mortality in older nursing home residents. Therefore, there is an urgent need to screen for frailty in nursing home residents and carry out appropriate multidisciplinary intervention strategies to prevent poor outcomes and reduce the rate of mortality among older nursing home residents.
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Affiliation(s)
- XiaoMing Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China.
| | - QingLi Dou
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - WenWu Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - CongHua Wang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - XiaoHua Xie
- Department of Nursing, The First Affiliated hospital of ShenZhen University, The Second People's Hospital of ShenZhen, Shenzhen, China
| | - YunZhi Yang
- Department of Nursing, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan ShenZhen, Shenzhen, China
| | - YingChun Zeng
- The Third Affiliated Hospital of Guangzhou Medical University, Research Institute of Gynecology & Obstetrics, Guangzhou, China
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Araújo Carvalho AC, Tavares Mendes ML, Santos VS, Tanajura DM, Prado Nunes MA, Martins-Filho PRS. Association between human herpes virus seropositivity and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev 2018; 48:145-152. [PMID: 30391341 DOI: 10.1016/j.arr.2018.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 12/30/2022]
Abstract
Frailty is an emerging geriatric syndrome characterized by decreased physiologic reserve and increased vulnerability to environmental factors. Several studies have examined the association between persistent cytomegalovirus (CMV) infection and poor clinical outcomes in the elderly, but the results are often contradictory. Here, we performed a systematic review and meta-analysis to analyze the association between human herpesvirus seropositivity [CMV, Epstein-Barr virus (EBV), Varicella zoster virus (VZV), and Herpes simplex virus (HSV)] and frailty in elderly people. Searches were performed in PubMed, SCOPUS, Lilacs, IBECS, and Web of Science databases. We used the odds ratio (OR) as a measure of the association between herpesvirus infections and frailty. Summary estimates were calculated using random-effects models. Six studies were included in the present systematic review. The data from 2559 elderly subjects were analyzed; 1571 of the subjects had ages between 60 and 79 years, and 988 of the subjects were older than 80. We found an association between CMV seropositivity and frailty in the elderly aged 60-79 years (OR 2.33, CI 95% 1.48-3.67) but not in the oldest-old subjects (OR 0.67, CI 95% 0.42-1.05). Moreover, no association was found between EBV, VZV, and HSV infections and frailty. Current evidence suggests an association between CMV seropositivity and frailty in individuals aged 60-79 years old.
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Liu Z, Hsu FC, Trombetti A, King AC, Liu CK, Manini TM, Fielding RA, Pahor M, Newman AB, Kritchevsky S, Gill TM. Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BMC Med 2018; 16:185. [PMID: 30352583 PMCID: PMC6199791 DOI: 10.1186/s12916-018-1174-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Whether physical activity can reduce cognitive frailty-a relatively new "compound" phenotype proposed in 2013-and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect. METHODS We used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70-89 years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline. RESULTS After adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64-0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction = 0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction = 0.835, 0.536, 0.934, and 0.458, respectively). CONCLUSIONS A 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging. TRIAL REGISTRATION Clinicaltrials.gov, NCT01072500.
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Affiliation(s)
- Zuyun Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston Salem, NC, USA
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Abby C King
- Department of Health Research and Policy and the Stanford Prevention Research Center, Department of Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | - Christine K Liu
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.,Section of Geriatrics, Boston University School of Medicine, Boston, MA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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Collins-McMillen D, Buehler J, Peppenelli M, Goodrum F. Molecular Determinants and the Regulation of Human Cytomegalovirus Latency and Reactivation. Viruses 2018; 10:E444. [PMID: 30127257 PMCID: PMC6116278 DOI: 10.3390/v10080444] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023] Open
Abstract
Human cytomegalovirus (HCMV) is a beta herpesvirus that establishes a life-long persistence in the host, like all herpesviruses, by way of a latent infection. During latency, viral genomes are maintained in a quieted state. Virus replication can be reactivated from latency in response to changes in cellular signaling caused by stress or differentiation. The past decade has brought great insights into the molecular basis of HCMV latency. Here, we review the complex persistence of HCMV with consideration of latent reservoirs, viral determinants and their host interactions, and host signaling and the control of cellular and viral gene expression that contributes to the establishment of and reactivation from latency.
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Affiliation(s)
| | - Jason Buehler
- BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA.
| | | | - Felicia Goodrum
- BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA.
- Department of Immunobiology, University of Arizona, Tucson, AZ 85721, USA.
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47
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Cao Dinh H, Bautmans I, Beyer I, Mets T, Onyema OO, Forti LN, Renmans W, Vander Meeren S, Jochmans K, Vermeiren S, Vella-Azzopardi R, Njemini R. Association Between Immunosenescence Phenotypes and Pre-frailty in Older Subjects: Does Cytomegalovirus Play a Role? J Gerontol A Biol Sci Med Sci 2018; 74:480-488. [DOI: 10.1093/gerona/gly135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Indexed: 02/02/2023] Open
Affiliation(s)
- Hung Cao Dinh
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
| | - Ivan Bautmans
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
- Department of Geriatric Medicine, Belgium
| | - Ingo Beyer
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
- Department of Geriatric Medicine, Belgium
| | - Tony Mets
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
- Department of Geriatric Medicine, Belgium
| | | | | | - Wim Renmans
- Laboratory of Hematology, Universitair Ziekenhuis Brussel, Belgium
| | | | - Kristin Jochmans
- Laboratory of Hematology, Universitair Ziekenhuis Brussel, Belgium
| | | | | | - Rose Njemini
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
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48
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Abstract
The majority of patients with common malignancies are older adults. Intrinsic complex biological changes of aging along with inflammation, immunosenescence, age-associated chronic diseases, and extrinsic environmental and psychosocial factors have significant impact on not only development and behavior of individual malignancies, but also physiologic reserve and vulnerability of older patients who suffer from them. As a result, clinical practice of geriatric oncology demands integration of careful geriatric assessment and management. This article provides an overview of basic biology of aging and its relationship with cancer. After a brief introduction about the definition and mechanisms of aging, as well as age-related biological and physiological changes, the discussion mainly focuses on recent development and insights into the relationship of frailty, inflammation, and immunity with cancer, highlighting how the new knowledge can help further improve assessment and treatment of older patients with malignancies and promote cancer research.
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49
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Differences in cognitive functions between cytomegalovirus-infected and cytomegalovirus-free university students: a case control study. Sci Rep 2018; 8:5322. [PMID: 29593335 PMCID: PMC5871756 DOI: 10.1038/s41598-018-23637-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/05/2018] [Indexed: 11/23/2022] Open
Abstract
Cytomegalovirus (CMV) is the herpetic virus, which infects 45–100% people worldwide. Many reports suggest that CMV could impair cognitive functions of infected subjects. Here we searched for indices of effects of CMV on infected subjects’ intelligence and knowledge. The Intelligence Structure Test I-S-T 2000 R was used to compare IQ of 148 CMV-infected and 135 CMV-free university students. Infected students expressed higher intelligence. Paradoxically, their IQ decreased with decreasing concentration of anti-CMV antibodies, which can be used, statistically, as a proxy of the time passed from the moment of infection in young subjects when the age of subjects is statistically controlled. The paradox of seemingly higher intelligence of CMV infected subjects could be explained by the presence of the subpopulation of about 5–10% CMV-positive individuals in the population of “CMV-negative students”. These false negative subjects had probably not only the oldest infections and therefore the lowest concentration of anamnestic antibodies, but also the lowest intelligence among the infected students. Prevalence of CMV infection in all countries is very high, approaching sometimes 90%. Therefore, the total impact of CMV on human intelligence may be large.
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Lu Y, Tan CTY, Nyunt MSZ, Mok EWH, Camous X, Kared H, Fulop T, Feng L, Ng TP, Larbi A. Inflammatory and immune markers associated with physical frailty syndrome: findings from Singapore longitudinal aging studies. Oncotarget 2018; 7:28783-95. [PMID: 27119508 PMCID: PMC5045356 DOI: 10.18632/oncotarget.8939] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/10/2016] [Indexed: 12/31/2022] Open
Abstract
Chronic systematic inflammation and reduced immune system fitness are considered potential contributing factors to the development of age-related frailty, but the underlying mechanisms are poorly defined. This exploratory study aimed to identify frailty-related inflammatory markers and immunological phenotypes in a cohort of community-dwelling adults aged ≥ 55 years. Frailty was assessed using two models, a Frailty Index and a categorical phenotype, and correlated with levels of circulating immune biomarkers and markers of senescence in immune cell subsets. We identified eight serological biomarkers that were associated with frailty, including sgp130, IL-2Rα, I-309, MCP-1, BCA-1, RANTES, leptin, and IL-6R. Frailty Index was inversely predicted by the frequency of CD3+, CD45RA+, and central memory CD4 cells, and positively predicted by the loss of CD28 expression, especially in CD8+ T cells, while frailty status was predicted by the frequency of terminal effector CD8+ T cells. In γ/δ T cells, frailty was negatively associated with CD27, and positively associated with IFNγ+TNFα- secretion by γ/δ2+ cells and IFNγ-TNFα+ secretion by γ/δ2- cells. Increased numbers of exhausted and CD38+ B cells, as well as CD14+CD16+ inflammatory monocytes, were also identified as frailty-associated phenotypes. This pilot study supports an association between inflammation, cellular immunity, and the process of frailty. These findings have significance for the early identification of frailty using circulating biomarkers prior to clinical manifestations of severe functional decline in the elderly.
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Affiliation(s)
- Yanxia Lu
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Crystal Tze Ying Tan
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Wing Hei Mok
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Xavier Camous
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Hassen Kared
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Tamas Fulop
- Geriatrics Division, Department of Medicine, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Liang Feng
- Graduate Medical School, Duke-National University of Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore.,Geriatrics Division, Department of Medicine, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada
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