WELCOME TO THE FOURTH
GEROSCIENCE SCIENCE SUMMIT.
AND IN THE INTEREST OF TIME AND
SIMPLICITY, PLEASE WELCOME Dr.
HODES.
DIRECTOR OF THE NATIONAL
INSTITUTE ON AGING.
>>THANK YOU, IT'S A GREAT
PLEASURE TO BE HERE.
I THINK MY FIRST TIME IN THIS
AUDITORIUM SINCE THE PANDEMIC
AND IT'S A GREAT OCCASION TO
HAVE EVERYBODY BACK.
SO MANY IN-PERSON AS WELL AS
THOSE LISTEN IN REMOTELY.
THE FOURTH GEROSCIENCE SUMMIT IS
A PRODUCT IN SOME SENSE, OF THE
FORMATION OF THE GEROSCIENCE
SCIENCE INTEREST GROUP.
BACK IN 2012 NOW SO TIME HAS
FLOWN.
IT BEGAN WITHIN NIA, EVOLVED
WITH DISCUSSION AMONG A NUMBER
OF INSTITUTE DIRECTORS WHO SAW
IT ACROSS NIH SO IT'S GROWN TO
AND VERY BROAD.
IN THE PAST, THE EARLY
GEROSCIENCE SUMMITS INTRODUCED
RESEARCH AND BROADER PUBLIC.
THAT'S WHAT GEROSCIENCE WAS ALL
ABOUT.
WE LOOKED AT THE INTRODUCTION OF
GEROSCIENCE AND MAJOR DISEASE
AND THEIR TREATMENT AND
INTRODUCED THE CONCEPT TO LARGER
GROUPS OF ADVOCATES AND SPECIAL
ORGANIZATIONS WHO WERE LESS
FAMILIAR.
TODAY, YOU WILL SEE AN OUT
STANDING SYMPOSIUM PLANNED.
SPEAKERS WHICH INVOLVE THIS
MORNING DIRECTORS OF TWO OTHER
INSTITUTES AT NIH REFLECTING
THAT LEADERSHIP.
MULTIPLE REPRESENTATIVE SIGN
SCIENTIST AND NOTABLY,INCLUDINGE
ASSURANCE THE RESEARCH CONDUCTED
IN GEROSCIENCE IS APP PUBLIC
ABLE TO A BROAD AND DIVERSE
COMMUNITY.
ALSO OVER THE YEARS WITH THE
EMERGING COMPUTATIONAL
TECHNOLOGY AND ASSURANCE WE
MAXIMIZE THE USE OF THESE
CURRENT AND CUTTING EDGE
TECHNOLOGIES IN GEROSCIENCE AND
CARRY OUT WITH AN EYE TOWARDS
APPLICATION TO IMPROVING THE
QUALITY OF LIFE IN OLDER
INDIVIDUALS.
I SHARE THE ANTICIPATION OF A
FANTASTIC THREE DAYS OF SCIENCE
AND TURN IT BACK TO RON KOHAN
KOHANSKI.
>>THANK YOU, RICHARD.
>>I'M THE DIRECTOR AT THE
NATIONAL INSTITUTE ON AGING.
MY PREDECESSOR HAS NOTED WAS IN
DEVELOPING IDEAS ABOUT
GEROSCIENCE.
ROSALIE AND ASSOCIATES AND MY
THANKS GO TO THEM.
I BELIEVE THAT THIS SUMMIT WOULD
NOT HAVE HAPPEN WITHOUT THEIR
DAILY ENGAGEMENT.
SO PETER HORNSBY, SPEAKING OF
EVERYTHING IN THE UNIVERSE, SAID
THAT THINGS AGE EVENTUALLY
DETERIORATE AND BECOME NON
FUNCTIONAL.
AND THERE ARE MANY ASPECTS OF
AGING THAT ARE NOT DETERIORATION
BUT THE PARTS THAT WE ARE
INTERESTED IN SUPPORTING ARE
THOSE THAT ARE MAINTAIN ABLE AND
THE PARTS THAT WE'RE INTERESTED
IN FINDING WAYS TO AMELIORATE
THE THOSE ARE DESCRIBED IN THE
OUTLOOK ON AGING.
BUT THEN, WE COME ALONG WITH THE
GEROSCIENCE SIGH PHYPOTHESIS INT
PHILLIPPE ORGANIZED AND WE
EDITED.
THE GEROSCIENCE HYPOTHESIS.
ANY INTERCEPTIONS THAT READDRESS
IT THE AGING PROCESS WILL
SIMULTANEOUSLY DELAY THE ON SET
OF MULTIPLE DISEASES.
THIS IS ROUGHLY SPEAKING 10
YEARS AGO WHEN THE EMPHASIS WAS
ON DISEASES AND HE WOULD
OBSERVE, FREQUENTLY, THAT WE'RE
AT NATIONAL INSTITUTES OF HEALTH
AND WE SEEM TO BE FOCUSED VERY
SPECIFICALLY ON CLUSTERS OF
DISEASES AND SPECIFIC DISEASES
AND IT'S TRUE AND IT'S
JUSTIFIABLE BECAUSE IT'S ONE WAY
OF LOOKING AT HEALTH.
IT'S SUGGESTED BY THE DISEASES
OR DYSFUNCTIONS THAT ARE CARRY.
WE THINK WE SHOULD EXPAND
GEROSCIENCE A LITTLE BIT TO
THINK ABOUT NOT JUST DISEASES,
AGING AND MULTIPLE CONDITIONS
RELATED TO AGE.
EYE TRY TO EXPLAIN A LITTLE BIT
OF SOME OF THE BACKGROUND OF
WHERE WE WERE.
BACK IN 2008, THIS 2008 THIS PS
PUBLISHED AND THIS WAS LOOKING
FOR CARDIOVASCULAR RISK
PROFILES.
THE WAY THIS IS LAID OUT, IS YOU
GET A SCORE, HIGHER THE SCORE
THE GREATER OF RISK AND THE
DEVELOPING A CARDIOVASCULAR
ILLNESS.
AND THERE ARE SOME WELL-KNOWN
MARKERS THAT ARE MOLECULAR OR
CLINICALLY DIAGNOSTIC OR
BEHAVIORAL OR FUNCTIONS OF
METABOLISM, FOR EXAMPLE.
SO, HIGH DENSITY CHOLESTEROL IS
GOOD AND YOU CAN HAVE EFFECT BY
THE NEGATIVE NUMBER.
LOW BLOOD PRESSURE IS A GOOD
IDEA, NOT TOO LOW OF COURSE.
HIGH BLOOD PRESSURE IS
INCREASINGLY A RISK WITH THE
INCREASING NUMBERS.
TOTAL CHOLESTEROL GOES TOO HIGH
BIGGER RISK AND SMOKER, RISK FOR
EVERYTHING DELETERIOUS AND
DIABETES, NOT A GOOD CONDITION
TO HAVE BUT CAN BE TREATED.
YOU CANNOT TREAT THE PASSAGE OF
TIME.
IF YOU ARE OLDER, YOUR RISK IS
MUCH GREATER THAN IF YOU ARE
YOUNGER AND YOUR AGE IS GREATER
RISK THAN ANY OTHER FACTOR
INDIVIDUALLY AND YOU CAN GET OLD
ENOUGH, COMBINED.
SO, THE QUESTION IS, IF IT'S
AGE, WHAT CAN YOU DO?
NOT MUCH.
CHECK YOUR WATCH FREQUENTLY.
BUT IF YOU THINK OF IT AS THE
PROCESS'S THAT OCCUR OVER THE
COURSE OF A LIFETIME, THAT WOULD
BE AGING AND IT COULD BE
ADDRESSED FROM A BIOLOGICAL
POINT OF VIEW AS WELL AS HAVE
CLINICAL IMPLICATIONS FOR
IMPROVING HEALTH AT OLDER AGES.
IN EFFECT, IT MIGHT BE 75 OR 65
BUT MAYBE THESE NUMBERS COULD BE
REDUCED IN TERMS OF WHAT IS
THEIR RELATIVE CONTRIBUTION TO
YOUR RISK FOR CARDIOVASCULAR
DISEASE.
SO WE THOUGHT WE WOULD TALK
ABOUT AGING AND IN THE CONTEXT
OF GEROSCIENCE, HOW WOULD THAT
PLAY OUT?
SO, YOU COULD THINK THAT IF YOU
TAKE THE GEROSCIENCE HYPOTHESIS
TO A MATHEMATICAL VIEW, YOU
WOULD THINK THAT YOU WOULD HAVE
DIFFERENTIAL IMPACTS ON AGE
RELATED DISEASES BECAUSE THE AGE
RELATED DISEASES HAVE DIFFERENT
PATTERNS.
SO, HYPERTENSION HAS INCIDENTS
THAT SEEMS TO -- IF YOU WERE TO
EXTRAPOLATE THIS LINE DOWN IT
MIGHT INTERSECT AT AROUND 45 OR
SO BUT IF YOU LOOK AT CON GUESS
TIVE HEART FAILURE, THE
INCIDENTS MIGHT EXTRAPOLATE DOWN
TO 70 OR 60 BUT THE RISKS SEEM
TO BE DIFFERENT IN SOME CASES
BETWEEN MEN AND WOMEN.
IT'S NOT CLEAR IF YOU LOOKED THE
A SINGLE ORGAN SYSTEM OR
PHYSIOLOGICAL SYSTEM DOES AGING
HAVE THE SAME IMPACT?
EVEN WITHIN A SINGLE ORGAN
SYSTEM.
WITH THE BRAIN, IN TERMS OF
LET'S SAY THESE TWO CONDITIONS,
DEMENTIA AND SCHIZOPHRENIA HAVE
A HIGHER INCIDENTS -- THIS IS
INCIDENTS VERSUS AGE.
SO THERE'S A HIGHER INCIDENTS
BUT IT'S THE ONSET SEEMS TO BE
MUCH LATER IN LIFE.
SIMILARLY FOR STROKE BUT IF YOU
LOOK AT DEPRESSION, WHICH
DOESN'T SEEM TO HAVE A BIG AGE
RELATED FACTOR TO IT, AT LEAST
AS FAR AS WE CAN SEE FROM THIS
INCIDENTS PLOT.
THIS IS A SINGLE STUDY OF
126,000 PEOPLE IN ONE COUNTY IN
MINNESOTA SO IT MAY NOT BE
APPLICABLE ALL THE WAY ACROSS
BUT IT DOES ILLUSTRATE THAT EVEN
WITHIN A SINGLE POPULATION
STUDY, YOU WILL FIND MULTIPLE
CHARACTERISTICS IN TERMS OF HOW
THESE AGE RELATED DISEASES PLAY
OUT ACROSS AGE.
AND THEN THEY'RE NOT ALL
MONATONIC IN THE SENSE THAT
DIABETES, WHICH YOU CAN THINK OF
AS METABOLIC CONDITIONS OR
CONDITIONS OF METABOLISM, THEY
SHOW A DIFFERENT PATTERN AND
SINCE IT'S THE SAME POPULATION,
YOU ARE PROBABLY NOT LOOKING AT
DIFFERENCES DUE TO SURVIVAL BIAS
AND THEN IF YOU LOOK AT A SINGLE
SYSTEM SUCH AS BONE, MAYBE IT'S
NOT REALLY A SINGLE SYSTEM.
OSTEOPOROSIS EFFECT A DIFFERENT
PART OF THE POINT FROM ARTHRITIS
BONE -- THE PHYSIOLOGY OFWHAT IT
LEADS TO THESE INCREASES WITH
AGE ARE POSSIBLY INFORMATIVE BUT
THEY HAVE TO BE DEALT WITH
BECAUSE IT'S A QUESTION OF
HETEROGENEITY IN PHYSIOLOGICAL
SYSTEMS.
SO, IT LEADS YOU TO THE
QUESTION, IF APPROXIMATE YOU
WANTED TO THINK ABOUT AGING AND
HOW IF YOU HAD SOME TREATMENT
THAT WOULD SLOW THE RATE OF
AGING, HOW WOULD THAT PLAY OUT
IN THE INCIDENTS OF DISEASE SO
THE HYPOTHESIS STATES THAT THERE
WOULD BE LATER ONSET AND LESS
SEVERITY.
SO, YOU CAN THEN LOOK FOR THE
INCIDENTS OF DISEASE IN THE
PRESENCE OF AN INTERVENTION THAT
YOU HAVE GOOD REASON TO THINK
WILL SLOW THE RATE OF AGING.
FOR ANY DISEASE THERE'S AN
INTERACTION BETWEEN THE GENES
AND THE ENVIRONMENT AND THE
QUESTION IS, WHAT CAN YOU
EXTRACT ABOUT AGING OF INCIDENTS
VERSUS AGE?
SO, HOW WOULD YOU INTERPRET THIS
BEFORE YOU EXTRACT BIOMARKERS OF
AGING.
IF THIS IS ALL AGING AND WE KNOW
IT ISN'T BECAUSE OF THESE
INTERACTIONS LET'S JUST SUPPOSE
IT WAS ALL AGING OR IT'S
DOMINATED BY AGING SO THIS IS
THE BIGGEST CIRCLE, UNLIKELY,
BUT AS A THOUGHT EXPERIMENT IS
THIS FASTER AGING BECAUSE THE
AGE RELATED CONDITION OCCURS
EARLIER AND IS IT SLOWER AGING
BECAUSE THE AGE OF ONSET OR THE
INCIDENTS IS LATER?
OR IS THIS REALLY LITTLE
EFFECTED BY AGING AND IT IS MORE
BY GENES AND ENVIRONMENT HOW DO
YOU KNOW IT'S NOT THE CASE
THERE?
IT'S A PROBLEM TO COME TO TERMS
DIS TINGEING IF YOU ARE LOOKING
AT INCIDENTS OF AND AGING
FACTORS AND WHAT ARE THE NON
AGING FACTORS AND WITH YOUR
LOCAL EPIDEMIOLOGIST THEY SHOULD
BE ABLE TO HELP YOU PARSE THAT.
LET'S JUST TAKE ANOTHER EXAMPLE.
IF YOU LOOK AT THE INCIDENTS
PULMONARY FIBRO SIS OVER TIME
YOU HAVE A LOT OF COMPLEXITY IN
THE RELATIVELY SIMPLE QUESTION
WHAT IS THE CONTRIBUTION OF AGE
TO FIBROTIC DISEASE IN THE LUNG
SO FROM THIS STUDY THERE'S A
DRIFT UPWARDS IN THE INCIDENTS
OF THE DISEASE SO OVER THAT
TIMEFRAME IT'S NOT GENETICS
UNLESS IT'S PEOPLE MOVING INTO
THE POPULATION WHO ARE OF A
DIFFERENT GENETIC BACKGROUND.
BUT IT'S NOT THE CASE, BECAUSE
IT'S NOT ISOLATED GROUP AND OR A
RELATIVELY STABLE POPULATION BUT
SOMETIMES IT GOES UP AS IN THESE
TWO STUDIES BUT SOMETIMES IT
GOES DOWN.
WHY THAT WOULD BE IS NOT QUITE
CLEAR.
IT COULD BE POPULATION
COMPETITION, ENVIRONMENTAL
FACTORS ARE LIKELY CULPRIT BUT
MAYBE IT REFLECTS A HIGHER RATE
OF AGING BECAUSE THINGS MIGHT BE
MORE STRESSFUL OVER THAT DECADE
OR THE DIAGNOSTIC PARAMETERS MAY
HAVE CHANGED.
AND THAT IN A SENSE OF -- ALL OF
THESE ARE ILLUSTRATED HERE WERE
IN A STUDY OF A POPULATION IN
NEW MEXICO BACK IN 1994, THIS
WAS THE AGE DISTRIBUTION AND YOU
CAN SEE, IPF, DEFINITELY MORE
FREQUENTLY FOUND AT OLDER AGES
THAT'S TRUE ALL THE WAY ACROSS
AND IT TENDS TO BE MORE
PROMINENT AMONG MALES THAN
FEMALES AND THAT IS NEW MEXICO,
NORWAY, U.S. HEALTH RECORDS, AND
THAT POPULATION IN MINNESOTA
THTHAT I MENTIONED BEFORE.
THIS IS IMPORTANT IN THE SENSE
THAT IF YOU WANT TO LOOK AT
INCIDENTS, YOU NEED TO CONSIDER
WHETHER THE DISEASES RARE WHICH
WOULD SUGGEST THAT YOU HAVE TO
WORK WITH A SPECIFIC POPULATION
BUT RARE DISEASES OFTEN ARE
DOMINATED BY GENETIC PRE DOES
POSITION.
SO HOW MUCH IS AGING?
YOU MIGHT WANTS TO LOOK AT A
POPULATION WHERE THE INCIDENTS
IS HIGHER FOR NO OTHER REASON
THAN THE BIOLOGY GOING ON WITH
THE PRESENT.
BUT THAT WOULD ALSO BE THE SAME
FOR THE GENOTYPE BUT AGAIN, IF
IT'S JUST GENOTYPE, IT'S NOT
CLEAR WHY IT WOULD OCCUR LATER
WITH AGE SO YOUR TWO OTHER
PLACES TO LOOK ARE GOING TO BE
THE ENVIRONMENT AND EVERYBODY
HAS DIFFERENT SIDES HANDS, YOU
DON'T WANT TO MANAGE GRIP
STRENGTH AND A HAND.
THEIR HANDS ARE GOING TO BE BE
DIFFERENT SIZES BUT IF YOU HAVE
YOUR EQUIPMENT GEARED TO THE
SIZE OF THE PERSON THAT YOU ARE
EXAMINING AND IT'S CALIBRATED,
YOU CAN GET VERY ACCURATE
MEASUREMENTS OF GRIP STRENGTH
AND IT'S ADD GUY PREDICT OR
ALONG WITH WALKING SPEED, FOR
EXAMPLE.
OF CONTINUED HEALTH SO THE
DECLINE IN GRIP STRENGTH.
THERE'S A RISE IN MUZZ MUSCLE AD
BONE AND THERE'S PLATEAU AND THE
DECLINE.
WHAT IS ILLUSTRATED HERE IS THE
SET ITER OWE GENEITY OF THE
EXAMINING VARIABLE WHICH IS
STRENGTH.
BUT THAT CAN BE HANDLED NOW.
THE TOOLS TO HANDLE
HETEROGENEITY IS AVAILABLE BUT
IT UNDERSCORES THE PRECISION
MEDICINE FOR MEDICINE GEARED TO
THE INDIVIDUAL AS WELL AS AT THE
POPULATION LEVEL BOTH NEED TO BE
ADDRESSED TO UNDERSTAND HOW
AGING TAKES PLACE AND WHAT WE
CAN DO ABOUT IT AND WHAT METRICS
WE MIGHT BRING TO BEAR.
WALKING SPEED.
THE RECORD HERE.
MOST OF US ARE BELOW THAT AND WE
COULDN'T SUSTAIN IT FOR 24 MILES
OR 50 KILOMETRES.
IF YOU LOOK AT DISEASES THERE'S
INCIDENTS IN CANCERS, ALL KINDS,
AND IT'S NOT MONATONIC IT'S
EXPONENTIAL UP TO THIS POINT AND
THEN IT SEEMS TO LEVEL OFF AND
SO YOU HAVE TO TAKE INTO ACCOUNT
WHEN YOU THINK ABOUT HOW TO
MEASURE AGING OF THE
CHARACTERISTICS OF HOW THINGS
CHANGE WITH AGE.
AND THEY BE MONATONIC OR NOT,
THEY MAY BE LINEAR OR NOT.
GENERALLY SPEAKING, FOR LOSSES
OF FUNCTION THEY'RE EXPONENTIAL
OR INCIDENTS OF DISEASE.
SO WE HAVE THE QUESTION OF
AGING.
THERE'S ARE TWO THAT IS TO SAY
IN GENERAL HOW DO YOU MEASURE
THE RATE OF AGING?
SO, THESE ARE TWO THAT CAME OUT
IN 2013 ALTHOUGH STEVE HORVATH
DID PUBLISH IN 2011 WHAT SHOULD
BE CONSIDERED THE FIRST AGING
PLOT.
BUT THE GENERAL IDEA HERE IS YOU
HAVE FROM AT THE TIME, 600
SOMETHING THOUSAND DNA
METHYLATION MARKS.
THAT'S METHAL CYTISINICLINE THAT
COULD BE MEASURED AND YOU FEED
THAT INTO A COMPUTER SO YOU HAVE
POPULATION OF DIFFERENT AGES AND
METH LAYING IN BLOOD CELLS AND
YOU ASK THE CUESER COMPUTER TO T
IF THAT LARGE MOUNTAIN OF
INFORMATION.
SO THE INTERPRETATION APPLIES TO
ANY OF THESE.
IF YOU ARE ABOVE THE LINE, YOUR
RATE OF AGING MAY BE FASTER.
IF YOU ARE BELOW THE LINE, YOUR
RATE OF AGING WOULD BE SLOWER
AND IF YOU ARE TRYING TO DEVELOP
AN INTERVENTION THAT SLOWS THE
RATE OF AGING, YOU MIGHT USE
SUCH DNA METHYLATION CLOCK IN
THE ORIGINAL PAPER, THEY HAD
T -- YOU COULDFIND IT IN THE BOA
CRIME SCENE.
IT'S THE BEST APPLICATION BUT
IT'S CHANGED SINCE THEN AND
THESE HAVE BECOME A BENCHMARK
WAY OF ANALYZING AGING ALONG
WITH SOME OTHER BIOCHEMICAL
CHANGES SUCH AS TILA MERE
SHORTENING OR THE HALLMARKS OF
AGING.
THIS IS A HIGHLY ACCESSIBLE AND
IT'S ACCESSIBLE IN LABORATORY
ORGANISMS, WILD POPULATIONS,
DOMESTIC ANIMALS AND US.
AND IT'S -- IT HAS A LOT OF
UTILITY BECAUSE BLOOD DRAWS ARE
QUITE FAMILIAR TO EVERYONE WHO
GOES TO THE DOCTOR.
SO, THERE ARE SOME QUESTIONS
THAT GO ALONG WITH THIS.
IS THERE A SINGLE RATE OF AGING?
SO IF YOU LOOKED AT THIS WAS A
BROAD POPULATION.
IF YOU LOOKED AT THE COMPONENTS
OF THE POPULATION YOU MIGHT SEE
ETHNIC GROUP OR SOCIOECONOMIC
STATUS OR ANY OTHER PARAMETERS
THAT YOU WOULD CARE TO PUT IN
YOU MIGHT SEE DIFFERENT RATES OF
AGING.
THAT'S THE LINE LOOKS DIFFERENT.
SO IF THIS IS YOUR REFERENCE
LINE OF THE WHOLE POPULATION,
SUB PARTS WILL ACTUALLY APPEAR
TO BE AGING SLOWER AND SOME
MIGHT APPEAR TO BE AGING MORE
QUICKLY.
AND IT'S NOT OBVIOUS WHICH WAY
THE PREDICTIONS SOME PEOPLE
MAINTAIN GREAT ROBUSTNESS IN
PHYSICAL ABILITY TO PERFORM BUT
MAY HAVE COGNITIVE IMPAIRMENTS
OR VICE VERSA AND SO IT'S NOT
CLEAR THAT THERE'S A SINGLE RATE
OF AGING.
THIS DELTA MIGHT INDICATE FASTER
AGING BUT DOES IT HAVE THE SAME
MEANING BIOLOGICALLY IF THAT
DELTA SAY 10 YEARS AT AGE 40 OR
10 YEARS AT AGE 60 OR 10 YEARS
AT AGE 80.
IF YOU ARE AN OPTIMIST, WHAT
DOES IT MEAN IF A PERSON IS 100.
SO, IT'S NOT CLEAR WHAT THE
DELTA AGE WOULD MEAN WHETHER
IT'S ACCELERATION OR
DECELERATION OF AGING.
THESE BLOOD CELLS ARE RESPONDING
BY CHANGING THEIR DNA
METHYLATION SO THAT'S ONE WAY OF
VIEWING THE MEANING OF CHANGES
IN DNA METHYLATION IN CELLS THAT
ARE NOT ORGAN SYSTEMS ON THE
OTHER HAND, AND TALKING TO
ISABEL PUREMAN SHE POINTED OUT
IT COULD WORK THE OTHER WAY
AROUND.
THAT IS THE BLOOD CELLS ARE
AGING AND BLOOD INTERACTS WITH
ALL THE ORGAN SYSTEMS SO THE
BLOOD CELLS ARE CONVEYING TO THE
ORGAN SYSTEMS, INFORMATION ABOUT
AGING, PROMOTING AIMING, OR
DECELERATING AGING AND THAT'S
THE OTHER WAY OF LOOK AGENT IT
AND BOTH POSSIBILITIES ARE
REALISTIC AND SOME FACTORS AND
OLD BLOOD TRANSFER TO YOUNG
ORGANISM AND VICE VERSA YOU CAN
DECELERATE AGING DEPENDING ON
THE PHENOTYPE THAT YOU ARE
MEASURING.
WE WOULD LIKE TO KNOW WHAT ALL
OF THESE DNA METHYLATION MARKS
MEAN.
IN TERMS ARE THEY VALID SUPPO
SUPPORTERS OF WHERE ARE THE
BOUNDARY CONDITIONS BECAUSE
THESE ARE STRAIGHT LINES THAT GO
ON FOREVER AND MAYBE THEY WERE
NOT AS EXTREME AND THAT REMAINS
TO BE SCENE SEEN SO IT'S A QUICK
OVERVIEW OF WHAT THE SUMMIT WILL
BE BASED ON THESE QUESTIONS HOW
WE THINK ABOUT AGING AND HOW WE
THINK ABOUT HEALTH AND WE'LL
START WITH A SET OF PRESENTATION
ONLYPREN ONHEALTH DISPARITIES.
IF GEROSCIENCE APPLIES WE HAVE
TO BEGIN WITH THE VIEW POINT
THAT GEROSCIENCE WILL APPLY TO
EVERYONE.
SO WE'LL ASK ABOUT HEALTH
DISPARITIES AND HOW IT PLAYS OUT
AND IT WILL LEAD INTO WHAT
POPULATIONS ARE ENGAGE IN THE
STUDY OF AGING.
THERE ARE MULTI MORBID TEASE
THAT ARE OLDER AGES AND MULTI
MORBIDITY AND THE POLY PHARMACY
INCREASES AND THOSE ARE AND
THOSE ARE PRESSING PROBLEMS.
NOT ONLY THE -- IF ONE CAN
ANTICIPATE WHAT IS NEXT FOR YOUR
PATIENT, THAT WOULD CERTAINLY
HELP THE PATIENT.
IT'S GUIDANCE ON THINGS WE COULD
DO WHAT METRICS DO YOU USE TO
EXAMINE AGING AND HOW DO YOU USE
THOSE TO MODEL AGING BECAUSE
MODELING OF BIOLOGICAL
PHENOMENON HAS BEEN FACILITATED
BY COMPUTER ADVANCES IN COMPUTEN
ABILITIES BUT HOW YOU MODEL IT
IS REALLY NOT ALWAYS CLEAR AND
TALKS I'VE HEARD AT VARIOUS
MEETINGS, THERE'S BEEN A GOOD
INTERCHANGE BETWEEN THE -- WE'RE
CONVERGING NOW ON BETTER WAYS TO
UNDERSTAND AGING.
IT TELLS YOU WHAT CAN YOU FIND
AND WHAT YOU SHOULD STILL BE
LOOKING FOR.
AND CAN YOU ASSEMBLE TOGETHER TO
GIVE YOU A BETTER PICTURE IN
ABOUT A PERSON'S HEALTH AS
THEY'RE AGING AND THERE'S THE
PRACTICE OF GERIATRICS AND HOW
IT'S INFORMED BY GEROSCIENCE AND
UNDERLYING THE PRACTICE AND
PULLING A LOT OF THIS TOGETHER
WOULD BE THE CLINICAL TRIALS
THAT CAN BE DONE IN ORDER TO
DETERMINE WHETHER AN
INTERCEPTIONS IS EFFECTIVE IN
PRODUCING GREATER HEALTH AT
OLDER AGES.
AND THAT'S REALLY THE KEY.
IS TO PRODUCE -- TO AID THE
POPULATION TO AGE BETTER.
THANK YOU.
WELCOME TO THE FOURTH
GEROSCIENCE SCIENCE SUMMIT AND
I'LL TURN IT OVER.
[APPLAUSE]
>>ALL RIGHT.
GOOD MORNING, EVERYONE.
I CAN ACT UP, I'M AT HOME,
RIGHT.
GOOD MORNING, EVERYONE.
SO, YOU KNOW, I'M SO EXCITED
ABOUT THE OPPORTUNITY TO SERVE
AS YOUR CHAIR AT A PANELIST ON
THE FIRST SESSION.
I WANTED TO SAY THANK YOU TO THE
ORGANIZERS AND JUST JOIN ME IN
GIVING Dr. KOHANSKI ANNA
PLOWS.
A ROUND OF
APPLAUSE.
[APPLAUSE]
>>I WANT TO SHARE HOW WE'RE
ORGANIZED IN THIS NEXT -- UP
UNTIL NOON.
WHAT WE'RE GOING TO DO HERE IS
WE'RE GOING TO HEAR FOUR
PRESENTATIONS AND WE'LL HEAR
FROM TWO PANELISTS AND WHAT
WE'VE DECIDED TO DO IS WE'RE
GOING TO HEAR ALL OF THE
PRESENTATIONS, THEN THE TWO
PANELISTS AND THEN WE'LL OPEN IT
UP FOR QUESTION AND ANSWER.
SO PLEASE HOLD ON TO YOUR
QUESTIONS BECAUSE WE WANT TO
HAVE A GROUP -- WE FEEL IT WOULD
BE BETTER TO HAVE A MORE ROBUST
AND GROUP DISCUSSION IN THE END
AFTER YOU HEAR ALL OF THE TALKS.
SO OUR GOAL HERE TODAY IS TO
THINK ABOUT, TO BE ABLE TO THINK
ABOUT HOW WAYS GEROSCIENCE AND
THE BIOLOGY OF AGING CAN PROVIDE
IMPORTANT AND NEW INSIGHTS INTO
UNDERSTANDING THE DISPARITIES OF
AGING OF OLDER ADULTS IN LATER
LIFE AS WELL AS DIVERSE
POPULATIONS.
AS YOU MAY KNOW, ONE OF THE KEY
THINGS AS IT RELATES TO HEALTH
DISPARITY WE'VE COME TO LEARN
OVER THE LAST TWO DECADES,
HEALTH DISPARITIES IS A RESULT
OF THE SYNERGISTIC EFFECTS OF A
NUMBER OF DIFFERENT FACTORS
OPERATING.
WE HAVE CYCLE SOCIAL FACTORS,
CULTURAL FACTORS, BIOLOGICAL
FACTORS AND UP WIT ONE OF THE TN
IMPROVE UPON AND WE HAVE AN
OPPORTUNITY IN THIS SPACE THE
NEXT THREE DAYS IS THINK HOW TO
BETTER SITUATE AND INTERNET
OPINTEGRATETHIS.
WE HAVE SUCCESS IN OTHER FACTORS
BUT THINKING ABOUT HOW TO
INGRATE IN BIOLOGY AND A LIFE
COURSE PERSPECTIVE IS IMPORTANT.
I WANT TO INTRODUCE ALL OF OUR
SPEAKERS AND THEN HAVE THEM COME
UP AND WE'LL ENGAGE IN FRUITFUL
DISCUSSION.
OUR FIRST SPEAKER IS Dr. FIRST .
PEREZ-STABLE.
HE IS RECOGNIZED AS A LEADER IN
LATINO HEALTHCARE AND
DISPARITIES AND HE SPENT PRIOR
TO COME TO NIH HE SPENT 32 YEARS
LEADING RESEARCH ON TOBACCO
CONTROL AND IN LATIN AMERICAN
AND THE UNITED STATES AND
FOLLOWING Dr. PEREZ-STABLE WE
WILL HEAR FROM Dr. SHANNON
ZENK WHO IS THE DIRECTOR OF THE
NATIONAL INSTITUTE ON NURSING --
OF NURSING RESEARCH.
SHE WAS PREVIOUSLY A NURSING
COLLEGIATE PROFESSOR AT THE
UNIVERSITY OF ILLINOIS CHICAGO.
HER OWN RESEARCH FOCUSES ON
SOCIAL INEQUITIES IN HEALTH WITH
A GOAL OF IDENTIFYING EFFECTIVE
MULTI-LEVEL APPROACHES TIME
PROVE HEALTH AND ELIMINATE
RACIAL ETHNIC SOCIAL ECONOMIC
DISPARITIES.
AFTER WE'LL HAVE FROM Dr.
WALLACE FROM THE OFFICE OF THE
DIRECTOR OF THE NATIONAL CANCER
INSTITUTE AND CENTER TO REDUCE
CANCER HEALTH DISPARITIES AND
PRIOR TO JOINING NCI, SHE WAS AN
ONCOLOGIST SCIENTIST AT THE
HUMAN GENOME SCIENCES A
BIOMEDICAL PHARMACEUTICAL
CORPORATION.
AND CLOSING OUT OUR SPEAKER IS
Dr. STACEY CARRINGTON
LAWRENCE, WHO IS A DEPOSIT YOU
AT THE DIRECTOR OF DIVISION OF
AGE AND BIOLOGY AND PRIOR TO
JOINING NIA IN 201, SHE WAS A
SENIOR SCIENTIFIC ADVISER IN THE
OFFICE OF AGING RESEARCH.
HER EXPERTISE ENCOMPASSES AREAS
INCLUDING HEALTH DISPARITIES
RESEARCH, HIV RELATE CODE
MORBIDITY AND CO INFECTION AND
STRUCTURAL BIOLOGY, SYSTEM
BIOLOGY AND IMMUNOLOGY AND BASIC
VIROLOGY AND AFTER WE HEAR THOSE
FOUR PRESENTATIONS, WE'LL HAVE
TWO PANELISTS, THE FIRST WILL BE
Dr. JERMAINE DAVIS AND
BIOPHYSICAL CYST AND AND HIS
RESEARCH AIMS TO DETERMINE HOW
GENETIC VARIANTS OF PROTEIN
ABCCA7 CONFER RISK FOR
ALZHEIMER'S FOR AFRICAN
AMERICANS AND I'M ROLLAND THORP
I'M A PROFESSOR AT THE PLOOM
BURG SCHOOL OF PUBLIC-HEALTH AND
MINORITY AGING RESEARCH.
PLEASE HELP ME JOIN Dr.
PEREZ-STABLE.
[APPLAUSE]
>>Eliseo J. Perez-Stable: GOOD
MORNING, EVERYBODY.
I WANT TO THANK RICHARD HODES
AND RON FOR PUTTING THIS ON.
I HAVE A LOT OF ROOTS IN NIA, AS
YOU WILL SEE.
I'VE BEEN HERE AT NIH NOW FOR
OVER SEVEN AND A HALF YEARS.
SO I'M GOING TO TRY TO PUT IN
CONTEXT THE IDEA OF HEALTH DIS
PDISPARITIES FRAMEWORK AND
SHANNON WILL ADD MORE ON THE
STRUCTURAL ISSUES.
.
SO MY GOALS FOR YOU IN THE NEXT
20 MINUTES OR SO WILL BE TO LOOK
AT WHAT THIS WORKING DEFINITION
TO FACILITATE INTER DISCIPLINARY
COLLABORATION.
IT'S CRITICAL FOR US TO ADVANCE
IN THIS AUDIENCE.
THAT WOULD BE MY MAIN GOAL.
I'LL SHARE A LITTLE BIT OF A
CONCEPTUAL FRAMEWORK PROCESS.
I'M A GENERAL INTERNIST SO I'M
NOT A SOCIAL SCIENTIST OR
THINKING IN THOSE TERMS.
I LEARNED IT THIS ALONG THE WAY
OF MY RESEARCH, PARTICULARLY
THROUGHOUT THE LATTER PART OF
THE '90s AND IN 2000s.
I WILL TRY TO DWELL ON THE
EMPHASIS OF INDIVIDUAL FACTORS
UNDERSTANDING THAT Dr. ZENK
WILL COVER MORE ON THE
STRUCTURAL SIDE.
I'LL START WITH DEFINITIONS.
THESE ARE THE POPULATION WITH
HEALTH DISPARITIES.
THERE MIGHT BE A DIFFERENT
PERSPECTIVE.
THIS IS OFFICIALLY WHAT NIH
ACKNOWLEDGES.
WE LEAD THIS EFFORT AT NIMHD AND
IT'S IN OUR CONGRESSIONAL
MANDATE FROM THE YEAR 2000.
THOSE FIRST THREE BULLETS ARE
THERE, RACIAL AND ETHNIC
MINORITY POPULATIONS AS DEFINED
IN THE CENSUS.
FOR PEOPLE OF ANY RACE,
ETHNICITY AND UNDERSERVED ROLE
RESIDENTS.
BRIEFLY IF YOU LOOK AT ORIGINAL
LEGISLATION, WHICH WAS REDONE IN
2010 WITH THE AFFORDABLE CARE
ACT, 90% OF THE 'E EMPHASIS IS N
RACIAL AND ETHNIC GROUPS.
THERE'S LANGUAGE THAT SAYS IF IF
THERE ISN'T A PROVEN DISPARITY
NOT ALL MINORITY GROUPS NEED TO
BE INCLUDED.
CLEARLY, FROM OUR PERSPECTIVE,
RACE ETHNICITY, THIS IS
SELF-IDENTIFIED SOCIAL CONSTRUCT
THAT EXPLAINS SO MUCH THAT WE
DON'T UNDERSTAND AND SOCIAL
ECONOMIC STATUS, SOCIAL CLASS,
THE TWO PILLARS OF OUR SCIENCE.
AND INTERACTIONS WITH OTHER
POPULATIONS UNDER SERVE
RESIDENTS OR SEXUAL AND GENDER
MINORITIES LOOKING AT THAT
INTERSECTION KEEP IN MIND THESE
POPULATIONS WITHOUT DISPARITIES
APPLY TO THE ENTIRE AGING AND
THIS IS NOT AN DOMAIN ONLY.
AND SO ALL INTERNET STUDENTS AND
CENTERS ARE EXPECTED TO DO
RESEARCH AND SOME RESEARCH ON
HEALTH DISPARITIES AS IT APPLIES
TO THEIR AGENDA AND WE ENDORSE
THIS CONCEPT THAT EVERY
POPULATION WE SAY HAS HELPED
DISPARITIES HAS A SOCIAL
DISADVANTAGE THAT RESULTS IN
PART OF THIS IS A CENTRAL PART
OF THIS DEFINITION AND THEN ALSO
IN ADDITION IN CLINICAL CARE,
ALMOST ALWAYS FOLLOWED WITH
BEING UNDERSERVED IN HEALTHCARE?
SOMEWAY.
WE HAVE USED A HEALTH OUTCOME
WORSE IN THESE POPULATIONS
COMPARED TO A EVERYONE GROUP AND
THE MAJORITY POPULATION AND IT
DEFINES THE HEALTH DISPARITIES.
WE'RE THINKING WE MIGHT WANT TO
RETHINK THAT THIS YEAR AND
CREATE MORE ASPIRATIONAL
CONTROLS OF WHERE WE SHOULD BE
AT A POPULATION AND I'LL SHOW
YOU A REASON WHY.
TO RERATE THE FUNDAMENTAL THEY
EXPLAINS SO MUCH THAT IN OUR
PERSPECTIVE, EVERY CLINICAL
STUDY, EVERY STUDY WITH HUMAN
BEINGS NEEDS TO CONSIDER THESE
FACTORS WITH MECHANISMS AND
OUTCOMES.
IT DOESN'T MEAN YOU HAVE TO
POWER EVERY STUDY TO LOOK AT
DIFFERENCES AND IT DOESN'T MEAN
IT WILL ALWAYS BE AN IMPORTANT
CONTRIBUTE OR BUT BECAUSE WE
DON'T UNDERSTAND THE WAYS TO
IMPACT HEATH AND TWICE AS MANY
STROKES AND WHEN COMPARED TO
THEIR WHITE COUNTERPARTS FOR THE
EXACT BLOOD PRESSURE AND THE 45
AND 64 AND THIS IS SYSTEM I CAN
BLOOD PRESSURE AND AND IF YOU
LOOK AT THE RACE OF ALL TIMES
DISEASE AND REEMPHASIZE THE
IMPORTANCE OF BOTH OF THESE
FACTORS.
THESE ARE, AS A PICTURE FROM A
PAPER THAT WAS PUB LASHED LAST
SUMMER IN LANCE ITS,
COLLABORATION, WE HAD WITH THE
INSTITUTE FOR HEALTH METRIC
EVALUATION AND THE SAME GROUP
THAT PRODUCES A LOOKING AT THE
UNITED STATES BY SUB POPULATION
BY RACE AND ETHNICITY AND IT'S
COMPARING THE LIFE EXPECTANCY TO
WHITES BY BLACKS OR AFRICAN
AMERICANS AND AMERICAN INDIANS
AND ALASKA NATIVES AND ASIANS
ALTHOUGH IT DOES SAY PACIFIC
ISLANDERS IT'S ONLY ASIANS IN
THAT PICTURED HERE AND IF YOU
WERE BLUE PURPLE YOU ARE BETTER
THAN WHITES IF YOU ARE IN THE
FELLOW BROWN RANGE YOU ARE DOING
AND WE SEE IN THIS SLIDE THIS
LATINOS AND ASIAN HAVE LONGER
LIFE EXACTLIFE EXPECTANCY THAN .
WE'VE KNOWN THIS FOR A LONG TIME
IN LATINO AND PROVEN FOR ASIANS
AS WELL AND GEOGRAPHY MAY
MATTER.
NORTHERN ARIZONA, THE RIO GRANDE
VALLEY IN TEXAS AND EVEN IN
HAWAII, THE OUTCOMES ARE NOT
GOOD.
WITH BLACKS OR AFRICAN AMERICANS
WE SEE AREAS OF THE UNITED
STATES WHERE AFRICAN AMERICANS
ACTUALLY DO BETTER THAN WHITES
ALTHOUGH IN GENERAL IN THE CORE
PART OF THE SOUTHEAST WE SEE
WORSE OUTCOMES AND IN AMERICAN
INDIANS AND ALASKA NATIVES THEY
HAVE WORSE OUTCOMES SO THERE ARE
AREAS WHERE THEY MAY BE EQUAL OR
BETTER BUT OVER ALL, THEY HAVE
THE WORST OUTCOMES OF ANY OF THE
RACIAL AND ETHNIC GROUPS.
WE LOOK AT ISSUES RELATED SO AND
USING HOUSEHOLD INCOME AND THESE
ARE DATED 10 YEARS AGO AND YOU
ARE UNDER THE POPPER TEE LEVEL
ROUGHLY TASK THOUSAND DOLLARS
FOR HOUSEHOLD OF FOUR AND THE
THREE TIMES MORE LIKELY TO DIE
FROM ANY CAUSE COMPARED TO
SOMEONE'S HOUSEHOLD WITH A
INCOME OF $115,000 WHICH IS WELL
OFF BUT IT'S NOT WEALTHY AND SO
THIS LYNN YEAR RELATIONSHIP WITH
OUTCOME OF LIFE EXPECT SCAN SEE
IS ROBUST AND PERHAPS OTHER THAN
AGE THIS WAS PREVIOUSLY SHOWN
NOT TOO MANY PHYSIOLOGICAL
MEASURES THAT WE TAKE HAVE THIS
KIND OF LINEAR AND ROBUST
RELATIONSHIP MAYBE TOBACCO
SMOKING, MAYBE BODY MASK INDEX
AND SYSTEM I CAN BLOOD PRESSURE
AND HOW MANY KNOW THE SOCIAL
ECONOMIC STATUS OF THEIR
PATIENTS.
THERE WAS A PUBLICATION FROM THE
SURVEY LESS SYSTEM AND YOU CAN
SEE THE DISTRIBUTION
PREDOMINANTLY WHITE AND 60% OF
THE U.S. POPULATION IN 2020 WAS
IDENTIFIED AS WHITE.
BUT REGARDLESS, ALMOST 10%
REPORTED SOME LEVEL OF
SUBJECTIVE KIND OF DECLINE
WITHIN THE PRIOR YEAR AND THIS
WAS HIGHER FOR AMERICAN INDIAN
AND ALASKA NATIVES AND LATINO
HISPANICS AS WELL AND LOWER FOR
ASIANS AND WHITES AND BLACKS IN
THIS STUDY WERE NOT THAT
DIFFERENT.
WE SEE THE INFLUENCE OF AGE, OF
COURSE, AND EDUCATION AS WELL AS
SOCIAL SUPPORT AND SO THE
FACTORS OF OF WHAT THE
INDIVIDUALS BRING TO THE TABLE,
BY DESIGN, SO YOU ARE RACE
ETHNICITY YOUR SOCIAL CON TRUCK
AND OTHER ASPECTS OF SOCIAL AND
BEHAVIORAL SCIENCE, INTERACTING
WITH BIOLOGY TO DETERMINE
OUTCOME AND AND WITH OTHER
INSTITUTES WE HAVE SET UP A
SOCIAL DETERMINANTS OF HEALTH
MEASURES AT THE PHOENIX TOOLKIT.
THIS IS A PROCESS THAT BEGAN IN
2018 AND WE'VE HAD TWO SICK
CYCLES AND MOST OF THE EFFORTS
HAS BEEN VETTING STRUCTURAL
SOCIAL DETERMINANTS OF HEALTH
PROTOCOLS AND IN PHOENIX THESE
CON TRUCKS OR SURVEYS ARE CALLED
PROTOCOLS ARE MEASURES THE PAST
SET WAS DES OF 2022 AND THE
DEMOGRAPHICS AND INDIVIDUAL
PERMANENT WERE MOSTLY ALREADY
THERE GATHERED TOGETHER AND SOME
OF THEM WERE EVALUATED IN OUR
FIRST EICHEL BUT MOST WERE
PRESENT AND HAD BEEN PUT ON THE
PHOENIX WEBSITE BY OTHER
INSTITUTES IN THEIR ESPECIALLY
NCI AND NIADA AND WE'RE GOING TO
RETHINK OR REWALL WAIT SOME
GIVEN THE PROPOSAL FOR CHANGING
THE WAY RACE AND ETHNICITY IS
QUARRIED IN THE CENSUS AND IT'S
OUT FOR PUBLIC COMMENT NOW.
SO LET'S TALK ABOUT FRAMEWORK.
I WOULD LIKE TO TALK ABOUT THIS
MODEL.
IT IT'S USED BY SCIENTISTS IN
GENERAL INTERNAL MEDICINE AND
POPULATION SCIENCE TO EMPHASIS
HOW LITTLE IMPORTANCE HEALTHCARE
HAS TO YOUR HEALTH OUTCOMES.
AND IT'S ONLY ABOUT 10% OF
OUTCOMES AND WE SEE A BEHAVIOR
OVER 20 YEARS AGO McGINNIS
ADDRESSING PREMATURE MORTALITY.
THE GENETIC QUADRANT OF 30% IS
BECAUSE WE DON'T REALLY KNOW.
ESPECIALLY BACK THEN, WHEN THIS
WAS DESIGNED SOCIAL
INCOMPETENTER ACTIONS AND I
WOULD EMPHASIZE THAT THINKING
ABOUT THIS KIND OF PIE CHART,
THIS IS FOR SOMEONE WHO COMES
HEALTHY TO O THE QUESTIONS SO
SOMEONE WHO DOES NOT TAKE A
CHRONIC MEDICATION.
AS WE AGE, THOSE FACTORS ARE AND
MORE COMMON 30% HAVE MORE THAN
ONE CHRONIC DISEASE AND IN A
RECENT REPORT THAT I LOOKED AT
ALMOST 60% OF ADULTS OVER THE
AGE OF 65 TAKE A PRESCRIPTION
MEDICINE AND SO WHAT IS NORMAL
HAPPENS AS WE AGE AND THE ROLE
OF HEALTHCARE SYSTEMS INCREASES
SIGNIFICANTLY.
THIS WAS MY CRUDE ATTEMPT WHEN I
TAUGHT HEATH DISPARITIES COURSE
IN THE EARLY PART OF THE 2000s
AT UC SAN FRANCISCO, AS PART OF
THE CTSA PROGRAM AFTER IT WAS
FUNDED TO LOOK AT MULTI-LEVEL
DETERMINANTS OF DISPARITIES SO
WHAT GOES IN FACTORS THAT
INFLUENCE HEALTH AND HEALTHCARE
DISPARITIES AND ALL OF THESE
ELEMENTS ARE LISTED AND THEY'RE
CAPTURED AND THERE'S NO REAL
LEADERSHIP HERE AND IT WAS
TRANSMIT TAG WE WORRY ABOUT
INDIVIDUAL FACTORS THAT PEOPLE
BRING ON THE DEMOGRAPHIC AND THE
PSYCHOSOCIAL AND BEHAVIOR AND
THE BIOLOGICAL FEAR BUT ALSO
THERE ARE THESE OTHER CONTEXTUAL
FACTORS THAT REALLY MATTER
INCLUDING THE HEALTH-CARE
SYSTEM.
AT THE TIME, THE INFORMATION
ABOUT THE BIOLOGICAL FACTORS
PARTICULARLY INITIALLY WITH THE
GENOME PROJECT AND GENETICS, WAS
JUST REALLY ON AN ASTRO KNOT I
CANAL RISE AND WHERE THE ROLE
WAS WITH REGARDS TO WHAT WE KNEW
FROM POPULATIONS AND CLINICAL
SCIENCE, REALLY
BROUGHT HOME THE IMPORTANCE OF
STRUCTURAL FACTORS AND
INDIVIDUAL HEALTH AND WHEN THEY
WENT THROUGH A VISIONING
PROCESS, AND A NUMBER OF YEARS
AGO, IT WAS BEFORE I A RIDE AT
NIH CAN Dr. MADDOX LEADING
THAT EFFORT THESE WERE FACTORS
THAT WERE EXTRACTED FROM THAT
AND IT REALLY HAVE INFORMED OUR
FRAMEWORK.
NOTICE ON THE LEFT THESE SAME
CATEGORIES OF INDIVIDUAL FACTORS
WITH BEHAVIOR AND BIOLOGY AND
THE IMPORTANCE OF THE PHYSICAL
ENVIRONMENT HAD BECOME OBVIOUS
BY THEN AND YET THE SOCIAL
ENVIRONMENT HOW WE INTERACT WITH
PEOPLE AS VICTIMS OR FAMILY
UNITS OR GROUPS OF PEOPLE AS
WELL AS COMMUNITIES HAVE BEEN
KNOWN FOR DECADES TO BE
INFLUENTIAL IN HEALTH AND
INTERACTIONS BEING PROTECTIVE
AND OTHERS NOT BEING PROTECTED.
THE IMPORTANCE OF HEALTH AND
PUBLIC HEATH CARE SYSTEMS SHOULD
NOT BE UNDER EMPHASIZED FOR MANY
REASONS AND ESPECIALLY AS WE GET
OLDER AND CLINICIANS HAVE A
MAJOR ROLE TO PLAY IN ALL OF
THIS.
FROM NIMHD FILES, I FOUND THIS
CONCEPTUAL FRAMEWORK THAT WAS
USED IN TEACHING ABOUT HEATH
DISPARITIES BEFORE I ARRIVED AT
NIMHD AND THIS WAS 2013 IN THE
COURSE AND ALL OF THESE FACTORS
WERE INCLUDED DO NOTE, HOWEVER,
THE EMPHASIS ON RACISM.
AND I WOULD SAY COME BACK TO
THIS AS A CENTRAL FACTOR IN
HEALTH DISPARITIES, RAISES
DISCRIMINATION, IN THE U.S.
WHEN I WAS ON THE NATIONAL
INSTITUTE ON AGING COUNCIL,
THERE WAS A REVIEW OF THE HEALTH
DISPARITIES PORTFOLIO.
I DIDN'T REALLY UNDERSTAND THE
REASONS OR WHY I WAS PUT IN THAT
ROLE BUT I WAS IN MY FIRST YEAR
ON COUNCIL WITH Dr. BERNARD
BEING THE MAIN DRIVER OF IT AND
AFTER REVIEWING THE PORTFOLIO
AND UNDERSTANDING A LITTLE BIT
MORE OF WHAT NIA WAS DOING AND
HOW DISPARITIES, ONE OF THE
RECOMMENDATIONS WAS THAT THERE
SHOULD BE A PERSON HIGHER FOR
SPECIAL POPULATIONS THERE AND
UNDERSTAND THE INFLUENCE OF
COUNCIL ADVISE AND DID HODES
WOULD HIRE SOMEONE.
WE WERE SUPPOSED TO DEVELOP A
FRAMEWORK, A FRAMEWORK OF HEALTH
DISPARITIES.
RAATZ.
MODIFIED AND EXPANDED AND WITH
CARL HILL, MARIE BERNARD AND
Dr. KAPLAN WHO WAS ON COUNCIL
AS WELL.
AND CAPTURING THE DIFFERENT
COMPONENTS, ENVIRONMENT, SOCIAL,
CULTURAL, BEHAVIORAL AND
BIOLOGICAL.
THIS PROCESS, THINKING ABOUT
THIS IN A SORT OF A ROADMAP KIND
OF WAY, MADE ME ASK STAFF AT
NIHMD TO DEVELOP A FRAMEWORK
WHEN I ARRIVED NIA A IN 2015 ANS
WHAT WAS PRODUCED.
IT NEEDS TO BE RE-EVALUATE AND
RETHOUGHT OF AND IT HAD
SUGGESTION AND RECENT
PUBLICATION ADDING A BAND
BETWEEN THE PHYSICAL AND THE
SOCIAL CULTURAL ENVIRONMENT
FOCUSED ON THE DIGITAL
ENVIRONMENT WHICH I THOUGHT WAS
INTERESTING.
OTHERS HAVE ARGUED FOR THE ONE
HEALTH APPROACH AND WHAT ABOUT
THE ANIMAL AND PLANT WORLD AND
HOW IT INTER FACTS WITH HUMANS
AND IN FACT I WAS PART OF
WRITING UP A PROCESS FROM A
FORMER MENTEE OF MINE BUT I
THINK THE EMPHASIS IS HERE.
WE LOOK AT THE INDIVIDUAL
COLUMN, GOING TO SOCIETAL POLICY
CHANGES THAT INFLUENCE HOW A
MAJORITY OF OUR RESEARCH AT
NIMHD REMAINS IN THAT FIRST
COLUMN AND I HAVE TO SEE WHAT
THE LAST YEAR PORTFOLIO ANALYSIS
WOULD SHOW AND IT ISN'T AS
STRAIGHT FORWARD AS SAYING WELL
THIS IS A DISTRIBUTION AND SO WE
HAVE OUR RO1 AND ACROSS THE
SPECTRUM KNOW AND FOCUS ON
INDIVIDUAL RESEARCH AND PUSHING
THINGS TO BE RIGHT WILL BE
IMPORTANT IF YOU ASK ME WHAT'S
THE CAUSAL PATHWAY HERE?
THERE IS NONE DEPICTED IN THIS
FRAMEWORK NOR IS THIS INTENDED
TO BE COMPREHENSIVE AND I WOULD
SAY IT'S PROBABLY RIGHT TO LEFT
AND I WOULD GENRE EMPHASIZE THE
IMPORTANCE OF THE HEALTH-CARE
SYSTEM FOR 50% OF THE U.S.
POPULATION AND MAYBE EVEN A
THIRD OF THE U.S. POPULATION
WHERE IT BECOMES CRITICAL FOR
HALF OF THE ADULTS IN THE U.S.
IS IT'S A RELATIVELY SMALL OR
VERY MODEST RELEVANCE SINCE ONE
CAN GET MOST PREVENTATIVE
INTERVENTIONS NOW INTERACTION
WITH MINIMAL INTERACTION S WITH
A CLINICIAN.
IN TERMS OF VACCINATION OR TESTS
THAT ARE RECOMMENDED.
OUR COLLEAGUE, JAMES JACKSON WHO
WE LOST A FEW YEARS AGO
DEVELOPED A THEORY ABOUT CHRONIC
STRESS RACE AND UNHEALTHY
BEHAVIOR AND SOME OF YOU
FAMILIAR WITH THIS AND IT WAS
VERY CONTROVERSIAL WHEN JAMES
PUBLISHED THIS.
I DON'T WANT TO GO INTO DETAILS
WHAT THE VALUE OF THIS AND IT'S
THE THINKING THAT WENT INTO IT
SO, THE GROUPS SAID WELL
DEPRESSION AND SUICIDE IN WHITES
ARE MUCH HIGHER AND EVEN OVER
ALL YOU SEE AFRICAN AMERICANS
HAVING WORSE HEALTH.
HOWEVER, SUBSTANCE USE AND
REFLECTELLED BY EXTREME OR
MODERATE OBESITY AS WELL ARE
MORE COMMON AMONG AFRICAN
AMERICANS AND DIFFERENCES HAVE
REALLY ATTENUATED AND FROM THE
LATE 80 AND LOOKING AT CHRONIC
STRESS AND CHRONIC CONDITIONS IN
TWO YEARS OF FOLLOW-UP AND THEY
CONCLUDED ON STRENGTHEN
STRESSORS AND LEADING TO MORE
DEPRESSION DIAGNOSIS AMONG
WHITES.
AMONG BLACKS ON HEALTHY
BEHAVIORS WERE SOMEWHAT
PROTECTED FOR MENTAL HEALTH
CONDITIONS IT INCREASED BECAUSE
OF OTHER UNHEALTHY BEHAVIORS
OPPOSED TO MEMBER HEALTH AND THE
DEPRESSION AND SUICIDE AND I
FREQUENTLY THAT'S HOW MANY OF US
APPROACH THESE ISSUES AND NUMBER
OF BIOLOGICAL MEASURES WITH
CHRONIC STRESS AND RESEARCH HAS
BEEN USED AND WE'LL GO THROUGH
THEM IN DETAIL HERE AND MOST OF
THE ONES THAT PEOPLE ARE
FAMILIAR WORKING WITH HAVE
GATHERING OF WHAT IS CALLED
ALICE STATIC LOAD FOLLOWING THE
WEATHERING HYPOTHESIS THAT ARE
GENERATED OUT OF UNIVERSITY OF
MICHIGAN LOOKING AT
PHYSIOLOGICAL RESPONSE TO
CHRONIC STRESS AND OR CORTISOL
AND FLAM TORI ACCESS AND OTHER
INFLAMMATORY MARKERS AND THIS
LOOKED AT AND SLEEP AND A REALLY
IMPORTANT ACTIVITY AND SUPPOSED
TO SPEND UP TO A THIRD OF OUR
TIME IN SLEEP HAS BEEN EVALUATED
ALTHOUGH MEASUREMENT IS A
CHALLENGE AND THE FUNCTIONAL MRI
AS ANOTHER MEASURE AND PEOPLE
HAVE TO USE AND LET ME TRY TO
WIND DOWN WITH DISCUSSION ABOUT
RACISM AND DISCRIMINATION.
THESE ARE DATA FROM ABOUT 10
YEARS AGO AND FROM THE KAISER
FAMILY FOUNDATION OF AMERICANS
AND OVER THIRD OF LATINO AND
OVER HALF OF AFRICAN AMERICANS
SAID YES TO THE QUESTION OF HAVE
YOU BEEN TREATED UNFAIRLY
BECAUSE OF RACE OR ETHNIC
BACKGROUND IN A VARIETY OF
SETTINGS INCLUDING HEALTHCARE.
THIS IS BEFORE THE PANDEMIC AND
THIS IS BEFORE THE MURDER OF
GEORGE FLOYD.
THIS IS A TIME WHEN IT WAS MAYBE
NOT SCIENTIFIC TO TALK ABOUT
RESEARCH ON RACISM AND AS MUCH
AND I REMEMBER A CONVERSATION
WITH DR. TABAK WHEN I GOT HERE
ABOUT THIS ISSUE.
THIS WAS A TIME WHEN TALKING
ABOUT RACISM OR DISCRIMINATION
WAS CLEARLY NOT POLITE
CONVERSATION.
WITHIN EVERYONE EVEN AMONG
BETWEEN DIFFERENT RACIAL AND
ETHNIC GROUPS AND THINKING ABOUT
RACISM AS A RESEARCH CONSTRUCT
IS REALLY IMPORTANT IF WE
OPERATIONALIZE AND EVALUATE IT
AND INFLUENCE ON OUTCOMES AND
ALMOST ALL OF THE WORK THAT YOU
HAVE HEARD ABOUT, OR READ, HAS
BEEN ON INTRA PERSONAL ACCESS
WITH MEASURES THAT HAVE BEEN
WELL DEVELOPED AND SOUND.
THERE ARE SOME ASPECTS THAT ARE
INTERNALIZED WHICH IS WHAT THE
MEASURES OF LOAD AND OTHER
COGNITIVE MEASURES TRY TO GET AT
SO INDIVIDUALS SAY I'M NOT A
VICTIM AND I'VE NEVER HAD
EXPERIENCED ANY RACISM AND THEY
HAVE A ADOPTED THE RESPONSE AND
COG IN THEY'VELY OR
PHYSIOLOGICALLY.
THERE ARE OTHER ASPECTS THAT ARE
MUCH LESS WELL STUDIED.
IT WAS A STUDY FROM AMONG YOUTH
IN LOS ANGELES AND LOOKED AT
PERCEIVED SOCIETAL SO 14, 15 AND
DON'T HAVE MUCH EXPERIENCE TO
VERBALIZE WHAT THEY WOULD CALL
RACISM OR DISCRIMINATION BUT
THEY CAN SEE WHAT THEY HAVE
OPINIONS ABOUT SOCIETY AND THIS
IS BEYOND RACE ETHNICITY SO IT
INCLUDES BODY WEIGHT AND OTHER
ASPECTED ASKED IN THAT STUDY AND
A PROSPECT DESIGN AND INFLUENCE
AND BEHAVIOR AND I DON'T KNOW IF
ANYONE HAS DONE ENOUGH WORK ON
THE SECONDHAND EFFECTS OF RACISM
SO INDIVIDUALS WHO ARE EXPOSED
TO SOMEONE WHO IS TRAUMATIZED BY
BEING AROUND RACISTS.
THIS IS A MAP OF WASHINGTON D.C.
AND I EXPECT Dr. ZENK WILL
COVER MORE BUT TO BRING HOME THE
POINT ABOUT RED LINING.
PEOPLE DID NOT CHOSE NECESSARILY
TO LIVE IN SEGREGATED
NEIGHBORHOODS.
THIS WAS A POLICY DESIGNED BY
THE GOVERNMENT TO SEPARATE OUT
BLACKS OR NEGROES CALLED AT THE
TIME, WHICH WAS A REPRESENTED
LOW GRADE PROPERTIES SO THE
MECHANISM WAS TO BANKING SYSTEM
AND BANKS WOULD NOT LOAN MONEY
TO FAMILIES IN THESE AREAS TO
BUY PROPERTY OR WOULD MAKE IT
MUCH HARDER TO LOAN MONEY.
SO, THE WAY FAMILIES IN THE U.S.
BUILD EQUITY, MUCU.S. TO OWNSO N
THOUGH IT WAS LEGAL TODAY, IT
HAS HAD ITS EFFECTS IN THE U.S.
THIS IS ONE EXAMPLE OF AN
INTERVENTION WHERE WE MAY SEE
AND I KNOW NIA HAS FUNDED A
NUMBER OF BEHAVIORAL ECONOMIC
STUDIES, THIS WAS FUNDED BY
LOOKING AT DIABETES AND 60
AFRICAN AMERICAN WITH MILWAUKEE
WITH POOR CONTROL OF DIABETES
AND DEPENDING ON THE INCENTIVES
YOU SEE DROPS IN HEMOGLOBIN A1C
OVER THE COURSE OF THREE MONTHS
THAT WERE ALL SIGNIFICANT BUT
MODERATE OR HIGH FREQUENCY BEING
BETTER.
LET ME END WITH JUST SOME GLOBAL
THOUGHTS.
INTERVENTIONS TO ADDRESS
DISPARITIES NEED TO BE THOUGHT
OF FROM THE START AS MULTI
LEVEL.
WE'RE NOT GOING TO FIND THE
MAGIC PILL HERE THAT IS GOING TO
SOLVE DISPARITIES OR THE
BEHAVIOR CHANGES THAT IS GOING
TO TAKE ARE KAY OF IT OR THE
POLICY CHANGE FOR THAT MATTER.
WE REALLY NEED TO THINK IN
MULTIPLE LEVELS AND MULTIPLE
DOMAINS OF INFLUENCE.
I WANT TO EMPHASIZE THE
IMPORTANCE OF INTERSECTIONALITY
FROM OUR PERSPECTIVE, RACE
ETHNICITY AND SOCIOECONOMIC
STATUS ARE THE TWO FUNDAMENTAL
MILL ARREST AND YOU SEE THIS
ACROSS OTHER CONDITIONS OF WHICH
AGE IS ANOTHER ONE AND AS WELL
AS OF COURSE AS SEX AND
GEOGRAPHY AND SEXUAL ORIENTATION
AND GENDER IDENTITY IN MANY,
MANY CHRONIC COMPAN CONDITIONS E
ALL FAMILIAR WITH.
IDENTIFYING MECHANISMS IS REALLY
CRITICAL.
THEY'RE NOT RESTRICTED TO ONE
DOMAIN.
BIOLOGY, SOCIAL INTERACTIONS,
INDIVIDUAL BEHAVIOR AND THE
ENVIRONMENT AND THE HEALTH
SYSTEM ARE JUST GLOBAL
CATEGORIES WE USE.
THERE MAY BE OTHERS.
I HAVE A STRONG BELIEF IN THE
IMPORTANCE OF COMMUNICATION AND
COMMUNICATION SCIENCE IN THE
MICRO ASPECT, THERE'S A MINI
ASPECTS THERE'S A POWER OF
PATIENT CLINICIAN INTERACTIONS
THAT NEED TO BE STUDIED AND
CAPTURED IN DEVELOPED FURTHER.
THIS NOT JUST PHYSICIAN, THIS IS
INCLUDES ALL HEALTHCARE
PROVIDERS AT ALL LEVELS AND THIS
IDEA OF BUILDING TRUST THAT
SUSTAINABLE OVER TIME AND NOT A
ONE-TIME VISIT OR A ONE-TIME
HOSPITALIZATION THAT ONE HAS A
CRISIS AND THIS IS OVER A PERIOD
OF TIME.
WE HAVE AN OPPORTUNITY TO
FURTHER DEVELOP THAT.
THE IMPLEMENTING STRUCTURE
CHANGE TO MODIFY INDIVIDUALS AND
GROUP BEHAVIORS NOT ONLY WOULD
IT BE LIKE CREATING GREEN SPACE
WHERE PEOPLE FEEL LIKE THEY CAN
GO OUTDOORS AND HAVE A SAFE
ENVIRONMENT SO AGAIN, PEOPLE CAN
BE OUTDOORS AND WALK OR HAVE
STAIRS THAT ARE EASY TO ACCESS
SO THAT IF YOU ARE ABLE TO, YOU
CAN WALK UP TO THE SECOND FLOOR
INSTEAD OF TAKING THE ELEVATOR
ALL THE TIME SO THANK YOU FOR
YOUR ATTENTION AND I APOLOGIZE I
WOULDN'T STAY FOR THE PANEL.
I HAVE ANOTHER MEETING TO
ANOTHER SITE.
I'M SURE MY COLLEAGUES WILL HAVE
A GREAT CONVERSATION WITH YOU.
THANK YOU.
>>Shannon Zenk: GOOD MORNING TO
EVERYONE.
IT'S A PLEASURE TO BE HERE.
THANK YOU SO MUCH FOR THE
INVITATION AND IT'S ALWAYS GREAT
TO BE IN THE ROOM WITH Dr.
HODES AND GREAT TO FOLLOW MY
COLLEAGUE Dr. PEREZ-STABLE.
SO, I AM DELIGHTED TO BE WITH
YOU.
AS WE ALL KNOW, HEALTH
DISPARITIES RELATED TO AGING ARE
THE RESULT OF A COMPLEX
COMBINATION OF BIOLOGICAL,
BEHAVIORAL, PSYCHOLOGICAL, AND
ENVIRONMENTAL AND SOCIAL
FACTORS.
NOW, PARTICULARLY THE PANELIST
WHO'S WILL FOLLOW WILL FOCUS ON
THE BIOLOGICAL FACTORS BUT I'M
GOING TO FOCUS ON SOCIAL AND
STRUCTURAL DRIVERS OF HEALTH AND
OF HEALTH DISPARITIES ALSO KNOWN
AS SOCIAL DETERMINANTS OF
HEALTH.
SO I'M GOING TO COVER FOUR MAIN
TOPICS.
FIRST, WHAT DO WE MEAN WHEN WE
SAY STRUCTURAL AND SOCIAL
DETERMINANTS OF HEALTH AND
STRUCTURAL INTERVENTIONS?
SECOND, WHAT ARE THE
IMPLICATIONS OF SOCIAL
DETERMINANTS OF HEALTH ON AGING
RELATED HEALTH OUTCOMES?
I'LL HIGHLIGHT WHY DIFFERENCES
IN AGING OUTCOMES THAT MAY HAVE
BEEN ATTRIBUTED TO BIOLOGY OR
BEHAVIOR MAY ACTUALLY BE THE
CONSEQUENCES OF INEQUITABLE
SYSTEMS.
LASTLY, I'LL SHARE EXAMPLES OF
NIH INITIATIVES FOCUSED ON
STRUCTURAL AND SOCIAL
DETERMINANTS OF HEALTH.
SO FIRST, LET'S DEFINE A FEW KEY
TERMS TO HELP LAY THE FOUNDATION
FOR THE DISCUSSION.
THERE ARE MULTIPLE
CONCEPTUALIZATIONS OF SOCIAL
DETERMINANTS OF HEALTH ON THE
LITERATURE SO I'LL SHARE ONE
PERSPECTIVE ON THE DETERMINANTS.
SO WHEN I SAY SOCIAL
DETERMINANTS OF HEALTH I'M
REFERRING TO CONDITIONS WHICH
PEOPLE ARE BORN, GROW, LIVE,
LEARN, PLAY AND AGE.
AS WELL AS THE WIDER SET OF
FORCES AND SYSTEMS THAT SHAPE
THE DISTRIBUTION OF POWER AS
WELL AS PEOPLE'S SOCIAL POSITION
WITHIN SOCIETY.
NOW THESE ECONOMIC, LEGAL,
REGULATORY AND SOCIAL FORCES AND
SYSTEM ARE OFTEN REFERRED TO AS
STRUCTURAL FACTORS.
EXAMPLES INCLUDE SOCIAL AND
ECONOMIC POLICIES, GOVERNANCE,
SOCIAL VALUES AND RACISM AS
EXPRESSED IN POLICIES AND
REGULATIONS ARE ANOTHER EXAMPLE
OF A STRUCTURAL FACTOR.
THEY SHAPE WHETHER RESOURCES AND
OPPORTUNITIES NECESSARY FOR
HEALTH ARE EQUALLY DISTRIBUTED
AND SOCIETY OR WHETHER THEY ARE
UNJUSTLY DISTRIBUTED BASED ON
FACTORS SUCH AS RACE, ETHNICITY,
GENDER IDENTITY, SEXUAL
ORIENTATION, SOCIOECONOMIC
POSITIONS OR GEOGRAPHY.
NOW SOME SOCIAL DETERMINANTS OF
HEALTH ARE PROTECT TIVE WHERE AS
OTHERS ARE HARMFUL, INCRUISING
RISK OF POOR HEALTH.
WE THINK OF SOCIAL DETERMINANTS
AS NEGATIVE BUT THEY'RE POSITIVE
AND NEGATIVE SOCIAL DETERMINANTS
AND SOCIAL DETERMINANTS OF
HEALTH IMPACT NOT ONLY
INDIVIDUAL HEALTH BUT POPULATION
HEALTH AS WELL AND THIS APPLIES
ACROSS DISEASES AND CONDITIONS,
POPULATION GROUPS AND STAGES OF
THE LIFE COURSE.
SO LET ME FOCUS ON WHAT WE MEAN
BY STRUCTURAL INTERVENTIONS.
SO HERE IS HOW I WOULD
SUMMARIZE.
STRUCTURAL INTERVENTIONS ARE
MACRO LEVEL OR MAY SO LEVEL
STRATEGIES THAT TARGET THESE
ECONOMIC LEGAL, POLITICAL, AND
SOCIAL SYSTEMS AND FORCES.
OFTEN POLICIES TO EXAMINE THEIR
IMPACTS ON HEALTH.
STRUCTURAL INTERVENTION SPAN A
NUMBER OF SECTORS THAT CAN
INCLUDE ECONOMIC, EDUCATION,
HOUSING AND TRANSPORTATION TO
NAME JUST A FEW.
THESE APPROACHES OFTEN EFFECT
THESE DAILY LIVING CONDITIONS.
SO, ALL THE CONTEXT WHERE PEOPLE
THEIR LIVES.
COMMUNITIES, WORKPLACES,
SCHOOLS, AND THE HEALTH-CARE
SYSTEM THAT Dr. PEREZ-STABLE
HIGHLIGHTED.
NOW IT'S IMPORTANT TO KNOW THAT
STRUCTURE INTERVENTIONS ARE
GENERALLY DISEASE AGNOSTIC.
WHICH ENABLES THEM TO TACKLE THE
COMMON UPSTREAM RISK FACTORS
THAT HAVE IMPACTED MULTIPLE
HEALTH OUTCOMES AND THIS ABILITY
TO IMPACT MULTIPLE HEALTH
OUTCOMES WAS HIGHLIGHTED THIS
MORNING UNDER THE GEROSCIENCE
HYPOTHESIS.
NOW, INCREASINGLY DISCUSSING THE
LITERATURE, ESPECIALLY RELATED
TO HEALTHCARE ARE SOCIAL NEEDS
OR HEALTH RELATED SOCIAL NEEDS.
THE TERMS SOCIAL NEEDS IS OFTEN
USED TO REFER TO AN ADVERSE
INDIVIDUAL OR FAMILY LEVEL
SOCIAL RISK FACTORS SUCH AS LOW
INCOME, FOOD INSECURITY OR
HOUSING INSTABILITY.
SOME CONSIDER SOCIAL NEEDS AS
SOCIAL DETERMINANTS OF HEALTH
AND OTHER TIMES, THESE
INDIVIDUAL OR FAMILY LEVEL
FACTORS ARE CONSIDERED A MORE
DOWNSTREAM MANIFESTATION OF THE
IMPACT OF STRUCTURAL AND OTHER
SOCIAL DETERMINANTS OF HEALTH.
NOW REGARDLESS OF WHETHER
THEY'RE UNDER THE UMBRELLA IT'S
REALLY IMPORTANT TO NOTE THAT WE
NEED RESEARCH ON SOCIAL AND
ECONOMIC FACTORS AT THE
SOCIETAL, COMMUNITY, FAMILY, AND
INDIVIDUAL LEVELS.
WE NEED RESEARCH TO IDENTIFY
HEALTH SOLUTIONS AT ALL OF THESE
LEVELS.
WHEN WE DESCRIBE THE DIFFERENCES
AND HEALTH OUTCOMES, DUE TO
STRUCTURAL AND SOCIAL
DETERMINANTS OF HEALTH WE OFTEN
THINK ABOUT HEALTH DISPARITIES
WHICH ELISEO ADDRESSED IN HIS
TALK.
MANY PEOPLE BELIEVE ADDRESSING
THE SOCIAL DETERMINANTS OF
HEALTH IS A PRIMARY APPROACH TO
ACHIEVE HEALTH EQUITY.
AND I BELIEVE THAT THIS IS AS
WELL.
I WANT TO STRESS THAT WE CANNOT
UNDERSTAND AND ADDRESS HEALTH
DISPARITIES WITHOUT CONSIDERING
THE STRUCTURAL AND SOCIAL
FACTORS.
INEQUITABLE DISTRIBUTION OF
ADVERSE DAILY LIFE AND RESOURCES
ARE FUNDAMENTAL DRIVERS OF
HEALTH INEQUITIES.
SO NOW THAT WE HAVE A SHARED
UNDERSTANDING OF WHAT WE MEAN BY
SOCIAL DETERMINANTS OF HEALTH
AND ESPECIALLY STRUCTURAL
FACTORS AND INTERVENTIONS LET'S
TURN TO THEIR CRITICAL
IMPORTANCE FOR AGING RELATED
HEALTH OUTCOMES.
WE KNOW EXPOSURE TO VIS
ADVANTAGE CAN A COUPLE LATE OVER
TIME TO IMPACT HEALTH.
A LIFE COURSE PERSPECTIVE
RELATED TO SOCIAL DETERMINANTS
OF HEALTH IS HIGHLY RELEVANT FOR
UNDERSTANDING AND ADDRESSING
AGING RELATED HEALTH OUTCOMES.
ALSO RELEVANT FOR THIS SESSION,
WHICH I'LL LEAVE TO MY FELLOW
PANELIST TO EXPOUND UPON IS
STRUCTURAL AND OTHER SOCIAL
DETERMINANTS OF HEALTH ARE
BIOLOGICALLY EMBEDDED THAT'S
THEY INITIATE AND SUSTAIN
BIOLOGICAL CHANGES THAT CAN LEAD
TO DISPARITIES AND WEATHERING OR
ACCELERATED AGING AND HEALTH
STATUS LATER IN LIFE AND LIFE
EXPECT APP SEE AND I WOULD LIKE
TO ACKNOWLEDGE THIS FIGURE FROM
Dr. MICHELLE EVANS AT NIA AND
HER COLLEAGUES SHOWING THESE
RELATIONSHIPS.
SO, WHAT SOCIAL DETERMINANTS AND
SOCIAL NEEDS ARE RELEVANT FOR
AGING RESEARCH.
IN FACT, WE HAVE DECADES OF
RESEARCH ON SOCIAL DETERMINANTS
OF HEALTH, SOCIAL NEEDS, AND
AGING RELATED HEALTH OUTCOMES.
FOR EXAMPLE, THIS PAPER
DISCUSSED EVIDENCE ON SOCIAL
DETERMINANTS AND OLDER ADULTS
ACROSS TEN SOCIAL DETERMINANTS
AND NEEDS IDENTIFIED BY THE
WORLD HEALTH ORGANIZATION.
NOW ALL WERE RELEVANT FOR HEALTH
OF OLDER ADULTS.
IN GENERAL, THOUGH, SOCIAL
DETERMINANTS AND SOCIAL NEEDS
THAT ARE RELEVANT FOR THE HEALTH
OF OLDER ADULTS, ARE THE SAME AS
THOSE THAT WE SEE AT OTHER LIFE
STAGES.
WITH SOME DIFFERENCES.
BUT, DO THEIR CUMULATIVE EFFECT
OVER THE LIFE COURSE, IT'S MUCH
MAGNIFIED CONSIDERABLY AS PEOPLE
AGE.
SO LET'S CONSIDER THE
RELATIONSHIPS BETWEEN SOCIAL
DETERMINE ADULTS.
OLDER ADULTS FOUND THAT SEVERAL
DOMAINS OF THE NEIGHBORHOOD
BUILT ENVIRONMENT INCLUDING LAND
USE, PHYSICAL DISORDERS, WALK
ACT AND GREEN SPACE, WERE
ASSOCIATED WITH MEASURES OF
COGNITIVE FUNCTION AND DEMENTIA
RISK.
RELATIONSHIPS WELL COGNITIVE
FUNCTION WERE STRONGER, AMONG
OLDER WOMEN AND THOSE WITH DIS A
DISABILITY AS WELL AS THOSE WITH
LOWER SOCIOECONOMIC STATUS.
BLACK OLDER ADULT AND BIRTH IN A
JIM CROW STATE USED AS A MEASURE
OF STRUCTURAL RACISM WAS HAVING
MORE AGGRESSIVE BREAST CANCER
SUBTYPES AS WELL AS PREMATURE
MORTALITY.
NOW INTERESTINGLY THE
RELATIONSHIP WITH PREMATURE
MORTALITY WAS STRONGEST AMONG
THOSE WHO WERE OLDEST DURING THE
JIM CROW ERA.
THAT MEANS THEY HAD GREATER
DEGREE OF EXPOSURE TO JIM CROW
POLICIES OVER TIME.
ONE OF THE MOST STRIKING SOCIAL
INEQUITIES IS THE RACIAL WEALTH
GAP WHICH HAS BEEN LINKED TO
HEALTH OUTCOMES AND HEALTH
INDDISPARITIES.THEY WERE THREE R
THE LEAST WEALTHY COMPARED TO
THE MOST WEALTHY INDIVIDUALS.
THE RECENT ANALYSIS FOUND THAT
DIFFERENCES IN WEALTH WERE
ASSOCIATED WITH THE LONGEVITY
GAP BETWEEN BLACK AND WHITE
OLDER ADULT AND MORE OVER,
SIMULATIONS IN THAT STUDY SHOWED
THAT REPARATIONS PAYMENTS,
GREATLY REDUCED THE RACIAL GAP
AND LONGEVITY AND FROM BETWEEN
65 AND OVER 100 PERCENT.
AGAIN, HIGHLIGHTING THE ROLE OF
POLICIES AND IDENTIFYING
SOLUTIONS FOR HEALTH
DISPARITIES.
SO WHAT ARE THE IMPLICATIONS OF
STRUCTURAL AND SOCIAL
DETERMINANTS FOR AGING RESEARCH?
I WOULD ARGUE THAT IF WE ARE
CONDUCTING HEALTH DISPARITIES
RESEARCH BUT IGNORING STRUCTURAL
AND SOCIAL FACTORS THAT WE RISK
AN INCOMPLETE OR INACCURATE
UNDERSTANDING AND MISGUIDED
CONCLUSIONS ON THE UNDERLYING
DRIVERS OF AGING RELATED HEALTH
DISPARITIES AND OUTCOME.
I WOULD ARGUE IGNORING
STRUCTURAL AND SOCIAL
DETERMINANTS RISKS INTERVENTIONS
THAT ARE LESS EFFECTIVE.
AND SHORT TERM HEALTH
IMPROVEMENTS THAT ARE NOT
SUSTAINABLE OR TRANSLATABLE.
AND THIS IS BECAUSE STRUCTURAL
FACTORS ARE FUNDAMENTAL CAUSES
OF DISEASE.
THEY CONTRIBUTE TO MULTIPLE
HEALTH DISPARITIES THROUGH
MULTIPLE MECHANISMS AND
PATHWAYS.
AND AS NEW TREATMENTS OR
DISEASES OR HEALTH SOLUTIONS ARE
AVAILABLE TO ADDRESS ONE OF
THESE MECHANISMS, SOCIAL
INEQUALITIES EMERGE OR ARE
REPLICATEDDED BECAUSE THEY HAVE
RESOURCES NEEDED TO EXPLOIT THEM
AND WE SAW THIS IN COVID.
IDENTIFYING EFFECTIVE
INTERVENTIONS FOR PROXIMAL RISK
FACTORS OR MECHANISMS AND NOT
THE UPSTREAM DRIVERS IS NOT
ENOUGH.
WE MUST ADDRESS UPSTREAM
SOCIETAL DRIVERS TO ELIMINATE
HEALTH DISPARITIES.
SO, HOW SHOULD RESEARCHERS
INCORPORATE SOCIAL AND
STRUCTURAL FACTORS INTO THEIR
WORK AND WHAT DOES IT ALL HAVE
TO DO WITH THE NATIONAL
INSTITUTE OF NURSING RESEARCH.
AS OUR NAME SUGGESTS, NURSES ARE
AT THE HEART OF EVERYTHING WE
DO.
NURSES INTER AGENT WITH
INDIVIDUALS AND FAMILIES ACROSS
A WIDE VARIETY OF SETTINGS.
HOSPITALS AND CLINICS TO BE SURE
AND SCHOOLS AND WORKPLACES AND
HOMES AND LONG-TERM CARE
FACILITIES, AND IN POLICY
SETTINGS AND IN JUSTICE SETTINGS
AND COMMUNITIES FROM URBAN TO
SUBURBAN TO RURAL.
OUR WORK GIVES US A DEEP
UNDERSTANDING OF EYE WIDE ARRAY
OF FACTORS FROM PERSONAL TO
SOCIETAL THAT LEAD TO HEALTH
AMONG SOME AND ILLNESS AMONG
OTHERS.
WE'RE HIGHLY WELL POSITIONED TO
CONDUCT RESEARCH ON SOCIAL
DETERMINANTS OF HEALTH THAT PLAY
SUCH AN IMPORTANT ROLE IN
ADVANCING HEALTH EQUITY AND FOR
ALL AMERICANS INCLUDING OLDER
ADULTS.
AS LAID OUT IN OUR STRATEGIC
PLAN WHICH WE RELEASED LAST MAY
OUR RESEARCH WITH NURSING
PERSPECTIVE AT ITS CORE IS
HEALTH SOLUTIONS FOR PEOPLE IN
THE CONTEXT OF THEIR LIVES AND
LIVING CONDITIONS.
ACROSS SETTINGS WHERE NURSES
PRACTICE.
IT INCLUDES FIVE RESEARCH LENSES
WHICH REALLY ARE DESCRIBING A
PERSPECTIVE THROUGH WHICH TO
ADDRESS A HEALTH CHALLENGE.
WE HAVE FIVE RESEARCH LENSES
THAT WE THINK LEVERAGE THE
STRENGTHS OF NURSING SCIENCE TO
INNOVATE, THINK BIGGER AND
INCREASE OUR IMPACT.
THEY'RE HEALTH EQUITY,
POPULATION IN COMMUNITY HEALTH,
PREVENTION AND HEALTH PROMOTION
AND SYSTEMS AND MODELS OF CARE.
THESE RESEARCH LENSES ARE
COMPLIMENTARY, THEY LEVERAGE
STREP AND PROMOTE MULTI LEVEL
APPROACHES CROSS DISCIPLINARY
AND CROSS SECTORAL CO SECTOR CON
ALL WITH THE GOAL OF INFORMING
PRACTICE AND POLICY.
SO AS SHOWN IN THIS FRAMEWORK,
NINR SUPPORTED INVESTIGATORS
HAVE THE FLEXIBILITY TO APPLY A
SINGLE LENS OR A COMBINATION OF
LENSES IN LENSES AND WE ENCOURAE
HEALTH ECONOMIC AND SOCIAL
DETERMINANTS OF HEALTH LENSES
THROUGH WHICH TO CONSIDER THE
OTHERS.
IN OUR STRATEGIC PLAN, WE CALL
FOR BOTH MIGHT LEVEL AND
STRUCTURAL APPROACHES TO
OPTIMIZE HEALTH AND ADVANCE
HEALTH EQUITY.
I AGREE WITH Dr. PEREZ-STABLE
THAT MULTI LEVEL INTERCEPTIONS
ARE IMPORTANT AND WE NEED TO
ADDRESS SOCIAL DETERMINANTS AT
MULTIPLE LEVELS AS WELL A
COMBINATION OF SOCIAL FACTORS
WITH OTHER FACTORS SUCH AS THE
HEALTH-CARE SYSTEM AND BEHAVIOR
TO NAME A COUPLE.
RESEARCH HAS APPROACHES AT
MULTIPLE LEVELS THAT ARE AIMED
AT OFFSETTING EXPOSURE YOU WITH
YOU WILL HE ALSO NEED RESEARCH
ON STRUCTURAL INTERVENTIONS TO
IDENTIFY WHAT POLICIES AND
APPROACHES AND EFFECTIVE AND
ECONOMIC LEGAL REGULATORY AND
DRIVERS OF HEALTH DISPARITIES A
FAIR AND JUST OPPORTUNITY TO A
FEIGN THEIR FULL HEALTH AND
REQUIRES ADDRESSING SYSTEMS AND
DOES MY APPROACH AT A MINIMUM
ACKNOWLEDGE OR IDEALLY ADDRESS
HISTORIC AND PERSISTENT
STRUCTURAL INEQUITIES THAT COULD
BE TRIBUTE TO DISPARITIES AND
ACCELERATED BY A BIOLOGICAL
AGING THE HEALTH OF OLDER ADULT
AND LIFE EXPECTANCY.
SO WE HAVE FUNDING CONTINUES AT
NINR WHERE INVESTIGATORS CAN AND
THE FIRST IS COMPASS WHICH IS
IT'S ALSO INNOVATIVE FOR NIH AND
IT AIMS TO FUND DIRECTLY THERE
ARE TWO GOALS FOR THE COMPASS
PROGRAM TO CHAT ALLIES DEPLOY
AND EVALUATE COMMUNITY LED
HEALTH EQUITY STRUCTURAL
INTERVENTIONS AND A 10 YEAR
PROGRAM IS TO DEVELOP A NEW
HEALTH EQUITY RESEARCH MODEL AND
FOR THIS TYPE OF RESEARCH FOR
NIH AS WELL AS OTHER FEDERAL
AGENCIES AND ANOTHER INITIATIVE
IS THE TRANSFORMATIVE HEALTH
DISPARITIES RESEARCH THAT
SUPPORTS TRANSLATIONAL RESEARCH
PROJECTS TO REDUCE HEALTH
DISPARITIES AND ADVANCE HEALTH
EQUITY.
SO THIS PROGRAM STRONGLY
ENCOURAGES INTERVENTIONS ON
SOCIAL DETERMINANTS AND REQUIRES
COMMUNITY PARTNERSHIPS.
AND WE ARE COMMITTED AT NIH TO
ACCELERATE SOCIAL DETERMINANTS
OF HEALTH RESEARCH ACROSS THE
AGENCY.
THIS IS ACROSS DISEASES AND
CONDITIONS POPULATIONS, STAGES
OF THE LIFE COURSE, AND SOCIAL
DETERMINANTS OF HEALTH DOMAINS.
SO THIS RESEARCH COORDINATING
COMMITTEE THAT WAS FORMED ONE
YEAR HAS SEVERAL AMBITIOUS
OBJECTIVES AND THIS AIM SHOWN
HERE AND I WANT TO THANK NIA WHO
PLAYED SUCH AN IMPORTANT ROLE
LAUNCH NORTH EFFORLAWNING THIS S
ENGAGE 18 ON THE EXECUTIVE
COMMIT AND MORE OPT COORDINATING
COMMITTEE.
THANK YOU FOR IN INVITING ME.
IF YOU HAVE HAVE QUESTIONS OR
WANT TO REACH OUT, DO SO AT THE
E-MAIL ADDRESS DOWN HIGHER.
THANK YOU SO MUCH.
[APPLAUSE]
BEFORE WE BEGIN, I WANT TO
EMPHASIZE WHAT A PRIORITY
ADDRESSING HEALTH DISPARITIES
AND PROMOTING HEALTH EQUITY ARE
FOR NCI.
IF YOU HAVEN'T SEEN THIS MONTH
OUR DIRECTOR AT NCI RELEASED THE
NATIONAL CANCER PLAN.
AND THIS BUILDS UPON WORK THAT'S
BEEN DONE ACROSS NCI AND THE
ENTIRE NCI RESEARCH ENTERPRISE
OVER THE YEARS TO REALLY
RECOGNIZE EIGHT GOALS ARE
DESCRIBED THROUGH THIS PLAN
HOWEVER YOU CAN SEE OVERLAP TO
FIRST ELIMINATE INEQUALITY AND
SECOND TO ENGAGE EVERY PERSON.
I WANT TO TALK ABOUT HOW WE
DEFINE CANCER DISPARITIES AND
THIS VARIES ACROSS NCI AND NIH
AND NHHS AND IN OUR FUNDING
OPPORTUNITIES, WHEN WE TALK
ABOUT DISPARITIES, WE'RE
REFERRING TO ADVERSE DIFFERENCES
BETWEEN POPULATION GROUPS WHEN
WE TALK ABOUT POPULATION GROUPS,
THIS IS VERY BROAD.
WE TYPICALLY WILL FOCUS ON
POPULATION GROUPS THAT HAVE
SYSTEMICALLY EXPERIENCED GREATER
OBSTACLES IN HEALTH AND AS WE'VE
HEARD THESE ARE LINKED TO
DISCRIMINATION AND EXCLUSION.
AND SO MANY OF THE POPULATIONS
THAT WE'VE SUPPORTED IN OUR
FUNDING, ARE BASED UPON RACE AND
ETHNICITY AND DISABILITY, SEXUAL
GENDER MINORITY, GEOGRAPHIC
LOCATION AND VARIOUS OTHER SES
CHARACTERISTICS.
MANY OF THESE FACTORS ARE INTER
RELATED AND THIS IS SCHEMATIC
AND YOU CAN SEE IT FROM THE
AMERICAN ASSOCIATION OF CANCER
RESEARCH IN THEIR CANCER
DISPARITIES PROGRESS REPORT
RELEASED IN 2022.
WE KNOW ALL OF THESE FACTORS ARE
AT LEAST PARTIALLY AND DIRECTLY
INFLUENCED BY STRUCTURAL AND
SYSTEMIC RACISM AND SOCIAL
INJUSTICES.
AND THESE FACTORS ARE INTER
RELATED AND SOCIAL DETERMINANTS
ARE AT THE MIDDLE OTHER
CONTRIBUTORS SUCH AS BIOLOGY
BEHAVIOR AND ENVIRONMENT ARE ALL
PLAYING A ROLE AND NCI, WE WERE
INTERESTED IN LEARNING MORE
ABOUT ALL OF THESE FACTORS AND
ALL OF THE CANCER DISPARITIES
WE'VE IDENTIFIED IN THE UNITED
STATES.
SO WE HAVE A NUMBER OF FUNDING
INITIATIVES.
THIS IS JUST A VERY SMALL
SLITHER OF WHAT WE OFFER AT NCI
IN THE SPACE OF DISPARITIES
RESEARCH AND THEY HAVE DIFFERENT
RESEARCH DISCIPLINES SO AS YOU
CAN SEE HERE, WE HAVE
OPPORTUNITIES IN BASIC RESEARCH
AND SOME MORE IN TRANSLATIONAL
AND CLINICAL RESEARCH AND SOCIAL
SCIENCES AND POPULATIONS
SCIENCES AND A MOUNTING NUMBER
IN MULTI-DISCIPLINARY RESEARCH
IN TEAM SCIENCE BUT I'M GOING TO
FOCUS PRIMARILY ON SOME OF THE
FUNDING AND SOME OF THE RESEARCH
WE'VE SUPPORTED POWER IN THE
SPACE OF BASIC AND TRANCAL.
SO WHEN WE TALK ABOUT
TRANSLATIONAL RESEARCH, WE'RE
TALKING ABOUT RESEARCH THAT
STARTS AT THE BENCH.
TRANSLATED INTO THE CLINIC AND
OFTEN TIMES FURTHER INTO THE
COMMUNITY WHERE WE SEE AN
IMPROVEMENT OF PUBLIC-HEALTH.
THIS IS NOT JUST ONE DIRECTIONAL
IT'S BIDIRECTIONAL AND WE
SUPPORT WORK THAT IS OBSERVED IN
THE COMMUNITY OR THE CLIP I CAN
AND WORK BACK TO THE BENCH TO
BORE EXPLAIN.
BUT DOING THIS TYPE OF RESEARCH
AND DISPARITIES CAN BE VERY
CHALLENGES.
FIRST WE KNOW THAT THERE'S POOR
REPRESENTATION OF RACIAL AND
ETHNIC AND UNDERSERVED
POPULATIONS IN THERAPEUTIC
CLINICAL TRIALS AND WE'RE
WORKING HARD TO ADDRESS THIS.
THERE ARE RESERVATIONS TO
PATIENTS TO DONATE BIOSPECIMEN
OR SHARE CLINICAL DATA AND IT'S
A GENERAL LACK OF DIVERSITY AND
BIO REPOSITORY AND OTHER PATIENT
COHORTS AND WHEN THEY DO
CONTRIBUTE TO THESE COHORTS
THERE'S A LACK OF OF
STANDARDIZATION AND THIS CAN
MAKE SECONDARY DATA ANALYSIS
CHALLENGING IF THE RIGHT
INFORMATION WASN'T COLLECTED
FROM THE PATIENT AND LASTLY,
THERE'S A DEBATE ON GOING ON IF
BIOLOGIBIOLOGICAL ARE ENOUGH TON
TRIB TO THE DISPARI DISPARITIES.
THERE ARE CHALLENGES WE ARE
CREDITS RESEARCH AS ONE OF THE
PRIORITY AREAS AND THIS BECAUSE
WE RECOGNIZE ACHIEVING DIVERSE
REPRESENTATION IN ALL OF OUR
CANCER RESEARCH ACTIVITIES IS
ABSOLUTELY CRITICAL TO ENSURING
THAT THE ADVANCEMENTS BEING MADE
ARE EQUITABLE TO ALL PATIENT
POPULATIONS SO WE'RE SEEING SOME
ADVANCEMENTS AND FUNDING MORE
RESEARCH AND WE'RE DEVELOPING
MORE MODELS USEFUL FOR THE REECE
SEARCH COMMUNITY AND WE'RE
SEEING PUBLICATIONS AND
PRESENTATIONS THAT ARE SCREENING
DESCRIBING EVIDENCE IN THIS
SPACE.
WE HAVE THREE RESEARCH
INITIATIVES THAT ARE OPEN REALLY
FOCUSED IN ON THIS BASIC AND
TRANSLATITRANSLATIONAL AND I'LLW
THE PROGRAMS WE HAVE AND I'LL
TALK ABOUT THE DATA AND RESEARCH
WE'RE COMING OUT OF THESE.
THE FIRST PROGRAM IS ON BASIC
RESEARCH IN CANCER HEALTH
DISPARITIES.
IT'S BEEN AROUND SINCE 2010 AND
THE PURPOSE OF THIS IS TO
PROVIDE INVESTIGATIONs AND YOU
PROBABLY WON'T BE SURPRISED TO
HEAR THAT MORE AND MORE
APPLICATIONS AND PROJECTS WE'RE
FUNDING ARE FOCUSING ON HOW
SOCIAL DETERMINANTS ARE
INFLUENCING BIOLOGY TO
CONTRIBUTE TO THOSE DIFFERENCES.
THEY DEVELOP METHODS AND MODELS
ON SECONDARY ANALYSIS SO HE WE
FUNDED 150 GRANTS ACROSS 17
DIFFERENT CANCER SITES AND HAVE
1100 PUBLICATIONS THAT HAVE
RESULTED FROM THIS AND JUST LAST
YEAR WHEN WE LOOKED AT OR ACTIVE
PORTFOLIO, WE SEE THE MAJORITY
OF STUDIES ARE IN PROSTATE,
BREAST AND COLORECTAL CANCER AND
THIS IS NOT SURPRISING MOST OF
THE EVIDENCE FALLS WITHIN THOSE
CANCER SITES AND WE LOOK AT
POPULATIONS THE MAJORITY OF THE
PORTFOLIO IS AFRICAN AMERICAN OR
BLACK PATIENTS WITH A CHUNK
FOCUSED ON HISPANIC AND LATINO
AND OTHERS INCLUDED AS WELL.
ANOTHER PROGRAM WE'VE BEEN
LARGELY FOCUSED ON ARE THE
SPORTS AND THESE ARE SPECIALIZED
PROGRAMS OF RESEARCH.
THOSE ARE LARGE PROGRAMS AND
THEY FOCUS ON RESEARCH AND I
MIGHT BE FAMILIAR WITH A
PROSTATE SPORE BUT THEY HAVE
MORE THEMES CROSS CUTTING THEMES
SO CANCER DISPARITIES IS ONE
ADDRESSING MINORITY HEALTH WOULD
BE ANOTHER AND TO DATE THEY ARE
NOT FOCUSED IN ADDRESSING HEALTH
DISPARITIES OR MINORITY HEALTH.
TO REDUCE CANCER HEALTH
DISPARITIES WHERE I WORK, WE
TEAMED UP WITH THE TRANSLATIONAL
RESEARCH PROGRAM TO HAVE A
PLANNING GRANT OPPORTUNITY AND
THIS WAYS DESIGNED TO HELP THE
LARGE TEAMS GET UP TO SPEED, GET
THEIR INFRASTRUCTURE TOGETHER,
GET THEIR PRELIMINARY DATA
TOGETHER AND COME IN FOR A FULL
SPORE SO WE AWARDED 12 GRANTS
AND THEY WERE ACROSS A WIDE
NUMBER OF CANCER SITES AND
ACROSS A WIDE NUMBER OF
POPULATION GROUPS AND A LOT OF
DATA HAS RED LIGHTED FROM THIS.
A LOT OF DATA WILL COME FROM
THIS PROGRAM.
THE LAST PROGRAM I WANTED TO
MENTION DEALS WITH OR EFFORTS IN
TRYING TO DEVELOP MORE CANCER
MODEL THAT REFLECT DIVERSITY OF
PATIENT POPULATION AND WE HAVE
MODELS AND OF WE ARE ADDING ONE
CELL LINE HERE EX ORGANIZE
ANNOYED THERORGANOIDS ANDTHEY VA
PIECE OF TUMOR AND IT YOU GRAFT
IT IN A MOUSE AND IT BETTER
REFLECTS THE HETEROGENEITY SO WE
HAVE THE PDX DEVELOPMENT IT
TRIALS RESEARCH NETWORK AND THIS
WAYS STARTED IN 2017 BY THE
DIVISION OF CANCER TREATMENT AND
DIAGNOSISDIAGNOSIS AND THOSE WID
TO CONDUCT PRECLINICAL TESTING
OF THERAPEUTIC TARGETED AGENTS
AND THE HOPE IS THAT IT WILL
LEAD FOR WHAT THERAPEUTICS
SHOULD GO INTO EARLY PHASE
TRIALS.
WE NOTICED THE DIVERSITY OF THE
MODELING BEING MADE WAS NOT VERY
PRONOUNCED SO THROUGH THE CENTER
THROUGH REDUCE CANCER HEALTH
DISPARITIES WE ADDED TWO CENTERS
TO THIS AND THESE CENTERS FOR HE
CAN USED ON DEVELOPING MODEL 0 S
FROM UNDERSERVED POPULATIONS AND
THEIR RESEARCH QUESTIONS ARE
BETTER UNDERSTANDING THERAPEUTIC
OUTCOME DISPARITIES SO THIS IS
CONTINUING ON EX IT'S BEEN
REISSUED AND NEW AWARDS ARE
PENDING.
THOSE ARE THE THREE PROGRAMS
THAT WE'VE BEEN FUNDING OVER
RECENT YEARS AND I WANT TO TALK
ABOUT SOME OF THE FINDINGS THAT
ARE COMING OUT.
THIS IS NOT MEANT TO BE READ
INDIVIDUALLY BUT TO GIVE YOU AN
IDEA OF HOW PROCEED SOME OF THE
DATA THAT HAS RESULTED IS AND
I'M GOING TO TALK ABOUT SPECIFIC
THEMES AS A FEW SPECIFIC
STUDIES.
BUT AS YOU CAN SEE A LOT OF THIS
IS FOCUSED IN ON RISK ALLELES
AND LOOKING AT LARGE-SCALE
GENETIC PROFILING TO UNDERSTAND
DIFFERENCES BETWEEN POPULATION
GROUPS, LOOKING AT RED MEAT
CONSUMPTION AND COORDINATION
WITH GENOTYPES AND HOW THAT
INCREASES PAN CREE OT TICK
CANCER RISK AND SO ON.
THESE ARE JUST SOME MORE OF THE
STUDIES OF BEING RELEASED AND
THIS IS THE FIRST ONE HERE AND
LOOKING AT GENETIC ANCESTRY.
IT WAS INTERESTING AS IT WAS
LOOKING AT PEDIATRIC PATIENTS
AND LOOKING AT THEIR GENETIC
ANCESTRY WERE ABLE TO FIND
MOLECULAR SUBTYPES CAN PREDICT
WHETHER A CHILD WOULD HAVE
ADVERSE EVENTS OR RESPOND TO
TREATMENT SO REALLY ADVANCING
SOME OF OUR PRECISION EFFORTS.
WE HAD PRESS RELEASED OVER THE
STUDIES OVER THE YEARS.
I WANT TO FOCUS ON SOME OF THE
THEMES THAT MIGHT BE RELEVANT
FOYER AGING.
WE'VE HAD STUDIES LOOKING AT
DISPARITIES AND EPIGENETIC AGING
AND CANCER.
THIS IS ONE STUDY FROM A GROUP
THROUGH OUR P20 SPORES MOVED TO
THE UNIVERSITY OF VIRGINIA
HEALTH SERVICES SYSTEMS AND IN
THIS STUDY THEY'RE LOOKING AT
RACIAL DISPARITIES AND
EPIGENETIC AGING SO BETTER
UNDERSTAND WHY WE SEE
DISPARITIES IN COLORECTAL CANCER
AND THIS IS BASED ON THE AFRICAN
AMERICANS TYPICALLY GET EARLIER
ONSET COLORECTAL CANCER AND IN
ADDITION, TYPICALLY GET MORE
RIGHT-SIDED COLON CANCER WHICH
HAS BEEN ASSOCIATED WITH POORER
PROGNOSIS SO THIS IS A QUICK
LOOK AT SOME OF THE DATA WHERE
THEY LOOKED AT METHYLATION
STUDIES AND THEY DID EPIGENETIC
AGE AND LOOKED AT CORRELATION
WITH CHRONOLOGICAL AGE AND THEY
SAW THE CORRELATION WAS VERY
GOOD IN EUROPEAN AMERICAN OR
WHITE PATIENTS BUT NOT
CORRELATED IN OUR AFRICAN
AMERICAN PATIENTS.
THEY LOOKED AT AGE ACCELERATION
ON THIS NEXT CHART AND THEY SAW
THAT IN THE AFRICAN AMERICANS,
AGE ACCELERATION WAS HIGHER ON
THE RIGHT SIDE OF THE COLON BUT
WHEN THEY LOOKED IN EUROPEAN
AMERICANS IT WAS OPPOSITE AND IT
WAS LOWER IN THE RIGHT SIDE.
THIS LOWER TABLE REINFORCES THAT
THE ACCELERATION EPIEN GET TICK
AGING WAS HIGHER ON THE RIGHT
SIDE OF THE AFRICAN AMERICAN
COLON'S LEADING POTENTIALLY TO
SOME OF THE REASONS WHY WE MAY
BE SEEING SOME DISPARITIES.
AND FINDING DNA THAT WERE
DISTINCT BETWEEN RACES AND
HINTING TO THE PREDISPOSITION TO
HAVING MORE COL OWE WRECK CALL
CANCER EX THAT POPULATION AND
THIS BOTTOM STUDY HERE, IT'S NOT
EVEN IN CANCER AND IT'S NOT
SUPPORTED BY US BUT LOOKING AT
EPIGENETIC AGING AND A COLDER
COHORT OF WOMEN AND POST
MENOPAUSING WOMAN AND THEY
LINKED INCREASED EPIGENETIC AGE
WITH LOW EDUCATION AND AS WELL
AS THE AFRICAN AMERICAN WOMEN IN
THAT STUDY AND END INDICATING
THIS COULD BE A SIGN FOR SOME OF
THE DISPARITIES AND HEALTH
OUTCOMES.
AND THESE ARE TWO STUD SKIS I
DON'T HAVE ANY DATA TO SHOW FOR
YOU AND HEART DISEASE AND THE
DIFFERENCES IN MECHANISMS
BETWEEN THOSE POPULATION GROUPS
AND IN THE FINAL LOWER PROJECT
HOW THIS CONTRIBUTES TO ONSET
AND AFRICAN AMERICAN PATIENTS.
AND ANOTHER THEME THAT REALLY
ARISES A LOT IN OUR STUDIES ARE
LOOKING AT GENETIC DIFFERENCES
SO THIS IS A STUDY RELEASED FROM
THIS IS FROM OUR P20 PORTFOLIO A
GROUP LED BY A DOCTOR WHO IS A
PIONEER IN BREAST CANCER
DISPARITIES AND HER CO AIs AND
THEY'VE DONE A LOT IN GENETIC
DISPARITIES BUT A PAPER SHOWS
THERE WERE RACIAL DISPARITIES IN
PATHOLOGICAL COMPLETE RESPONSE
IN RESPONSE TO CHEMOTHERAPY AND
EARLY STAGE BREAST CANCER AND SO
THIS IS A QUICK LOOK AT DATA BUT
IN SHORT, THEY HAD A LARGE MULTI
ETHNIC COHORT AND THEY LOOKED AT
690 PATIENTS ALL WITH EARLY
STAGE BREAST CANCER AND FOUND
OUT THE BLACK PATIENTS
SPECIFICALLY PATIENTS WITH HR
NEGATIVE H HER 2 POSITIVE TUMORS
HAD A SLOWER CHANCE OF GETTING A
PATHOLOGICAL COMPLETE RESPONSE
WHEN COMPARED TO THE WHITE
PATIENTS AND FURTHERMORE, THEY
FOUND THAT OF THOSE PATIENTS
THAT DID NOT HAVE A PATHOLOGICAL
COMPLETE RESPONSE, THAT THE
AFRICAN AMERICANS OR BLACK
PATIENTS HAD MUCH WORSE IN LOWER
SURVIVAL SO THEY LOOKED FURTHER
TO UNDERSTAND WHY THESE
DIFFERENCES EXIST AND THEY DID
SOME NEXGEN SEQUENCES AND IN THE
BLACK PATIENTS WITH POSITIVE
TUMORS THEY FOUND EVIDENCE OF
I'M GOING TO END TALKING ABOUT
IMMUNE RESPONSE AND
INFLAMMATION.
THIS IS A WIDELY DISCUSSED TOPIC
IN CANCER DISPARITIES AND I'M
GOING TO FOCUS ON SOME OF THE
WORK BEING DONE HERE AT NCI AND
THROUGH DIFFERENT GROUPS AND
THERE'S INCREASED INFLAMMATION
AND IMMUNE RESPONSE IN THE
AFRICAN AMERICAN PATIENTS AND
THEY SEE A SIMILAR AND SYSTEMIC
INFLAMMATION AND FINDING THE
SAME THING BUT WHAT HASN'T BEEN
KNOWN IS EXACTLY WHY THIS
INCREASED NOT THEY LOOKED AT
THESE MULTI LEVEL DRIVERS THAT
COULD BE CONTRIBUTE TO GO RACIAL
AND ETHNIC DISPARITIES AND KANG
SER AND LOOKING ACROSS
INDIVIDUAL LEVELS AND FOR THIS
THEY REALLY HONED IN ON
ENVIRONMENTS AND NEIGHBORHOOD
INFLUENCE TO SEE IF THIS COULD
CONTRIBUTING AND INTERACTING SO
THERE'S A HYPOTHESIS THAT
NEIGHBORHOOD DEPRIVATION IS A
RISK FACTOR FOR PROCESS INDICATE
EUROPEAN AMERICAN OR WHITE MEN
SO WHEN THEY DID THEIR
NEIGHBORHOOD DEPRIVATION INDEX
THERE WAS A ESTABLISHED BY
MESSER AND USING CENSUS TRACK
DATA LEVEL THAT WAS DRAWN FROM
THE THEY FOCUSED ON MODEL WITH
SIX VARIABLES SHOWN HERE BUT YOU
KNOW AT THE END IT'S LOWER NDI
VALUES AND IT MEANS LESS
DEPRIVATION AND HIGHER NDI
VALUES MEANS GREATER DEPRIVATION
AND THIS IS THE RAPE PUBLISHED
THIS YEAR IN JAM A AND WHAT THEY
FIND IN SURE IS THAT IN THEIR
CASE CONTROL STUDY, IT WAS
ASSOCIATED WITH A 55% OF ODDS OF
HAVING PROSTATE CANCER AND BUT
THIS WAS NOT SEEN IN EUROPEAN
AMERICAN MEN AND THEN WHEN THEY
LOOKED IN JUST THEIR CONTROLS,
THEY FOUND THAT NEIGHBORHOOD
DEPRIVATION WAS ASSOCIATED WITH
MARKERS THAT WERE LINKED TO
CHEMO TAX IS, TUMOR IMMUNE FEE
AND INFLAMMATION SO THIS DATA
SUGGESTS THAT WHAT WE KNOW IS
DERIVED NEIGHBORHOOD RESIDENCY
IS ALSO A RISK FACTORS AND THIS
IS NOT STRIC STRICTLY BIOLOGICAL
ORIGIN ET TICK AND THIS IS IN
AFRICAN AMERICAN MEN WITH
PROSTATE CANCER AND LINKED TO
SYSTEMIC INFLAMMATION AND
IMMUNITY.
SO I'LL END ON THIS SLIDE IT'S
DONE THROUGH THE GROUP WITH
ELITE AUTHOR OF BRITTANY LORD
AND IT NICELY DETAILS SOME
RECENT STUDIES THAT LINK
BIOLOGICAL EFFECTS THERE ARE
ASSOCIATED WITH BOTH
ENVIRONMENTAL AND SOCIAL FACTORS
AND SO YOU KNOW, FOR
ENVIRONMENTAL FACTORS, BOTH AIR
POLLUTION AND NEIGHBORHOOD
DEPRIVATION ARE KNOWN TO
DISPARITIES EFFECT COMMUNITIES
OF COLORS AND THERE'S A LONG
LIST OF BIOLOGICAL EFFECT THAT'S
RESULT FROM THIS INCLUDING
THINGS LIKE STUDIES HAVE SHOWN A
DIRECT LINK TO MANY BIOLOGICAL
EFFECTS OF THIS AND COLLECTIVELY
THEY BELIEVE THIS IS HAVING AN
EFFECT ON THE OUTCOMES OF THE
BLACK INDIVIDUALS AND THEIR
STUDIES AND SO WITH THIS I AM
HAPPY TO TAKE QUESTIONS AND
ADDRESS THEM IN THE PANEL.
[APPLAUSE]
>>OUR LAST SPEAKER IS
Dr. CARRINGTON LAWRENCE.
I APOLOGIZE FOR NOT BEING
THERE IN-PERSON THIS MORNING BUT
I WILL BE THERE IN THE
AFTERNOON.
I'LL BE ADDRESSING HEALTH
DISPARITIES AND IT'S INTERESTING
HOW EVERYTHING CONVERGES AND IT
SEEMS THERE ARE MUCH
SIMILARITIES ACROSS THE SPECTRUM
WHEN IT COMES TO HELP
DISPARITIES, I'LL GIVE A
BACKGROUND ON AGING.
AND THE DEMOGRAPHICS AROUND
AGING AND HEALTH DISPARITIES.
AND THEN I'LL LEAD INTO SOME
DISCUSSIONS ABOUT APPROACHES FOR
EXAMINING BIOLOGICAL
DETERMINANTS OF HEALTH.
SO OLDER ADULTS OVER THE AGE OF
65 REPRESENT 16% OF THE U.S.
POPULATION.
OVER THE NEXT DECADE THIS NUMBER
IS EXPECTED TO GROW TO DECREASES
IN THE BIRTH WEIGHT AS WELL AS
ADVANCES IN HEALTHCARE LEADING
TO INCREASED LONGEVITY IN THIS
POPULATION.
THIS IS GOING TO RESULT IN OLDER
ADULTS AND CHILDREN FOR THE
FIRST TIME IN HISTORY BY 2034 SO
NOT THAT FAR OFF 1/4 ADULTS OVER
65 ARE MEMBERS OF RATE AND
ETHNIC POPULATION AND BY 2040,
IT IT'S ESTIMATED THAT 23% OF
OLDER ADULTS WILL BE MEMBERS OF
RACIAL AND ETHNIC MINORITY
GROUPS.
BY 2050 THE U.S. POPULATION OVER
ALL WILL BE MORE RACIALLY AND
ETHNICALLY DIVERSE WITH THE
BIGGEST IN ADULT IDENTIFYING IS
TWO OR MORE ETH NICE TEASE AND
IN 2016, AFRICAN AMERICANS ARE
PROJECTED TO BE 13% OF THE U.S.
OLDER ADULT POPULATION.
WHILE THE PERCENTAGE OF AMERICAN
INDIAN AND ALASKA NATIVE
INDIVIDUALS WILL INCREASE
SLIGHTLY TO .7%.
WHICH WE'LL SEE AN INCREASE FROM
8% TO 21%.
IN ADDITION, AGING AND IN OF
ITSELF IS CONSIDERED A HEALTH
DISPARITIES AND OLDER ADULTS
HAVE PREPORTION AND BURDEN OF
CHRONIC DISEASES INCLUDING
CANCER AND HYPERTENSION AND
CARDIOVASCULAR DISEASE AND
DIABETES AND ET CETERA.
AS WELL AS THEIR SOCIOECONOMIC
STATUS, SEX, AGE AND SEXUAL
ORIENTATION, GEOGRAPHIC
LOCATION, AND OTHER
CHARACTERISTICS HISTORICALLY
LINKED TO DISCRIMINATION AND EX
CLUES AND WE HEARD A BIT ABOUT
THIS FROM BOTH Dr.
PEREZ-STABLE AND Dr. ZENK THIS
MORNING.
SO FOR OLDER ADULTS WHO ARE
MEMBERS OF ETHNIC MINORITIES AND
INDIVIDUALS WHO HAVE LOWER
SOCIOECONOMIC STATUS ARE MORE
LIKELY TO EXPERIENCE CHRONIC
DISEASES AND HAVE MULTI
MORBIDITY AND SEVERITY OF THOSE
DISEASES AND IN ADDITION THEY
HAVE HIGHER MORTALITY AND SOME
OF THE MOST COMMON OCCURRING AGE
ASSOCIATED CHRONIC DISEASES AND
MANY ARE SIGNIFICANT HEALTH
DISPARITIES WITHIN AFRICAN
AMERICAN, AMERICAN INDIAN, AND
HISPANIC INDIVIDUALS.
AMERICAN INDIANS, ALASKA
NATIVES, HAVE THE HIGHEST
PREFERENCE OF DIABETES FOLLOWED
BY HISPANIC AND AFRICAN AMERICAN
AND AFRICAN AMERICANS HAVE
HYPERTENSION MORE LIKELY AND
HISPANIC AMERICANS AND AFRICAN
AMERICANS ARE MORE LIKELY TO BE
OBESE.
INTERESTINGLY, NON-HISPANIC
WHITE INDIVIDUALS HAVE
CARDIOVASCULAR DISEASE BUT
AFRICAN AMERICANS HAVE THE
HIGHEST AGE ADJUSTED DEATH RATE
FROM CARDIOVASCULAR DISEASE.
OLDER ADULTS LIVING IN RURAL
COMMUNITIES ALSO EXPERIENCE
SIGNIFICANT CHALLENGES AND
INCLUDING HIGHER RATES OF
OBESITY AND HIGHER PREVALENCE OF
CHRONIC DISEASE AND LESS ACCESS
TO SERVICES.
AND IN ADDITION, PEOPLE ARE
AGING WITH THE DISABILITY, OF
HIGHER PREPORTION OF HEALTH RISK
FACTORS AND PHYSICAL INACTIVITY
AND HYPERTENSION AND OBESITY.
NEXT SLIDE.
SO THE NIA IS COMMITTED TO
SUPPORTING RESEARCH THAT
ADDRESSES HEALTH DISPARITY.
NIH SEEKS TO UNDERSTAND THE
ENVIRONMENTAL SOCIOCULTURAL
BEHAVIORAL AND BIOLOGICAL OF
HEALTH DISPARITIES AND
DISPARITIES RELATED TO AGING AND
DISEASES SUCH AS ALZHEIMER'S AND
RELATED DEMENTIA.
WE ALSO SUPPORT RESEARCH TO
DEVELOP STRATEGIES FOR IMPROVING
HEALTH AMONG MID LIFE AND OLDER
ADULTS IN UNDER REPRESENTED
GROUPS EXPERIENCE DISPARITIES.
AND THESE PRIORITIES ARE
OUTLINED IN THE NIA STRATEGIC
DIRECTIONS FOR RESEARCH AND ALSO
REFLECTED WITHIN THE NIA HEALTH
DISPARITY RESEARCH FRAMEWORK.
THE NIA STRATEGIC GOALS FOR
HEALTH DISPARITIES WHICH IS GOAL
F, AND OUR OVER ALL DOCUMENT
AIMS TO UNDERSTAND HEALTH
DISPARITIES AND DEVELOPS
STRATEGIES TO IMPROVE THE HEALTH
STATUS OF OLDER ADULT AND
DIVERSE POPULATIONS.
POPULATION POPULATIONS.THE GOALH
F-4.
UNDERSTAND AND IDENTIFY OF
ENVIRONMENTAL, SOCIAL, CULTURAL,
BEHAVIORAL AND BIOLOGICAL
FACTORS THAT CREATE AND SUSTAIN
HEALTH DISPARITIES AMONG OLDER
ADULTS AND WE DO THIS BY
SUPPORTING RESEARCH TO GATHER
DATA AND PATTERNS OF HEALTH
DISPARITIES AND TO TRACK AND THE
ANALYZE AND REDUCE LIFE
EXPECTANCY AND DIVERSE OLDER
ADULT POPULATIONS AND WE ALSO
STRIVE TO UNDERSTAND THE
DIFFERENCES IN AGING PROCESSES
ACROSS AND DIVERSE POPULATIONS
AND IN ADDITION IT'S IMPORTANT
TO UNDERSTAND HOW ENVIRONMENTAL
SOCIOCULTURAL BEHAVIORAL AS WELL
AS BIOLOGICAL FACTORS LEAD TO
DISPARITIES AND HEALTH AT OLDER
AGES AND TO DEVELOP
INTERVENTIONS THAT RADIO DUCE
THOUGH AND I WOULD LIKE TO
UNDERSTAND AND DETERMINE HOW
ENVIRONMENTAL SCIO AND
BIOLOGICAL DETERMINANTS INTERACT
TO INCREASE THE RISK OF DISEASE
AND CIVILITY AND TO DETERMINE
THE EFFECTS OF EARLY LIFE
FACTORS OF HEALTH DISPARITIES
AMONG OLDER ADULTS.
AIM F-2.
AIMS TO DEVELOP STRATEGIES TO
PROMOTE ACTIVE LIFE EXPECTANCY
AND IMPROVE THE HEALTH, STATUS
OF OLDER ADULTS AND DIVERSE
POPULATIONS AND LIFE EXPECTANCY
HAS INCREASED AMONG ALL
POPULATION GROUPS HOWEVER
AFRICAN AMERICAN MEN HAVE THE
LOWEST LIFE EXPECTED OF ALL LIFE
GROUPS IN THE U.S. SO IT'S
IMPORTANT TO NOTE THAT
DISPARITIES STILL EXIST IN LIFE
EXPECTANCY IN CERTAIN GROUPS.
F-3 AIMS TO DEVELOP AND
IMPLEMENT STRATEGIES TO INCREASE
INCLUSION OF DIVERSE POPULATIONS
AND RESEARCH.
UNDERSTANDING OR IMPROVING THE
ABILITY OF NIA INVESTIGATORS TO
RECRUIT AND RETAIN RESEARCH
PARTICIPANTS THAT ARE
REPRESENTATIVE OF THE TOTAL U.S.
POPULATION IS ESSENTIAL IN ORDER
TO CONDUCT RIGOROUS HEALTH
DISPARITIES RESEARCH RELATED TO
AGING.
AND FINALLY F-4 SUPPORTS
RESEARCH ON WOMEN'S HEALTH
INCLUDING STUDIES OF HOW SEX AND
GENDER INFLUENCE AGING PROCESSES
AND OUTCOMES.
AND NIA SUPPORTS A DIVERSE
PORTFOLIO OF RESEARCH AND OLDER
WOMEN'S HEALTH AND INCLUDING
STUDIES ON SEX DIFFERENCES AND
THE BASIC BIOLOGY OF AGING.
AND RON HIGHLIGHTED SOME OF THE
DIFFERENCES THAT ARE SEEN ACROSS
THE SEXES IN HIS PRESENTATION
EARLIER THIS MORNING AND WE ALSO
ARE INTERESTED IN HORMONAL
INFLUENINFLUENCES ON COGNITIVE .
WE LOOK AT RESEARCH ACROSS THE
LIFESPAN AND INCLUDING THE
MENOPAUSAL TRANSITION AND AND
INCLUDING OF SEX AND GENDER
OLDER AGES AND NEXT SLIDE,
PLEASE.
THE NIA HEALTH DISPARITIES
RESEARCH FRAMEWORK WHICH IS A
COMPANION TO THE GOALS, WAS
DEVELOPED IN 2015 SO BEFORE OUR
GOALS DOCUMENT AND INTEREST IN
DOING HEALTH DISPARITIES AND
RESEARCHES AND THE FRAMEWORK CAN
BE FOUND AT OUR NIA WEBSITE AND
IT IDENTIFIES PRIORITY
POPULATIONS FOR HEALTH
DISPARITIES RESEARCH AND IT IS
SHOWCASING AND IT HAS FOUR KEY
LEVELS OF ANALYSIS RELATED TO
DISPARITIES RESEARCH AND THOSE
CAN BE SEEN HERE AS
ENVIRONMENTAL, SCIO, CULTURAL
AND BEHAVIORAL AND BIOLOGICAL
INCORPORATING LIFESPAN THAT
DETERMINE THE TRAJECTORY OF
HEALTH AND DETERMINE HEALTH
DISPARITIES.
NEXT SLIGHT.
SOCIOCULTURAL LEVEL OF ANALYSIS
THAT INCLUDES STIGMA, BIAS AND
LONELINESS.
AND THE BEHAVIORAL LEVEL OF
ANALYSIS, PRIORITIZES COPING
MECHANISMS AND HEALTH BEHAVIOR
INCLUDING SUBSTANCE USE AND
NUTRITION AND PHYSICAL ACTIVITY
AND FINALLY THE BIOLOGICAL LEVEL
OF ANALYSIS SUPPORTS AREAS AND I
WILL DISCUSS AND AS YOU CAN SEE
THE RESEARCH WITHIN THE
FRAMEWORK AND RESEARCH SUPPORTED
AT NI A AND HEALTH DISPARITIES
WHICH ARE PARTICULARLY AN
IMPORTANT FACTOR INFLUENCING OR
DRIVING HEALTH DISPARITIES AND
THEY NEED TO BE FURTHER DEFINED
AND NOT LISTED HERE ARE OTHER
FACTORS INCLUDING INFECTIOUS
DISEASE AND PATHOGEN BURDEN
WHICH IS SOMETHING WE'VE
OBSERVED DURING COVID OR
IMPORTANT AREAS TO UNDERSTAND
FOR HEALTH DISPARITIES AND
AGING.
SO, IN ADDITION TO THE FRAMEWORK
AND THE STRATEGIC PLAN WE REACH
OUT TO OUR NATIONAL ADVISORY
COUNCIL ON AGING TO GET ADVICE
ON AREAS TO PRIORITIZE FOR AGING
RESEARCH AND THE NATIONAL CONSUL
ON AGING, PROVIDED
RECOMMENDATIONS TO NIA AND ASKED
THAT WE CONSIDER THE FOLLOWING.
TO REEXAM PRIORITY AREAS THAT
GUIDE THE RESEARCH AND ALL
DIVISIONS AT NIH RELATED TO
HEALTH DISPARITIES ISSUES AND
SUPPORT MORE RESEARCH ON SOCIAL
AND ECONOMIC FACTORS THAT
PREDICT HEALTH AND WELL-BEING
AND VULNERABLE DIVERSE
POPULATION GROUPS.
AND INTERESTINGLY OR I SHOULD
SAY ENCOURAGINGLY, THEY WANT
TO -- THEY ASKED US TO ENCOURAGE
AGING BIOLOGY RESEARCH AND
CONTRIBUTE TO GO DEFINING THE
BIOLOGICAL BASIS OF HEALTH
DISPARITIES AND ENHANCING
AWARENESS OF HEALTH DISPARITIES
AMONG BASIC BIOLOGY
INVESTIGATORS ENGAGE IN THE
STUDY OF AGING RELATED DISEASES.
THEY ALSO WOULD LIKE US TO
DEVELOP AND SUSTAIN LEADERSHIP
TO FURTHER WORKFORCE DIVERSITY
AND HEALTH DISPARITIES RESEARCH.
SO THERE ARE, THERE'S QUITE A
BIT KNOWN ABOUT THE DETERMINANTS
OF HEALTH AND INFLUENCE HEALTH
DISPARITIES AND WE'RE ALSO QUITE
AWARE OF THE DISPARITIES IN
AGING CLINICAL OUTCOMES AS I
REFER TO EARLIER IN MY TALK.
NEXT SLIDE.
WHAT ARE THE MEDIATOR THAT TIE
THE INPUTS AND THE OUT PUTS, THE
MOLECULAR AND PHYSIOLOGICAL
INCOMPETENTER ACTIONS THAT ARE
INFLUENCED BY SOCIAL
DETERMINANTS OF HEALTH THAT
IMPACT RATES OF AGING, AGING
HEALTH AND LIFESPAN.
THERE'S BEEN SEVERAL STUDIES
SUPPORTED BY NIA AIMING TO
UNDERSTAND WHAT THE BIOLOGICAL
MECHANISMS UNDERLINE HEALTH
DISPARITIES IN THE CON SEX OF
SCONTEXTSOCIAL DISPARITIES OF H.
MAINLY BY EXAMINING THE ROLE OF
EPIGENETIC MODIFICATIONS AND
WE'VE HEARD A BIT ABOUT THAT
TODAY.
RON GAVE HIS PRESENTATION
MOLECULAR CLOCKS AND TIFFANY
HIGHLIGHTED STUDIES RELATED TO
LOOKING AT EPIGENETICS TO
MEASURE ACCELERATED BIOLOGICAL
AGE AMONG POPULATIONS
EXPERIENCING HEALTH DISPARITIES.
AND THERE'S BEEN A SMALL NUMBER
OF STUDIES EXAMINING THE ROLE OF
GENOMIC INSTABILITY AND
SHORTENING ATTRITION AND
CELLULOSE AND MEASURE RATES OF
AGING AND HEALTH DISPARITIES
POPULATIONS.
HOWEVER, THERE'S STEL A
SIGNIFICANT GAP IN OUR
UNDERSTANDING OF THE BIOLOGICAL
AND PHYSIOLOGICAL MECHANISMS
INVOLVED IN DIFFERENTIAL HEALTH
OUTCOMES.
SO THERE'S A CRITICAL NEED TO
DISCOVER THE FUNDAMENTAL
BIOLOGICAL MECHANISMS OF AGING.
AND IF WE HOPE TO DESIGN
INTERVENTIONS AND TREATMENTS
THAT PREVENT OR AMELIORATE AGING
RELATED DISEASES AND ARE
EFFECTIVE FOR EVERYONE.
IT WILL BE IMPORTANT TO
RECOGNIZE THE BIOLOGY LINKED TO
HEALTH DISPARITIES IN THE
CONTEXT OF MULTIPLE DETERMINANTS
OF HEALTH AS BEING CRITICAL TO
DESIGNING INTERVENTIONS THAT
PREVENT AND TREAT AGING RELATED
DISEASES.
AND IT WILL ALSO BE IMPORTANT TO
RECOGNIZE OR TO UNDERSTAND THE
ACCELERATED AGING PHENOTYPE
DESCRIBED BY MY NIA COLLEAGUES
AND THE INTRAMURAL PROGRAM LEAD
BY Dr. MICHELLE EVANS AND
ANOTHER OFTEN UNDER LOOKED
OVERLOOKED AREA IN MANY STUDIES
OF HEALTH DISPARITIES IS
HETEROGENEITY AND SO HETERO
BEGIN A TEE IS A FUNDAMENTAL
PROPERTY OF BIOLOGICAL SYSTEMS
THAT CONTRIBUTES TO THE
DEVELOPMENT, DIFFERENTIATION,
IMMUNE MEDIATED RESPONSES AND
MANY OTHER CELLULAR TISSUE ORGAN
AND ORGANISMS FUNCTIONS AS WELL
AS DISEASE AND DISEASE
PROGRESSION AND THIS
HETEROGENEITY INCREASES WITH
AGE.
SO A LITTLE BIT ABOUT THE
ACCELERATED AGING PHENOTYPE AND
WE'VE SEEN THIS PICTURE EARLIER
IN Dr. ZENK'S PRESENTATION.
AND THIS PHENOTYPE IS A RESULT
OF THE INNER PLAY OF SOCIAL
DETERMINANTS OF HEALTH WITH
COMPLEX BIOLOGICAL FACTORS AND
PATHWAYS WHICH ARE THE ROOT
CAUSES OF DISPARATE HEALTH
OUTCOMES WITH AGING.
AGING AND HEALTH DISPARITIES
OPERATE THROUGH COMMON
CONVERGING PATHWAYS.
ULTIMATELY RESULT IN SIMILAR
HEALTH OUTCOMES WITH DIFFERENT
TRAJECTORIES.
THE DIFFERENT TRAJECTORIES MAY
BE INFLUENCED BY MANY FACTORS
INCLUDING DYSFUNCTIONAL GENE
ENVIRONMENT INTERACTs AND
SOCIAL AND POLITICAL
DETERMINANTS OF HEALTH AND
BIOLOGICAL PATHWAYS THAT CAN BE
SEEN HERE RESULTING IN HEALTH
DISPARITIES AND SHORTENED LIFE
EXPECTANCY.
ALTHOUGH THERE'S EVIDENCE THAT
INFLAMMATION STRESS AND IMMUNE
FUNCTION AND DNA REPAIR PLAY A
ROLE IN THE DEVELOPMENT OF AN
ACCELERATED AGING PHENOTYPE OF
HEALTH DISPARITIES, THE
MULTI-LEVEL INTERACTING FACTORS
AND PATHWAYS ARE NOT FULLY
UNDERSTOOD.
MUCH OF THE DIVERSITY AND LATE
LIFE HEALTH OUTCOMES FROM AGE
RELATED FLUCTUATIONS OVER TIME,
COMES FROM WITHIN INDIVIDUALS,
CELL, TISSUE, ORGANS AGE AT
DIFFERENT RATES AND INCREASES
VARIABILITY AND BECAUSE BIOLOGY
DEMANDS ROBUSTNESS, TO ENSURE
SURVIVAL, IS LIKELY THAT
SIGNIFICANT REDUNDANCY EXISTS
BETWEEN GENES PROTEINS AND
PATHWAYS AND BIOLOGICAL
NETWORKS.
THESE NETWORKS ARE VARIABLE AND
DEPENDS ON MULTI -- MULTIPLE
DETERMINANTS OF HEALTH INCLUDING
STRESS AND LOAD WHICH WE HEARD
ABOUT EARLIER AS WELL.
AND DISPARATE HEALTH OUTCOMES
ARE LIKELY CORAL RATED BY
BIOLOGICAL HETEROGENEITY.
SO STUDYING HEALTH DISPARITIES
FROM THE BIOLOGICAL PERSPECTIVE
MAY PROVIDE TARGETS AND PATHWAYS
FOR DEVELOPING INTERVENTIONS TO
TREAT AGE AND RELATED CONDITIONS
AND IT'S IMPORTANT TO LINK THE
DRIVERS OF DISPARITIES WITH
BIOLOGICAL EFFECTORS THAT RESULT
IN CLINICAL OUTCOMES AS THIS IS
EXTREMELY COMPLEX.
MANY STUDIES EXAMINING THE
EFFECT OF STRESSORS ON CHANGES
IN BIOLOGICAL PRESSES SUCH AS
DNA METHYLATION, TO MEASURE
IMPACTS ON AGING, BUT MOST OF
THESE STUDIES AND IN MANY
STUDIES THE POPULATION ARE
STRATIFIED ACCORDING TO
CHRONOLOGICAL AGE, SOCIOECONOMIC
STATUS, RACE, ETHNICITY, GENDER,
IDENTITY, GEOGRAPHY AND THE SAME
POLL SIZES ARE REALLY SMALL FOR
MOST OF THE STUDIES AND CAN
IMPACT THE SIGNIFICANCE OF THE
BINDINGS AND SO, WHAT IF WE EXAM
THE BIOLOGY BY STRATIFYING
HEALTH STATUS AND TRACKING THE
DIVERGENCE AND HEALTH OVER TIME
WITHOUT REGARD TO THE INPUTS FOR
INFLUENCES OF HEALTH AND LARGE
DIVERSE WELL CHARACTERIZED
COHORTS.
NEXT SLIDE.
SO APPROACHING STUDIES OF HEALTH
DISPARITIES USING A STANDARD
METRIC OF HEALTH, COULD ALLOW
FOR AN UN BIAS IDENTIFICATION OF
BIOLOGICAL UN BIASES AND I
SHOULD SAY WELL POWERED STUDY TO
IDENTIFY INVOLVED IN DIFFERENT
HEALTH OUTCOMES DURING AGING.
IT'S HEALTH STATUS AND AGING AND
A DEFICIT ACCUMULATION INDEX
CANNING USED TO PREDICTED
SURVIVAL AS IT HAS A STRONG
RELATIONSHIP TO MORTALITY AND
THIS WAS OBSERVED IN CANCER
STUDIES WOMEN UNDERGOING
TREATMENTS FOR GYNECOLOGICAL
CANCERS AND DEFICIT ACCUMULATION
INDEXES INCLUDES VARIOUS METRICS
WITH SCORE AND THOSE METRICS
INCLUDED LABORATORY FINDINGS,
PHYSICAL FUNCTIONS, ASSESSMENTS
OF DISABILITIES, DISEASE,
SYMPTOMS, AND SENSORY AND
COGNITIVE FUNCTIONS SO IT'S SORT
OF GOT A WHOLE LOT OF METRICS
INCLUDED IN ORDER TO GIVE SORT
OF A COMPREHENSIVE SENSE OF WHAT
AN INDIVIDUAL'S HEALTH STATUS
IS.
IN ADDITION, DEFICIT
ACCUMULATION INDEXES CAN BE
USEFUL ESPECIALLY IN THE
CIRCUMSTANCE BECAUSE YOU CAN
MEASURE THE SAME DEFICITS
SERIALLY IN THE SAME INDIVIDUAL.
SO COHORTS CAN BE BEND BE BINNEE
GRAPH AND TRACKED OVER AN
EXTENDED PERIOD OF TIME.
BIOLOGICAL SAMPLES CAN BE
OBTAINED AT BASELINE AND EACH
POINT WHERE THERE'S A DIVERGENCE
AND THE DEFICIT ACCUMULATION
SCORE AND THE MEASURES OF THE
HALLMARKS AND SIGNALING MODEL IS
INDICATIVE OF ALTER INTRA ORGAN
COMMUNICATION AND BE ASSESSED TO
UNDERSTAND MORE ABOUT MOLECULAR
MECHANISMS INVOLVED IN THOSE
POINTS OF DIVERSION.
SO JUST TO SAY A LITTLE BIT
ABOUT THE HALLMARKS OF AGING AND
HEALTH DISPARITIES, THEY'RE
DEFINED AS FACTORS THAT ARE
DEPENDENT, HAVE A TIME DEPENDENT
MANIFESTATION OF ALTERATIONS
ACCOMPANYING THE AGING PROCESS.
THEY HAVE THE POS ABILITY TO
ACCELERATE AGING BY
EXPERIMENTALLY ACCENTUATING
HALLMARK AND THEY HAVE THE
ABILITY TO REDUCE OR REVERSE
AGING BY THERAPEUTIC
INTERVENTIONS TARGETING THE
HALLMARKS AND THERE ARE
CURRENTLY 12 HALLMARKS INCLUDING
GENOMIC INSTABILITY AND
EPIGENETIC ALTERATIONS AND LOSS
OF PROTEO STAY IS AND
DEREGULATED NUTRIENT SENSEING
AND CELLULAR AND CREM STEL
EXHAUSTION AND CHRONIC
INFLAMMATION AND MICROBIAL DIS
BIOS SIS AND CHANGES IN THESE
BUY LODGE PATHWAYS MAY BE
INDICATING AGE ACCELERATION OR
THE RISK OF ADVERSE HEALTH
OUTCOMES AND THEY COULD BE
TARGETS OF EARLY INTERVENTIONS
FOR HEALTH DISPARITIES AND THEY
MAY BE IDENTIFIED BY EXCESSING
TIME POINTS OF DIVERGENCE.
SO ALL 12 HALLMARKS ARE RELATE
TO ONE ANOTHER AND THEY INTERACT
ACROSS AND WITHIN AND BETWEEN
EACH OTHER.
THEY'RE ALSO INTERCONNECTED WITH
THE EIGHT HALLMARKS OF HEALTH
ALONG WITH ORGANISMAL --
ORGANIZATION THAT CREATES A
MULTI DIMENSIONAL CASCADE OF
INTERACTIONS THAT MAY FURTHER
EXPLAIN IMPORTANT FEATURES OF
THE AGING PROCESS.
AND AS YOU CAN SEE, SOME OF
THESE HALLMARKS OF HEALTH
INCLUDE BARRIER INTEGRITY,
MAINTENANCE HOME YO HOME YO STN
AND REPAIR AND REGENERATION
WHICH IS THINGS WE'VE HEARD
EARLIER TODAY RELATED TO HEALTH
DISPARITIES.
AND JUST TO SAY A LITTLE BIT
ABOUT INTERIM COMMUNICATION AS
ANOTHER, POTENTIAL BIOMARKER
LOOKING AT DIVERGENCE AND HEALTH
STATUS AND TO COMMUNICATION ARE
CONSIDERED A HALLMARK OF AGING
IS ASSOCIATED WITH HALLMARK HATH
WAYS AND TO ORGAN COMMUNICATION
IS THE GATEKEEPER OF METABOLIC
HEALTH AND TRAVEL
FROM ORGANS TO ORGAN THE
CIRCULATION, THERE ARE NEW
AVENUES THAT HAVE BEEN
DISCOVERED IN PARTICULAR IN THE
MIDDLE PANEL HERE SHOWN
NEURAL-IMMUNE INTERACTIONS THAT
MAINTAIN TISSUE HOME YO STAY IS
AND INVOLVE THE RAIN AND
PERIPHERAL NERVOUS SYSTEM AND
THEIR AN ATOMICALLY LINKED TO
VARIOUS ORGANS AND ALSO, ON THE
RIGHT, YOU WILL SEE VES KELS
INVOLVED SIGNALING IN BETWEEN
CELLS, TISSUES, ORGANS,
PHYSIOLOGICAL SYSTEMS AND BODY
DEPARTMENTS SUCH AS BETWEEN THE
BLOOD BRAIN BARRIER SO INCREASE
OUR UNDERSTANDING OF THESE
PROCESSES AND AGING AND HOW THEY
RELATE TO DIVERGENCE AND HEALTH
OUTCOMES WE'LL BE IMPORTANT FOR
ADDRESSING HEALTH DISPARITIES.
AND THEY CAN BE IDENTIFIED AND
MANIPULATED IN HUMANS AND ANIMAL
MODELS WHICH MAKES IT
BIOMARKERS.
BUY IDENTIFYING SPECIFIC
PATHWAYS AND THE APPROACH TO
ASSESSING HEALTH DISPARITIES WE
CAN DEVELOP TO DEPARTMENT AND
HEALTH STATUS AND PREDICT HEALTH
OUTCOMES AND TO INDICATE
EFFECTIVENESS OF INTERVENTIONS.
IN FACT CURRENTLY AS YOU CAN SEE
THERE ARE SEVERAL IDENTIFIED
POTENTIAL MOLECULAR BIOMARKERS
FOCUSED ON THE HALLMARKS OF
AGING AS WELL AS OTHER PATHWAYS
THAT INCREASE OR DECREASE AGING
PARAMETERS IN BOTH HUMAN AND
ANIMAL STUDIES.
NEXT SLIDE.
THE PROCESS OF AGING IS COMPLEX.
AGING IS INFLUENCED BY THE
BIOLOGICAL, PHYSICAL, AND SOCIAL
DETERMINANTS OF HEALTH.
BECAUSE BIOLOGY IS MOST PROM I
GUESSAL TO HEALTH THE
CONTRIBUTION OF BIOLOGY OR
UNDERSTANDING RATES OF AGING,
AND THE ROLE OF THE HALLMARKS OF
AGING IN COMMUNICATION AND
HETEROGENEITY MUST BE CLARIFIED
TO BETTER UNDERSTAND AGING
HEALTH DISPARITIES AND
UNDERSERVED AND DISADVANTAGED
POPULATIONS.
TRANSLATE BASIC BIOLOGICAL
FINDING TO CLINICAL
INTERVENTIONS FOR TREATING AGE
RELATED DISEASES AND CONDITIONS
AND LASTLY, AND RONNA LEWD TOD Y
THIS AS WELL, GIVEN THE
COMPLEXITY AND THE PRECISION
MEDICINE MAY BE REQUIRED.
ONE-SIZE-FITS-ALL INTERVENTION
WILL BE DIFFICULT IF NOT
IMPOSSIBLE.
THANK YOU.
AND I GUESS WE CAN GO TO THE
PANEL AND TAKE QUESTIONS.
>>IF YOU HOLD ON, WE'RE GETTING
READY TO MOVE INTO THE PART OF
THE PROGRAM WHERE WE'RE GOING TO
HEAR FROM THE TWO PANELIST AND
AFTER WE HEAR FROM THE TWO
PANELISTS WE'LL BRING THE
SPEAKER UP AND ENGAGE IN AN
ALL-INCLUSIVE DISCUSSION.
NEXT, THE FIRST PANELIST WE'LL
HEAR FROM IS Dr. DAVIS.
>>GOOD MORNING.
I AM EXCITED TO BE HERE AND I'M
LEARNING A LOT AND SEEING A LOT
OF OVERLAP IN MANY AREAS.
AND SO AS OUR LAST SPEAKER KIND
OF CONCLUDED WITH, SHE MENTIONED
PRECISION MEDICINE.
SO I THOUGHT INITIALLY I WOULD
TALK ABOUT SOME APPROACHES TO
ACHIEVING PRECISION MEDICINE
BECAUSE AS WE THINK ABOUT WHAT
HAS BEEN PRESENTED, WE
UNDERSTAND THAT THERE ARE
SOCIETAL FACTORS AND
ENVIRONMENTAL AND BIOLOGICAL
FACTORS AND THESE CAN ALL LEAD
TO DIFFERENT DISEASE
MANIFESTATIONS SO WE NEED TO
REALLY UNDERSTAND HOW THESE
DISEASES AND EVEN TREATMENT
RESPONSES ACTIVATE CERTAIN
PATHWAYS TO ACTUALLY ACHIEVE
PRECISION MEDICINE FOR ALL.
BUT ONE OF THE THINGS THAT I
THOUGHT I WOULD TALK ABOUT IS
SOME OF THE LIMITATIONS TO THIS
SO WE NEED DATASETS FROM AND
EVERY ENGAGE WE NEED THEM TO
PARTICIPATE IN RESEARCH EX
CLINICAL TRIALS AND TO DO THAT A
MAN BEAR YEAR IS TRUST AND SO
HOW DO WE INCREASE TRUST IN
POPULATIONS THAT HAVE
HISTORICALLY BEEN EX LAWSUITED
AND DISADVANTAGED.
I THOUGHT I WOULD GO BACK TO
Dr. WALLACE WHEN SHE SHOWED
THE TRANSLATIONAL SPECTRUM AND A
LOOP TO COMMUNITY TO BASIC
SCIENCE AND THIS APPROACH
ACTUALLY SPEARHEADED BY WHAT
WE'VE LEARNED IN COVID.
ONE OF THE KEY BARRIERS WAS
ACCESS TO INFORMATION AND AS YOU
ALL KNOW, MISINFORMATION AND
DISINFORMATION WAS RAMPANT SO IT
LEAD TO POOR HEALTH OUTCOMES
BECAUSE PEOPLE COULD NOT MAKE
INFORMED DECISIONS.
WHEN WE STARTED, PART OF ONE
I'VE DONE, I'M A BASIC SCIENTIST
AND I THINK AS A Dr.
PEREZ-STABLE MENTIONED THAT WE
NEED INTER DISCIPLINE AR
COLLABORATIONS AND I RESEARCH AT
MEHARRY MEDICAL COLLEGE AND WE
LOOKED AT HOW WE CAN WORK
TOGETHER AND TO BUILD TRUST AND
TO PARTICULARLY FOR COVID
INCREASE VACCINATION RATES.
ONE OF THE KEY THINGS AND THE
PUBLIC WANTS ACCESS TO SO HOW DO
WE DO THAT.
BASIC SCIENTIST AND POPULATION
SCIENTISTS CAN HELP INCREASE
THIS TRUST.
SO IN ORDER TO ACHIEVE HEALTH
EQUITY, THE PUBLIC NEEDS MORE
ACCESS TO RESEARCHERS AND
SCIENTISTS.
WHAT WE STARTED TO DO, WE HAVE
COMMUNITY ENGAGEMENT CORE SO WE
STARTED TO USE THIS CORE TO
UNDERSTAND SOME OF THESE
BARRIERS.
THEY WERE WORKING WITH FACULTY
TO ADDRESS SOME OF THE KEY
THINGS WE THOUGHT WOULD BE
IMPORTANT IN ACHIEVING
IMPROVEMENT INFORMATION SO WE
CREATED DIFFERENT ACTIVITIES TO
HELP DISSEMINATE INFORMATION AND
WE GAVE DISSEMINATION TO FACULTY
AND WE HAD LISTENING SESSIONS TO
LISTEN TO BASIC SCIENCE
RESEARCH, WE DID Facebook LIVE
SEGMENT AS WELL AS TOWN HALL
MEETINGS NEWSPAPER ADDS AND
ON-LINE NEWSLETTER ABSTRACTS.
WE HELPED THESE BASIC SCIENTISTS
WRITE IT IN LAY MEN TERMS AND
FROM THIS, EACH ACTIVITY
RESEARCHER WAS PAID WITH A
MEMBER OF THE COMMUNITY
ENGAGEMENT CORE WHICH HELPED
THEM GUIDE THEM THROUGH THE
PROCESS.
SOME OF THESE ACTIVITIES
ENLISTED IN THIS TABLE HERE AND
THEN WE HAD COMPETENCY WE
DEVELOPED TO RESEARCH THE
ACTIVITIES AND RECOMMENDATIONS
FOR EVALUATION AND WE ALSO HAD A
POST TRAINING DISSEMINATION,
DISSEMINATION TRAINING WHERE WE
LOOKED AT THE RESULTS OF THE
PARTICIPANTS THE SIDE SO THROUGH
THESE ACTIVITIES, THESE CAN BE
USED BY POPULATION SCIENTISTS
AND THEN ACADEMIC INSTITUTIONS A
ADD MOL MODEL TO GUIDE THE
COMMUNITY AND ENGAGE RESEARCH
DISSEMINATION ACTIVITIES SO SOME
OF OUR NEXT STEPS ARE TO CONDUCT
MORE RESEARCHER TRAININGS AND
FURTHER DEVELOPED STRATEGIES
WITH INPUT FROM ESTABLISHED
COMMUNITY ADVISORY BOARDS TO
ENHANCE THE SCIENCE OF
DISSEMINATION WITH AN EMPHASIS
ON THE COMMUNITY PERSPECTIVE.
[APPLAUSE]
>
MINUTES GOES BY FAST.
MY JOB NOW IS THE SECOND
PANELIST TO PULL TOGETHER ALL
THESE GREAT TALKS OF WHAT WE
HEARD AND THEN LEAD US INTO THE
QUESTION AND ANSWER PERIOD.
SO I JUST WANT TO REFLECT ON
WHAT I LEARNED AND HEARD THIS
MORNING.
WE HAD FOUR OUTSTANDING
PRESENTATIONS WHICH EACH OF
THOSE PRESENTATIONS IN MY
REFLECTION, TALKS ABOUT THE
ROBUST APPROACHES THAT HAVE BEEN
TAKEN NOW TO ADDRESS HEALTH
DISPARITIES AND WHAT NEEDS TO BE
TAKEN TO ACHIEVE HEALTH EQUITY
AND ALSO THE OTHER THING IS, HOW
GEROSCIENCE CAN POSITION ITSELF
TO BE THE LEAD IN ONE IN THE
AREA OF ACHIEVING HEALTH EQUITY
AND THAT'S SUSTAINING AND
TESTING THIS GEROSCIENCE
HYPOTHESIS SO ONE OF THE KEY
THINGS I LEARNED FROM Dr.
PEREZ-STABLE'S PRESENTATION IS
THAT IT'S GOING TO BE IMPORTANT
FOR US TO TAKE THIS INTER
DISCIPLINARY COLLABORATION IN
ORDER TO ADDRESS THE INDIVIDUAL
LEVEL HEALTH DISPARITIES THAT
EXIST AND TO UNDERSTAND THAT
RACISM AND DISCRIMINATION ARE
KEY DRIVERS OF THOSE AND IN
ORDER FOR US TO BE ABLE TO
REALLY MOVE FORWARD, WE HAVE TO
PUT SOME CONCERTED EFFORT NOT
ONLY IN JUST TALKING ABOUT IT
BUT WHAT DOES IT MEAN TO MEASURE
IT AND MEASURE IT APPROPRIATELY
AND PUT IT IN DIFFERENT TYPES OF
STUDY DESIGNS.
NEXT I LEARNED FROM Dr. ZENK
THAT THE KEY MESSAGE I LEARNED
THERE IS THAT THE INDIVIDUALS'
CHOICES ARE CON TRAINED BY THE
SOCIAL STRUCTURES THAT THEY LIVE
IN.
THAT'S THE BIGGEST ONE I TOOK
FROM THERE AND THAT THERE ARE
THESE SEVERAL DIFFERENT SOCIAL
DETERMINANTS OF HEALTH THAT
IMPACT THESE INDIVIDUAL CHOICES
AND TO BE ABLE TO DISENTANGLE
THOSE AND SEPARATE THOSE MIGHT
NOT BE OPTIMAL AND WE NEED TO
UNDERSTAND HOW PEOPLE OPERATE IN
THEIR SPACES TO BE ABLE TO
CREATE MULTI LEVEL INTERVENTIONS
TO MOVE FORWARD SO WE CAN MEET
PEOPLE WHERE THEY ARE AND Dr.
WALLACE'S PRESENTATION, I REALLY
UNDERSTAND AND LEARNED THAT
THERE'S THIS DROVE HOME THE
POINT WITH MR. IS TO THINK ABOUT
THIS POOR REPRESENTATION WE HAVE
IN CLINICAL RESEARCH AND HOW DO
WE MOVE AND A ADVANCE TO
ACHIEVING THESE STUDIES WHERE WE
HAVE ALL DIFFERENT RACE
ETHNICITY AND NOT JUST RACE AND
ETHNICITY I KNOW A LOT OF TIMES
WE TALK ABOUT RACE AND ETHNICITY
AND AND THEY ARE A AT THE TIMER
OWE GIN TEE ACCESS AND THEN,
FINALLY.
THEY ADDRESS SOME OF THE THINGS
THAT ARE AT THE CRUX OF WHAT I
BELIEVE WILL TAKE FOR US TO BE
ABLE TO MOVE FROM HEALTH
DISPARITIES AND RESEARCH TO
ADVANCE HEALTH EQUITY AND TO DO
THAT IN A MEANINGFUL WAY WHICH
WE'RE NO LONGER DOING SILO
RESEARCH AND WE'RE UNDERSTANDING
AND THINKING ABOUT THOSE
DIFFERENT LEVELS OF A DOMAINS
THAT WERE SHOWN IN THE EARLIER
RESEARCH FRAMEWORK AND I WANTED
TO SAY THAT Dr. DAVIS HIS
COMMENTS REGARDING ENGAGING THE
COMMUNITY IS IMPORTANT WITH
RESPECT TO BUILDING TRUST AND
MAKING SURE THAT WE HAVE THIS
DIALOGUE AND IT'S BUY
DIRECTIONAL WHEN WE GO INTO THE
COMMUNITY AND ENGAGE IN SOME
DECISION-MAKING AND THEY OFTEN
TIMES WHAT WE MISS OUT IS WE GO
IN WITH THINGS WE WANT TO DO IN
MIND AND NOT NECESSARILY ASK OR
YOU COME WITH IDEA AND WE WANT
TO BE OPEN TO GOING INTO
PARTICULARLY IF WE'RE ASKING
PEOPLE, PEOPLE OF COLOR, TO GIVE
US BIOSPECIMENS THERE'S A WHOLE
STORY HISTORY OF DISTRUST AND WE
WANT TO BE ABLE TO DO THAT AND
BUILD A RELATIONSHIP THAT
INVOLVES INTO A PARTNERSHIP AND
I THINK THAT'S GOING TO BE
IMPORTANT AND I WANT TO CLOSE
WITH TWO QUESTIONS THAT COME TO
MIND AFTER HEARING THESE GREAT
PRESENTATIONS.
I'VE ALWAYS WONDERED THIS AND I
LOVE TO TALK ABOUT IT AND I ALSO
WONDERED, WE TALK ABOUT
ACCELERATED AGING PHENOTYPE.
HOW DO WE KNOW IT'S ACCELERATED
COMPARED TO WHOM?
IT MAY BE NORMAL BASED ON THE
LIVING CONDITIONS FOR WHICH
PEOPLE LIVE.
PUT THE REFERENCE GROUP IN THE
LIVED EXPERIENCE OF THE PEOPLE
THAT WE'RE SAYING ACCELERATED
AND DO WE SIT ACCELERATED IN
THEM AND THEY WILL CALL IT A
COUNTER FACTUAL BUT YOU KNOW,
LET'S THINK ABOUT THAT SO WE'RE
SAYING WE'RE AT THE TIMING AN
ACTESTING A AN ACCELERATEDPHENOT
HEAR BUT I KNOW IT'S THERE
BECAUSE I SA IT IN Dr. ZENK'S
SLIDE I WOULD LOVE TO ELEVATE
THE CONVERSATION ON HOW WE'RE
GOING TO TRAIN THE NEXT
GENERATION OF SCIENTIST TO DO
THIS WORK FOR THE BETTERMENT OF
ALL HUMANS AND TO IMPROVE THE
HEALTH OF NOT ONLY OLDER ADULTS
BUT ACROSS THE BOARD.
I'LL CLOSE ASK MY COLLEAGUES TO
JIN ME UP AT THE PODIUM AND SO
WE CAN OPEN IT UP FOR QUESTION
AND ANSWERS.
[APPLAUSE]
IS IT POSSIBLE TO GET Dr.
CARRINGTON UP ON THE SCREEN,
PLEASE?
AS YOU MAY RECALL, Dr.
PEREZ-STABLE SHARED WITH US HE
HAD TO LEAVE.
WE'RE NOW OPEN FOR QUESTIONS.
WE'LL TAKE QUESTIONS.
IF APPROXIMATE YOU HAVE A
QUESTION, PLEASE, APPROACH THE
MICROPHONE AND IDENTIFY.
YOUR NAME AND INSTITUTION,
PLEASE.
HELLO, THIS IS MANUAL NORAH.
I HAVE A BROAD -- I DON'T KNOW
WHAT TO SAY NAIVE QUESTION BUT
IT'S A BROAD QUESTION REGARDING
HEALTH DISPARITIES AND MY
QUESTION IS THIS, ALL THE
SPEAKERS HAVE DONE A GREAT JOB
IDENTIFYING HEALTH DISPARITIES
AND THE DIFFERENCE BETWEEN THE
CHALLENGES AND MY QUESTION IS,
NOT ABOUT THE ROLE OF NIH.
THINK WE'RE DOING A GREAT JOB.
WE'RE DOING A GREAT JOB BUT MY
QUESTION IS MORE ABOUT THE ARE
WE GOING THE RIGHT DIRECTION IN
HEALTH DISPARITIES.
WE KNOW THE FRAMEWORK IS COMPLEX
AND I DON'T EXPECT THE PANEL TO
KNOW ALL THAT BUT CAN WE SAY
THAT FIRST OF ALL, ARE WE GOING
IN THE RIGHT DIRECTION TO TRY TO
10, 20, 50 YEARS FROM NOW WE'LL
NOT HAVE THESE WE ARE SEEING
BETWEEN FOR EXAMPLE BETWEEN THE
DIFFERENT ETHNIC GROUPS, RACES,
SOCIOECONOMIC STATUS, THIS IS A
COMPLEX QUESTION BECAUSE
ECONOMICS PLAYS A BIG ROLL AND
POLITICS PLAY A BIG ROLE BUT ARE
WE GOING IN THE RIGHT DIRECTION
AS A COUNTRY OF OUR OWN?
THAT'S MY STARTING QUESTION.
THANK YOU.
>>ANYONE ON THE PANEL WANT TO
TAKE A SHOT AT THAT.
>>SO, IT'S AN INTERESTING AND A
GREAT QUESTION.
I WILL SAY OVER THE YEARS I'VE
BEEN INVOLVED IN HEALTH
DISPARITIES RESEARCH, I'VE SEEN
A BIT OF A CHANGE FROM TRYING TO
DESCRIBE WHAT HEALTH DISPARITIES
ARE AND UNDERSTANDING, YOU KNOW,
WHAT IS CONTRIBUTING TO IT TO
MORE TRYING TO ADDRESS THE ROOT
CAUSES AND WE'RE SHIFTING OUR
FOCUS AND DESCRIBING THEM TO
MAYBE TRYING TO FIGURE OUT
INTERVENTIONS AND WAYS THAT WE
CAN GET TO THOSE ROOT CAUSES OF
IT SO, I HOPE THAT WE'RE MOVING
IN A DIRECTION WHERE ELIMINATING
DISPARITIES IS A REALITY AND I
DON'T THINK IT'S GOING TO BE
OVERNIGHT AS THERE'S A LOT OF
CONTRIBUTORS THAT WILL BE
DIFFICULT TO ADDRESS AND WE ARE
CHANGING OUR MIND SET FROM
ADDRESSING AND I DON'T KNOW IN
YOUR EXPERIENCE IF YOU ARE ALSO
SEEING THAT CHANGE.
>>
>>YEAH, I DEGREE.
THERE'S A MOVEMENT OF BLAMING
INDIVIDUALS TO RECOGNIZING THE
FACTORS THAT MANY LEVELS AND
UNLESS WE GET AS THOSE WE WON'T
BE AS EFFECTIVE AS WE CAN BE AT
ELIMINATING HEALTH DISPARITIES.
>>AND ONE THING SMALL THING TO
ADD IS WHAT ROLLAND ENDED WITH
IS TRAINING THE NEXT GENERATION
OF SCIENTISTS TO ADDRESS THESE
PROBLEMS AND THERE WAS A TIME
WHERE A LOT OF HEALTH
DISPARITIES WORK WAS NOT FUNDED
AND SO NOW WE'RE SEEING MORE
PEOPLE ENGAGING IN HEALTH
DISPARITY AND THINKING ABOUT
HEALTH DISPARITIES FROM
DIFFERENT PERSPECTIVES.
>>I THINK THAT THE REAL POINT,
I AGREE WITH EVERYONE.
I THINK ONE INDICATION THAT WE
MADE PROGRESS IS WHEN THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES NAME RACISM IS A
PUBLIC-HEALTH ISSUE AND AFTER
THAT, NIH IMMEDIATELY,
IMMEDIATELY WEPT AND PUT OUT
CALLS AND ALLOCATED RESOURCES SO
I ABSOLUTELY CERTAINLY THINK
THAT WE ARE MOVING IN A RIGHT
DIRECTION.
I THINK WE'RE IN THE RIDE PACE
AND WE'RE ON THE RIGHT PLACE.
I DO AGREE WITH Dr. ZENK WE
COULD HAVE MOVED A LITTLE MORE
ABREAST BUT IT MIGHT BE THE
NATURE OF SCIENCE AND THE
IMPLICATION OF SCIENCE.
BUT I DO BELIEVE THAT WE ARE IN
THE RIGHT AREA.
REMEMBER, THIS DIDN'T HAPPEN
OVERNIGHT.
TO REVERSE IT OVERNIGHT IS
UNTHINKABLE SO WE WANT TO BE
MINDFUL OF THAT.
YES, MA'AM.
>>SO THESE QUESTIONS ACTUALLY
CAME IN FROM THE ZOOM AUDIENCE.
WHAT IS THE PROCESS TO DETERMINE
AND HIGHLIGHT PRIORITY HEALTH
DISPARITIES POPULATIONS FOR HIGH
PRIORITY RESEARCH SUPPORTED BY
NIH?
>>WHAT IS THE PROCESS --
>>TO DETERMINE AND HIGHLIGHT
PRIORITY HEALTH DISPARITIES
POPULATIONS.
>>IF I REMEMBER CORRECTLY, THAT
WAS ON Dr. PEREZ-STABLE SLIDE
AND HE IS NOT WITH US.
I'M NOT SURE WHAT THE PROCESS
WOULD BE WITH THEM.
BUT DOES ANYBODY WANT TO TAKE A
STAB AT IT?
I KNOW THAT WAS ON HIS
PRESENTATION.
>>Dr. LOOKED HOD HODES IT JOI.
LEGISLATIVE REQUIREMENTS OR
MANDATES WERE PART OF HOW THEY
WERE DEFINED AND I THINK BASED
ON THE CHANGING LANDSCAPE AS HE
ALLUDED TO THEY'RE REVISITING
THOSE PRIORITY GROUPS NOW.
>>WHEN I THINK OF AGING
RESEARCH, I THINK IT'S SO
IMPORTANT TO UNDERSTAND THE
GLOBAL PERSPECTIVE AND THERE'S
GREAT STUDIES OF COURSE FROM
ITALY AND JAPAN ABOUT LONGEVITY.
ARE THERE HEALTH DISPARITY
STUDIES FROM OTHER COUNTRIES
WHERE PEOPLE ARE MARGINALIZED
ALL THROUGH EUROPE OF COURSE AND
SOUTHEAST ASIA?
ANYTHING TO COMPARE TO?
>>I BELIEVE THERE ARE SOME
COMPARATIVE STUDIES.
MY PERSPECTIVE AS IT RELATES TO
COMPARING IT WITH HEALTH
DISPARITIES IT'S NOT THE RIGHT
BECAUSE IT'S APPLES TO ORANGES
BECAUSE PEOPLE'S CONTEXT ARE
DIFFERENT.
TO GIVE YOU A BRIEF EXAMPLE.
WHEN WE STUDY BLACK AND WHITE
DISPARITIES IN THE UNITED STATES
AND WE'RE THINKING ABOUT ACROSS
THE LIFE OR PARTICULAR OLDER
ADULTS WE CANNOT NOT UNDERSTAND
THE IMPACT, THE SLATE RE, JIM
CROW AND ALL THOSE THINGS THAT
HAVE OCCURRED WHEREAS IF WE
COMPARE IT IN SWEDEN THEY DON'T
HAVE THOSE.
WHEN WE THINK ABOUT MAKING
COMPARISONS IT NEEDS TO BE AS
COMPARABLE AS POSSIBLE BUT THERE
ARE SOME STUDIES THAT HAVE DONE
SOME COMPARATIVE STUFF AND
THERE'S NIA HAS FUND AID NUMBER
OF SISTER STUDIES WITH THE
HEALTH AND RETIREMENT SURVEY AND
A COUPLE OTHER SURVEYS THAT ARE
VERY SIMILAR TO IT AROUND THE
COUNTRY AND THEY DO PROVIDE SOME
COMPARATIVE RESEARCH ON THE
INDICATORS I THINK SEEM TO BE
APPROPRIATE.
ANYBODY ELSE?
>>WE HAVE A CENTER FOR GLOBAL
HEALTH AT NCI THAT'S GROWING IN
THE SPACE OF UNDERSTANDING AND
ADDRESSING HEALTH DISPARITIES
AND THE HOPE IS SOME OF THE
LESSONS LEARNED IN LOW AND
MIDDLE INCOME COUNTRIES AND
OTHER AREAS EXPERIENCING
DISPARITIES COULD POTENTIALLY BE
APPLIED BACK HERE IN CERTAIN
SCENARIOS BUT I COULDN'T AGREE
MORE THAT THE CONTEXT IS VERY
DISTINCT AND DIFFERENT AND IT'S
NOT A DIRECT COMPARISON SO, I
THINK CERTAINLY LEARNING MORE
AND LOOKING AT WHAT WE CAN
POTENTIALLY APPLY BACK HERE WILL
BE AVAILABLE BUT I DON'T THINK
IT WILL BE IN ALL CASES.
>>DID YOU HAVE ANYTHING?
>>I WAS JUST GOING TO ECHO WHAT
TIFFANY SAID.
THERE'S A LOT OF STUDIES
SUPPORTED NIA LOOKING AT
DISPARITIES AND OTHER SORT OF A
GLOBAL CONTEXT AND THERE'S SOME
NEW INITIATIVES LOOKING AT
ALZHEIMER'S DISEASE AND RELATED
DEMENTIA AND INTERNATIONALLY SO
I THINK THERE'S THIS INTEREST IN
LOOKING AT HEALTH DISPARITIES
FROM A GLOBAL PERSPECTIVE AND
SEEING ABOUT WHAT THINGS CAN BE
BACK TO COMPANIES IN THE U.S.
BUT CERTAINLY CONTEXT MATTERS.
>>THANK YOU.
>>DO YOU WANT TO COME FORWARD.
YOU CAN COMMENT ON THIS AS WELL.
>>SURE.
SURE.
VERY BRIEFLY.
SO LIZ NEIL SON FROM THE
DIVISION OF BEHAVIOR RESEARCH.
THERE'S AN INTERNATIONAL FAMI
FAMILY -- LIZ KNEELSON DIVISION
OF BEHAVE.
THERE'S AN INTERNATIONAL FAMILY
OF STUDIES LINKED TO THE HEALTH
AND RETIREMENT STUDY THAT LOOKED
AT THE SOCIAL BEHAVIORAL POLICY
ENVIRONMENTAL EXPOSURE THAT ARE
DRIVING HEALTH IN THESE
POPULATION REPRESENTATIVE GROUPS
AND I THINK JUST ALLUDING TO THE
SORT OF DEFINITION OF A HEALTH
DISPARITY THAT IS SOMETHING THAT
IS DRIVEN BY UNEQUAL ACCESS AND
RESOURCES AND OR DISADVANTAGE
WITHIN THE POPULATION THAT'S
GOING TO BE VERY DIFFERENT BY
THE DIFFERENT CONTEXT IN WHICH
PEOPLE ARE LIVING SO YOU KNOW,
RACE IS CONDUCTED SOCIALLY HERE
AND DIFFERENTLY IN ANOTHER
COUNTRY SO THOSE HAVE RICH
PUBLICLY AVAILABLE DATA
RESOURCES TO SHARE TO TACKLE
THESE QUESTIONS ACROSS THE
INTERNATIONAL ARENA.
>>THANK YOU.
>>YES, HI, THANK YOU VERY MUCH
FOR THIS INTERESTING SESSION.
I JUST WANTED TO ASK A GENERAL
QUESTION, THE EMPHASIS ON
DISADVANTAGED, SOURCES OF
ADVERSITY, MAKES A LOT OF SENSE
AND THINKING ABOUT HEALTH
DISPARITIES BUT THE WHOLE KIND
OF FLIP SIDE ABOUT ADVANTAGE AND
BUFFERING AND RESILIENCE, KIND
OF GOES HAND AND HAND BUT IT'S
NOT REALLY SEEMS TO BE GIVEN THE
EXPLICIT ATTENTION AND SO I'M
WONDERING EITHER ABOUT
INITIATIVES THAT ARE
SPECIFICALLY FOCUSING ON THE
POSITIVE ASPECTS THAT LEADS TO
DISPARITIES, WHY DO SOME GROUPS
HAVE MORE ADVANTAGE AND EVEN
MARGINALIZED GROUPS WITH
HISPANIC MORTALITY PARADOX FLEX
THETHATTHERE'S CERTAIN AGES SO S
EXPLICIT FOCUS ON RESILIENCE AND
BUFFERING IS THAT PART OF NIH
THE MULTIPLE INSTITUTES IS THERE
A FOCUS ON THAT?
THANK YOU.
>>UH-HUH.
>>DO YOU WANT TO TAKE THAT ONE.
>>I THOUGHT I SAW IT.
>>I'LL START, YEAH.
THANK YOU FOR THE QUESTION.
I AGREE, NOT ONLY DOES
DISADVANTAGE ACCUMULATE BUT SO
DOES ADVANTAGE AND THAT PLAYS
OUT IN DIFFERENT WAYS IN TERMS
OF HEALTHY AGING.
BUT I AGREE WITH YOU IN TERMS OF
THINKING ABOUT RESILIENCE AND
STRENGTH BASED STRATEGIES THOSE
ARE REALLY IMPORTANT AND I
TOUCHED ON IT BRIEFLY IN MY
PRESENTATION.
I THINK RESILIENT STRATEGIES,
STRENGTH BASED STRATEGY THAT
BUFFER THE IMPACT OF EXPOSURE TO
A DISADVANTAGE INEQUITABLE
SYSTEMS AND WE CAN DO A LOT
MORE IN TERMS OF IDENTIFYING
EFFECTIVE INTERVENTIONS.
>>ANYONE ELSE?
>>THANK YOU.
MY NAME IS RAGA I'M A GRADUATE
STUDENT FROM YALE.
SO, THERE WAS A REALLY
INTERESTING SLIDE IN Dr.
LAWRENCE'S PRESENTATION AROUND
SORT OF THE HEALTH DISPARITIES
FRAMEWORK WITH SPECIFICALLY WENT
THROUGH SOCIAL FACTORS AND
PSYCHOLOGICAL FACTORS.
MY QUESTION WAS MORE AROUND
SPECIFICALLY SOME OF THE SOCIAL
FACTORS THAT WERE POINTED OUT
AND THE DIFFERENT FORMS OF
STRESS THAT ARE THERE.
AND HOW THEY RELATE TO SORT OF
HEALTH DISPARITIES THAT ARE
THERE SO A LOT OF WORK SEEMS TO
BE DONE IN SORT OF LINKING STUFF
LIKE DEPRESSION.
>>BY RACIAL ETHNIC GROUPS AND
THEY NOW HAVE BEEN ABLE TO
IDENTIFY THEM USING THE STRESS
BIOMARKERS THEY HAVE.
I KNOW THERE'S WORK THERE AND
THERE'S BEEN DONE AND TO ADDRESS
THAT ISSUE BUT WE HAVE MORE WORK
TO DO IN THAT AREA BUT I KNOW
Dr. CRIMCRIMONS IS DOING THAT WE
USE OF THE HRS DATASET.
>>I HAVE A QUESTION.
STACEY HIGHLIGHTED IN YOUR TALK
TALKING ABOUT RATHER THAN
PREDICTORS OF HEALTH DISPARITIES
AND LOOK AT PEOPLE AND BINNED
THEM BY THEREBY LOGICAL PROFILES
AND I WAS RECONCILING WITH THE
IMPORTANCE OF A REPRESENTATIVE
SCIENCE AND MAKING SURE THAT WE
HAD THE INCLUSION OF ALL THE
RELEVANT POPULATIONS AND
ADEQUATELY TO GET THE VARIATION
IN THE POPULATION AND ALSO WITH
THE FUNDAMENTAL POINTS AND THE
DRIVERS ARE IN THESE SOURCES OF
DISADVANTAGE SO I WAS WONDERING
IF YOU CAN ELABORATE ON HOW YOU
DIFFERENTIATE THIS SORT OF
BINNING BY BIOLOGICAL STATUS VIA
V THE SORT OF STANDARD AND
GROUPING AND WHERE THOSE
APPROACHES HAVE COMPLIMENTARY
AND STRENGTH OR WEAKNESSES AN
AND -- I'M OFF MUTE.
>>WE CAN HEAR YOU NOW.
>>SO, MAYBE I DIDN'T EXPRESS IT
COMPLETELY RIGHT BUT THOSE
BINNING BY HEALTH STATUS IS FROM
A DIVERSE COHORT THAT HAS SORT
OF THE REPRESENTATIVE SAMPLES
THAT YOU WOULD EXPECT AND WANT
AND A COHORT.
BUT INSTEAD OF TAKING THE COHORT
AND SEPARATING PEOPLE OUT BY AGE
OR RACE OR SOCIOECONOMIC STATUS
OR WHATEVER CATEGORY YOU WANT TO
PLACE ON IT, YOU LOOK MORE
BROADLY AT HEALTH STATUS AND THE
MEASURE OF HEALTH STATUS MAY
INCLUDE THE SOCIAL DETERMINANTS
OF HEALTH AND IT DEPENDS ON WHAT
STATUS WE THINK WOULD WORK WELL
FOR WHAT YOU ARE TRYING TO SEE
AND I THINK SOME OF THOSE
FACTORS SUCH AS FUNCTION AND
DISABILITY AND THINGS IN THE
DEFICIT ACCUMULATION INDEX COULD
PLAY INTO THAT A LITTLE BIT AS
WELL.
SO ARE JUST LOOKING TO SEE ANY
PARTICULAR GROUP OF PEOPLE MAYBE
STARTING FROM A DIFFERENT POINT,
IN THAT MAKES SENSE.
>>THANK YOU TO ALL THE SPEAKERS
AND PANELISTS.
LISTENING TO ALL THE TALKS, I
REALIZE THERE'S SOME IMPLICIT
BIOLOGICAL HYPOTHESIS WE CAN
MAKE EXPLICIT IN WHAT WE'RE
TALKING ABOUT AND I THINK THE
PROMINENCE OF HEALTH DISPARITIES
AT THE GEROSCIENCE THAT AGING IS
A ROOT CAUSE OF MANY CHRONIC
DISEASES AND IF WE'RE WORKING AT
HEALTH DISPARITIES, MAYBE THE
HIGH POTH IS THAT HEALTH
DISPARITIES OR SOCIAL
DISPARITIES ARE ACCELERATING
AGING AND IT'S ONE HYPOTHESIS
THERE ARE THAT SET OF STREETORS
AND SOCIAL DETERMINANTS OF
HEALTH IS INFLUENCING A LOT OF
BIOLOGICAL PROCESSES, NOT
NECESSARILY AGING THAT ARE
THROUGH VARIOUS CHAINS IMPACTING
A WIDE RANGE OF DISEASES AND
MIGHT BE A SEPARATE PATHWAY
UNRELATED TO AGING OR THOSE TWO
THINGS MIGHT INTERACT PERHAPS
IT'S THE MOST LIKELY BUT I JUST
THOUGHT IT WOULD BE INTERESTING
TO FRAME THE HYPOTHESIS IMPLICIT
IN THINKING ABOUT IT AND I WOULD
LOVE TO GET YOUR REACTIONS.
YOU ARE LOOKING AT ME.
[LAUGHTER]
>>THANK YOU FOR THE QUESTION.
I THINK IT'S SIMILAR TO WHAT YOU
ARE SAYING.
YOU WANT TO KNOW, DOES AGING
PROCESS DOES HEALTH DISPARITIES
EX EXASPERATE THE AGING.
FROM USING IT GEROSCIENCE
ASPECT.
I STILL DON'T KNOW THE ANSWER TO
IT.
I PROBABLY CAN ARGUE BOTH SIDES
OF THE COIN.
PRESS ON IT.
BUT IT'S AN IMPORTANT QUESTION
TO ASK AND FOR THIS COMMUNITY
GEROSCIENCE I THINK MOVING
FORWARD IF WE START WITH
DISPARITIES WAS OUTSTANDING IDEA
BECAUSE IT CUTS ACROSS OR
IMPACTS THE OTHER SEVEN OR EIGHT
TOTAL, THE OTHER SEVEN AREAS AND
I THINK IT PROVIDES US AN
OPPORTUNITY TO THINK ABOUT THIS
PARTICULARLY AS WE GET TO DAY
THREE WHERE WE HEARD ALL THE
PRESENTATIONS AND THINK ABOUT
HOW WE AS A COMMUNITY CAN SET
THESE HYPOTHESIS UP AND TO TEST
THEM AND MAYBE, YOU KNOW, THE
SCIENTIFIC WAY IS TO TEST BOTH
OF THEM AND IT MAY BE IT BUT YOU
HAVE TO SEE, YOU SHOULD THINK
ABOUT WHAT IT IS YOU ARE TRYING
THINK AND HOW YOU CAN FIT EITHER
ONE OF THESE WITHIN SOME OF THE
WITHOUT STIGMATIZING THE PEOPLE
TO IMPROVE THEIR HEALTH.
THAT'S ALL I'VE GOT FOR YOU
RIGHT NOW.
I'M NOT GOING TO LOOK OVER AND
ASK IF THEY HAVE ANYTHING I KNOW
THEY DO BECAUSE DOES ANYBODY
HAVE ANYTHING ELSE TO ADD?
>>I MIGHT ANSWER.
IT'S AN INTERESTING QUESTION.
I'M TRYING TO WRAP MY BRAIN
AROUND HOW IT WOULD GO DIFFERENT
IN TERMS OF WHAT THE OUTCOMES OF
THE RESEARCH WOULD DIFFER.
ONE THING I WANT TO SAY IS MORE
AND MORE AT NCI WE'RE TRYING TO
STEER AWAY FROM DOING HEALTH
DISPARITIES RESEARCH.
RIGHT.
IT'S A SILOED KIND OF APPROACH
AND ONLY IN RESPONSE TO A
SPECIFIC RFA OR PAR AND GET ALL
RESEARCH TO CONSIDER DISPARITIES
AND UNDERSERVED POPULATIONS IT'S
JUST RESEARCH AND SO YOU KNOW,
ALONG THIS LINE EVENTUALLY WE'RE
GOING TO START -- STOP THINKING
ABOUT HOW DISPARITIES INTERVENE
AND JUST INCLUDE THEM FROM THE
BEGINNING AND SO I DON'T KNOW IF
I'M MAKING SENSE AS MUCHS -- ALL
RESEARCH SHOULD CONSIDER
UNDERSERVED POPULATION AND IF WE
CAN COMPARE AND LOOK FOR THINGS
THAT WOULD CONTRIBUTE TO
DISPARITIES AND IT WOULD BE A
RESULT OF SOMETHING IT SHOULD BE
DONE AND ORGANICALLY AND ALL
RESEARCH BEING DONE.
>>JUST IN CASE WE DON'T KNOW,
THERE'S DEMOGRAPHICS TRANSITION
THAT'S OCCUR IN AMERICA RIGHT
NOW.
WE'RE NOW A NATION WHERE THE
MINORITY ARE THE MAJORITIES AND
WE'RE A NATION WHERE OUR OLDER
SEGMENT POPULATION CONTINUES TO
LIVE LONGER AND LONGER THAT'S
BECAUSE OF THE ADVANCES WE HAVE
AND IF YOU PUT AT THE NEXUS OF
BOTH OF THOSE, WE'LL SEE THE
NATION EVENING HEAL'S HEALTH ISE
MINORITIES.
TO MOVE FORWARD AND THINK ABOUT
DISPARITIES, BY DEFAULT WE THINK
THERE'S A COMPARISON AND WE WANT
TO THINK BROADER AND WE WANT TO
THINK ABOUT HAVING INCLUSIVE
POPULATIONS TO BE ABLE TO
UNDERSTAND AND BE ABLE TO
SUFFICIENT SAMPLE SIZE TO STUDY
GROUPS AND SO WE NEED TO AND WE
WANT TO HAVE ALL MARKERS AND ALL
GROUPS SO WE DON'T JUST WANT ONE
GROUP WHERE THEY'RE HIGH AND
BIOSPECIMENS AND WE WANT A
BIOMEDICAL BANK WITH EQUAL
REPRESENTATION AND IT'S POWER TO
ANSWER ANY SCIENTIFIC INQUIRY IY
THAT WE WANT.
>>THOMAS.
WE ARE PART OF A GROUP THAT IS
TRYING TO DEVELOP A TRIPLET OF
GENERIC DRUGS AND AN ESSENTIAL
AMINO ACID SO IT COULD BE
ACCESSIBLE AND CHEAP FOR VARIOUS
CARDIOMETABOLIC BENEFITS.
WE HAVE PHASE 2 DATA ON OBESITY
AND BLOOD PRESSURE,
HYPERTENSION, VERY INTRIGUINGLY,
OUR PHASE 2 DATA SHOWED IT TO BE
DOUBLE LEE EFFECTIVE IN AFRICAN
AMERICANS.
WE DON'T HAVE GENOMIC DATA ON
THIS BUT WE'RE HAVING AN
INTERNAL DEBATE ABOUT HOW MUCH
TO FOCUS ON THIS FEATURE, PEOPLE
REFLECT BACK ON THE BUY
EXPERIENCE AND IT COULD BE
SOMEWHAT CONTROVERSIAL AND I'M
JUST CURIOUS TO ASK THIS PANEL,
ABOUT THE HEALTH EQUITY AND
ACCESS AND HEALTHY LONGEVITY ARE
MORE INFLUENTIAL AND MORE
PREVALENT IN THE COMMON
DISCOURSE, DO YOU THINK THAT
THIS FEATURE IN OUR DEVELOPMENT
PROGRAM IS SOMETHING THAT
DESERVES SPECIAL MENTION OR
FOCUS?
>>I THINK CERTAINLY IF YOU ARE
OBSERVE NORTH MARKED DIFFERENCE
THAN FURTHER INTERROGATION IS
WARRANTED.
ANYTHING THAT GETS PUT OUT INTO
A CLINICAL TRIAL OR OUT INTO THE
COMMUNITY PATIENTS SHOULD KNOW
WHAT THE DATA SUPPORTED AND HOW
THEY'LL RESPOND.
IT'S AN INTERESTING FINDING SO
JUST FOR THAT ALONE, I THINK
LOOKING INTO IT MORE.
I WOULD CAUTION WE'RE CERTAINLY
NOT SUPPORTIVE OF RACE BASED
MEDICINE.
WE DON'T GO INTO ANY STUDIES
WITH THAT INTENTION THAT WE'RE
GOING TO FIND A MEDICATION THAT
WILL WORK BETTER OR WORSE AND
ONE POPULATION BUT WE WANT TO
KNOW HOW THEY ALL WORK AND ALL
POPULATIONS TO MAKE SURE THAT
PERSONALIZED MEDICINE IS REALLY
ADVANCED.
SO, I WOULD FOLLOW-UP ON IT JUST
TO SEE IF IT'S REAL AND I DON'T
KNOW IF APPROXIMATE OTHERS HAVE
ANYTHING.
>>YEAH, JUST THE CAUTION,
RIGHT.
I THINK A NEW REPORT FROM THE
NATIONAL ACADEMY OF MEDICINE OF
PARTIALLY SUPPORTED BY THE NIH
MOVING AWAY FROM RACE,
SELF-REPORTED RACE TO GENETIC
MARKERS BECAUSE IT IS, WE DO
WANT TO CAUTION AGAINST, WE KNOW
RACE IS A SOCIAL CONSTRUCT AND
DOES NOT ADEQUATELY CAPTURE
GENETIC VARIABILITIES SO I WOULD
BE CAUTIOUS IN TERMS OF
INTERPRETATION BUT AGREE WITH
LOOKING INTO IT FURTHER.
>>DO YOU HAVE ANYTHING Dr.
LAWRENCE?
>>NOTHING MORE TO ADD.
I THINK Dr. ZENK HAD IT ALL.
I'M HAVING TROUBLE HEARING YOU.
I DON'T KNOW IF YOU ARE HAVING
TROUBLE HEARING ME.
I WAS GOING TO ACTUALLY MAKE A
COMMENT ABOUT THE NATIONAL
ACADEMY AND NEWLY LINKING
AGAINST TO GENETICS RATHER THAN
RACE.
HAVING SERVED ON THE H3 AFRICA
PANEL IT'S CLEAR THAT RACE IS A
SOCIAL CONSTRUCT AND GENETICS
TELLS A VERY DIFFERENT STORY
SOMETIMES SO I WOULD JUST ECHO
WHAT SHE SAID AND EXPLORE IT BUT
BE CAUTIOUS.
>>THANK YOU SO MUCH.
WE'RE AT TIME NOW.
I WANT TO THANK ALL THE
PANELISTS, THANK THE SPEAKERS
AND THE PAN PANELISTS FOR A JOB
WELL DONE.
JOIN ME IN A ROUND OF APPLAUSE
FOR THEM.
LUNCH OR YOUR OWN AND I START
SESSION 2 AT 12:45.
12:45.
BE BACK HERE READY TO GO.
BON APPETITE.
WELCOME BACK.
IT'S HARD TO MEETING OF THE
COLLEAGUES SO I APPRECIATE YOU
BEING HERE.
IT'S MY GREAT PLEASURE TO BE
HERE AND CHAIR THIS SESSION ON
HIGH AND LOW BURDENS OF
FUNCTIONAL DEFICITS AND
MORBIDITIES.
WHAT I THOUGHT I WOULD DO IS
INTRODUCE ALL THE AMAZING
SPEAKERS WE HAVE LINED UP TODAY
AND THEN I WILL HAND OFF TO THEM
AND WE'LL COME BACK AND DO A
LITTLE PANEL DISCUSSION.
OUR SPEAKERS FOR TODAY ARE Dr.
SOFIYA MILMAN THE ASSOCIATE
PROFESSOR DEPARTMENT OF MEDICINE
AT ALBERT EINSTEIN COLLEGE OF
MEDICINE AND SHE'S GOING TO TALK
ABOUT SEN NAN ARYANS AND THOSE
WITH EXCEPTIONAL AGING AND THOSE
WHO HIT 100.
I HAVE A FEW PATIENTS WHO ARE
LIKE THAT AND Dr. IS MICHAEL
GURVEN A PROFESSOR IN THE
DEPARTMENT OF ANTHROPOLOGY AT
UCSB IN SANTA BARBARA AND HE
WILL TALK ABOUT AGING IN
NON-INDUSTRY AMIZED CONTEXT AND
THE LESSONS WE CAN LEARN FROM
INDIGENOUS POPULATIONS.
FOLLOWING IS CHRISTINE ERLANDSON
SHE'S AN ASSOCIATE PROFESSOR OF
MEDICINE AND INFECTIOUS DISEASES
AT UNIVERSITY OF COLORADO AND
SHE WILL TALK ABOUT THE IMPACT
OF HIV AND AGING.
AFTER CHRISTINE IS MINA SEDRAK A
MEDICAL ONCOLOGIST AND THE
DEPUTY DIRECTOR OF CLINICAL
TRIALS AT THE CITY OF HOPE AND
HE IS GOING TO TALK ABOUT CANCER
AND ACCELERATED AGING AND HOW
CANCER AND THE CANCER TREATMENT
IMPACT ON MODERATING THE AGING
PROCESS AND THEN WE HAVE Dr.
NATHAN BRUMMEL A PULL
MINUTOLOGIST WHO IS GOING TO
TALK ABOUT THE POST ICU SYNDROME
AND ICU SE SUR RIVER AND THE IMT
OF A LONGER STAY LIFE AT AGING
PROCESS.
AFTER THE SPEAKERS WE HAVE DID
LEON MCDOOGLE WHO IS THE PAST
PRESIDENT OF THE NATIONAL
MEDICAL ASSOCIATION WHO IS GOING
TO GIVE US AN OVERVIEW OF
HOLISTIC GEROSCIENCE SCIENCE
APPROACHES AND INTERSECTIONAL
DIMENSIONS OF HEALTH AND
WELL-BEING.
USE USING THE 5A FRAMEWORK OF
AVAILABILITY ACCESSIBILITY,
ACCOMMODATION, AFFORDABILITY AND
ACCEPTABILITY.
AND AFTER THAT I WILL DO A
SUMMARY DISCUSSION.
MY NAME IS VY PERIYAKOIL FROM
SANFORD WHERE I SERVE AS THE
ASSOCIATE DEAN OF RESEARCH AND I
ALSO WORK AT THE PALO ALTO
HEALTH-CARE SYSTEM AS A CHIEF
STAFF.
I'M SO PLEASED TO BE HERE AND
IT'S OFF SO SOFIYA.
>>GOOD AFTERNOON, EVERYONE, I'M
REALLY EXCITED TO BE HERE.
I ENJOYED THE TALKS THIS MORNING
AND I'M LOOKING FORWARD TO THE
TALKS COMING UP.
SO TODAY I'LL TELL YOU ABOUT THE
WORK THAT WE'VE BEEN DOING
FOCUSED ON CENTENARIANS THAT ARE
A POPULATION OF EXCEPTIONAL
AGING.
AS WE'VE HEARD THIS MORNING, AND
MOST OF US KNOW, AGE ASKING A
MAJOR RISK FACTORS AND AIMING
RELATED DISEASES SUCH AS THAT
THE INCIDENTS OF DISEASE THAT'S
WE ASSOCIATE WITH OLDER AGE LIKE
CONGESTIVE HEART DISEASE,
DIABETES, DEMENTIA WILL RISE
WITH AGING EXPONENTIALLY.
SO THE WAY THE STATE CURRENTLY
IS, IS WE FIND THAT PEOPLE OFTEN
HAVE TO DEAL WITH CHRONIC
CONDITIONS AND DISABILITY FOR 20
TO 30 YEARS OF THEIR LIFE.
AND SO, IF WE LOOK AT THE TOP
BAR HERE, THE ENTIRETY OF THE
BAR REPRESENTS IT'S THE TIME OF
LIFE INDIVIDUAL EVENTS FREE OF
DISEASE AND THE ONSET OF AGE
RELATED DISEASES OR CHRONIC
DISEASES SO WHAT WE'RE HOPING TO
ACHIEVE IS WE WANT TO SEE A
COMPRESSION OF MORBIDITY AND THE
PERIOD OF LIFE A INDIVIDUAL
SPENDS IN CHRONIC DISEASE IS
ACTUALLY COMPRESSED OR
SHORTENED.
WE EXTEND THE LIFESPAN TOO IN
THE PROCESS, I DON'T THINK WE
MIND AS LONG AS THE PERIOD OF
MORBIDITY REMAINS SHORT.
NOW, IS THIS A REALISTIC IDEA OR
IS THIS SORT OF A PIE IN THE SKY
AND I WOULD ARGUE AND ACTUALLY
PRESENT EVIDENCE THAT THIS IS A
VERY REALISTIC BY LOGICALLY
PLAUSIBLE CONCEPT AND THAT IS
BECAUSE WE HAVE PEOPLE AMONG US,
RIGHT, PEOPLE WHO LIVE VERY LONG
LIVES, CENTENARIANS AND SUPER
CENTENARIAN WHO DON'T LIVE TO
AGE 100 AND BEYOND BUT MAINTAIN
THEIR HEALTH FOR THE ENTIRETY OF
THEIR LIVES.
WE'RE LOOKING FOR DISEASE FREE
SURVIVAL CURVES FOR PEOPLE WITH
DIFFERENT LIFE SPANS AND THE
TEAL CURVE REPRESENTS PEOPLE WHO
LIVE TO AGE 110 OR OLDER.
THE BLUE CURVE ARE PEOPLE AGE
105 AND SO ON AND THEY'RE BEING
COMPARED TO PEOPLE WHO HAVE AN
AVERAGE LIFESPAN AND THAT'S THE
BLACK CURVE.
AND WHAT WE'RE SEEING HERE IS
THAT THESE PEOPLE DELAY THE
ONSET OF AGE RELATED MORBIDITY
AND THIS IS A COMBINATION OF ONE
OR MORE OF THE FOLLOWING
DISEASES, CANCER, DIABETES AND
WE HAVE TO BE CAREFUL WHEN WE DO
THAT BECAUSE WE'RE FINDING
CENTENARIANS AT THE END OF THEIR
LIVES SO THEY'RE 100 AND MAYBE
THEY HAVE 10 MORE YEARS TO LIVE,
RIGHT.
THEY'VE ALREADY LIVED 100 YEARS
SO IN REALITY THEY'RE CLOSER TO
DEATH THAN THEY ARE TO THE
BEGINNING OF LIFE.
WHEN WE'RE MEASURING DIFFERENT
BIOLOGICAL PARAMETERS IN THE
BLOOD OF CENTENARIANS WE HAVE TO
ASK OURSELVES, IS THIS TO
EXPLAIN HOW THEY GOT HERE AND IS
IT A LONGEVITY PARAMETER THAT
ALLOWS THEM TO BE A CENTENARIAN
OR IS IT A FACTOR THAT IS
PREDICTING THEIR MORTALITY AND
THAT'S COMING VERY SOON.
SO THOSE ARE THINGS WE HAVE TO
KEEP IN MIND.
AND THIS IS AN EXAMPLE OF HOW WE
APPROACH OUR RESEARCH.
WHEN WE LOOK AT PHENOTYPES IN
THESE POPULATIONS.
SO HERE WE'RE LOOKING AT AVERAGE
AGE OF CHOLESTEROL LEVELS AND
MEN AND WOMEN AND NOT
CENTENARIANS COMPARED TO A
GENERAL POPULATION AND HAINES
CONTROL GROUP AND THAT IS 20 TO
30 YEARS YOUNGER, RIGHT.
IF WE LOOK AT THE SE CENTENARIAS
AND WELL WHO WERE BORN DURING
THE SAME TIME AS THEY WERE BUT
DID NOT ACHIEVE LONGEVITY AND
THEY'RE NOT AVAILABLE FOR US TO
STUDY.
SO WE HAVE TO COME UP WITH THE
BEST NEXT APPROACH AND CAN WE
COMPARE THE POPULATION CONTROLS
TO THE CHILDREN OF CENTENARIANS
AND WHY DO WE DO THAT?
BECAUSE THE OFFSPRING ZENT HAVE
THE MAKE UP OF THEIR PARENTS SO
IF IT'S INHERITED WE SHOULD FIND
SOME LONGEVITY FACTORS
REPRESENTED IN THE OFFSPRING OF
OF CENTENARIANS SO THIS IS WHAT
WE FIND.
WE FIND THAT THE OFFSPRING OF
CENTENARIANS WHO ARE AGE
MATCHED, SO THAT POPULATION
ENHANCE CONTROL, HAS
SIGNIFICANTLY HIGHER HDL LEVELS,
COMPARED TO THESE AGE MATCHED
CONTROLS, SUGGESTING TO US THAT
THIS MAY ACTUALLY BE A PHENOTYPE
OF ASSOCIATED WITH LONGEVITY.
SO AS I MENTIONED, LONGEVITY
CENTERS ON IN FAMILIES AND THESE
ARE FOUR SIBLINGS FROM THE SAME
FAMILY AND THESE ARE THE SAME
FOUR SIBLINGS 90 YEARS EARLIER
AND THE YOUNGEST SISTER LIVED TO
101 AND THE YOUNGER BOTHER TO
103 AND THE OLDER SISTER TO 109
AND THE OLDER BROTHER TO 109.
IT RUNS AMONG SIBLINGS AND WE
SEE INHERITANCE IN THE OFFSPRING
OF CENTENARIANS AND I'M JUST
SHOWING YOU THE PREVALENCE OF
DIFFERENT AGE RELATED DISEASES,
HYPERTENSION, DIABETES AND
STROKE AND IN CENTENARIANS SHOWN
IN BLOW IN THE POPULATION
CONTROLS SHOWN IN RED AND THE
OFFSPRING OF CENTENARIANS WHO
ARE AGE MATCHED TO THIS ENHANCED
CONTROL WE SEE THE OFFSPRING
HAVE PREVALENCE OF THESE AGE
RELATED DISEASES.
SO THEY ARE IN DEED A GOOD
POPULATION FOR US TO STUDY AS A
SURROGATE OF CENTENARIANS AND
RESILIENT TO AGE RELATED
DISEASES.
NOW, FAMILIES, CHILDREN AND
SIBLINGS SHARE THEIR
ENVIRONMENT, RIGHT.
AND SO WE SAID WE CAN'T REALLY
ATTRIBUTE EVERYTHING TO GENETICS
IF WE DO NOT LOOK AT THE
ENVIRONMEENVIRONMENVIRONMENT AL.
HERE WE HAVE THE ENVIRONMENTAL
EXPOSURE IN LIFESTYLES AND
CENTENARIANS COMPARED TO SO
THERE ARE A FEW OF THEM THAT
BECAME CENTENARIANS AND TO OUR
SURPRISE, THERE WAS NO
DIFFERENCES IN TOBACCO USE,
ALCOHOL CONSUMPTION, REGULAR
EXERCISE, LOW CALORIE, LOW FAT
OR LOW SALT DIET.
WE WENT ON AND COMPARED THE
LIFESTYLE IN THE CHILDREN OF
CENTENARIANS TO AN AGE AND SEX
MATCH CONTEMPORARY CONTROL AND
THIS IS WORK DONE BY SOMEONE IN
THE AUDIENCE AND HE DID THIS
WHEN HE WAS A RECEIPT DEPARTMENT
WITH US AND NOW HE IS A FACULTY.
THERE WAS IN DIFFERENCE IN THE
OFFSPRING.
THEY WERE SAME IN THE
EDUCATIONAL ATTAINMENT, SOCIAL
STRAT US SCORES, NO DIFFERENT IN
TOBACCO, ALCOHOL, USE OR
EXERCISE.
SO THIS REALLY THEN SUGGESTS
THAT TO US, WE SHOULD BE LOOKING
AT GENETICS CONTRIBUTORS.
THAT ALTHOUGH LIFESTYLE IS
IMPORTANT AND BY NO MEANS AM I
ADVOCATING FOR US TO START
SMOKING AND DRINKING, BUT FOR
THIS PARTICULAR POPULATION WHO
IS VERY UNIQUE, AND VERY RARE,
GENETIC FACTORS SEEM TO PLAY A
MUCH MORE IMPORTANT ROLE THAN
LIFESTYLE.
AND SO, HOW DO WE GO ABOUT
STUDYING GENETICS OR
SPECIFICALLY IDENTIFYING GENES
ASSOCIATED WITH LONGEVITY.
SO THIS IS A SCHEMATIC OF THE AN
IMAGINARY GENE.
THE RED LINE REPRESENTS AGING OR
GENOTYPES SO LET'S ASSUME THAT
IF A PERSON CARRIES THIS KIND OF
A GENOTYPE, THEY'RE AT HIGHER
RISK FOR A DISEASE AND HIGH-RISK
OF MORTALITY SO AT YOUNGER AGES,
YOU HAVE A LOT OF PEOPLE
CARRYING THE GENOTYPES AND IF
PEOPLE WITH THIS GENOTYPE DIE
OFF, THERE'S GOING TO BE VERY
FEW OF THEM WILL BE CARRIERS OF
THIS GENOTYPE AND ON THE OTHER
HAND IF YOU HAVE A GENOTYPE THAT
CONTRIBUTES TO LONGEVITY, YOU
ARE GOING TO HAVE VERY FEW
PEOPLE YOUNGER AGES WHO ARE
CARRYING THIS AGAIN OWE TYPE
BECAUSE IT'S A VERY RARE
GENOTYPE AND VERY FEW PEOPLE
BECOME CENTENARIANS BUT AS
EVERYBODY ELSE DIES OFF, THE
GINO TIME TYPE IS MORE AND MORE
PREVALENT IN THE POPULATION SO
WHEN YOU LOOK, THEY WILL BE MORE
COMMON IF YOU LOOK IN THE
GENERAL POPULATION.
SO NOW LET ME GIVE YOU A
SPECIFIC EXAMPLE.
USING THIS GROWTH HERE MONDAY ON
PATHWAY.
RODENTS THAT HAVE MUTATIONS.
>>WE LOOK AT DIFFERENT GENE
VARIANTS IN OUR CENTENARIANS
COMPARED TO GENERAL POPULATION
CONTROL IN GROWTH HOR MONDAY
IGF1 AND SLIM PATHWAY AND I'M
JUST SHOWING YOU AN EXAMPLE OF
THE RECEPTORS WHERE WE FOUND
MULTIPLE RARE GENETIC VARIANTS
IN DIFFERENT SITES BUT WE DID
THE SAME FOR OTHER PROTEINS AS
WELL.
WHEN WE TOOK AN AGO AGREE GET
THE RARE VARIANTS IN OUR
CENTENARIANS AND COMPARED IT
THEN PREVALENCE OF THESE
VARIANTS IN OUR PRO BEND
COMPARED TO A GENERAL POPULATION
CONTROL WE FOUND THAT THE
CENTENARIANS ARE THE OFFSPRING
HAVE INHERITED MANY OF THESE
FROM THEIR PARENTS.
TO SHOW THAT THESE VARIANTS ARE
FUNCTIONAL.
>>CARRYING THESE RISKS AND
THESE VARIANTS ARE RISK FACTORS
FOR LONGEVITY SO WE TOOK A
POPULATION OF OLDER ADULTS, AGE
65 AND OLDER WHOM WE FOLLOWED
PROSPECTIVELY AND DIVIDED THEM
INTO TWO GROUPS WITH VARIANT
WITHOUT A VARIANT AND WE FOUND
THAT THOSE WHO CARRIED ONE OR
MORE OF THESE VARIANTS, ACTUALLY
LIVED LONGER AND WHEN WE DID
ANNA JUST, WHEN WE RAN ANNA
JUSTED MODEL WE FOUND THAT
HAVING A VARIANT IN ONE OF THE
GENES IN THIS PATHWAY WAS
ACTUALLY ASSOCIATED WITH
SIGNIFICANT PROTECTION AND
REDUCTION HAZARD FOR MORTALITY
SUGGESTING THAT IN DEED THIS
PATHWAY LIKELY IS BENEFICIAL FOR
LONGEVITY IN HUMANS AS WELL.
SO WHERE DOES THAT LEAVE US?
WELL, NOW THAT WE KNOW THAT OR
AS WE FIND OTHER GENES AND
BIOLOGICAL PATHWAYS RELEVANT FOR
HEALTHY AGING AND LONGEVITY WE
CAN INTERVENE RIGHT.
WE CAN EITHER DESIGN
PHARMACOLOGICAL AGENTS OR
THOUSANDS THOSE THAT ARE READY
AVAILABLE AND ARE DISPOSAL TO
TRY AND ACT ON THOSE PATHWAYS.
THESE ARE DATA APPROVED DRUGS
THAT BLOCK THE ACCESS AND WE
HAVE ANNA LOGS AND TAKE THIS
AMOUNT WHICH BLOCKS THE GROWTH
HORMONE RECEPTORS AND THESE ARE
ALL APPROVED FOR THE USE AND A
CONDITION WHERE THERE'S ACCESS
GROWTH HORMONES SECRETION FROM
THE PEW TARRY AND AN ANTI GF1
AND A ANTIBODY THAT WAS
DEVELOPED BY SEVERAL
PHARMACEUTICAL COMPANIES
ALTHOUGH IT'S NOT FDA APPROVED
BECAUSE IT FEELS CLINICAL TRIALS
AS A CANCER DRUG BUT THERE WAS
DEVELOPMENT OF IT.
AND HERE IS SOME DATA FROM A
COLLEAGUE OF MINE, THIS WAS DONE
IN RODENTS NOT IN PEOPLE.
HE HAD ANTI-GF1 ANTIBODY TO
MIDDLE AGE MICE.
THEY WERE NOT MICE THEY WERE
GENETICALLY ENGINEERED TO HAVE
THIS IT WAS NOT EXPRESSED DURING
THE LIFE AND IT WAS GIVEN TO
THEM IN MIDDLE AGE BECAUSE WE
DON'T WANT TO BLOCK GROWTH
HORMONE BECAUSE YOU WOULDN'T
GROW.
AND HE FOUND THAT ADMINISTERING
THAN THIS DRUG AND BLOCKING THIS
PATHWAY EVEN IN MIDDLE AGE
EXTENDED THE LIFESPAN AND
SHOWING YOU CAN INTERVENE EVEN
IN MIDDLE AGE.
SO WE CAN DELAY RELATED DISEASES
IMPROVE QUALITY OF LIFE AND
PERHAPS EXTEND LIFESPAN.
AND BY DISCOVERING THESE
VARIANTS IN HUMANS, WE HOPE
WE'LL ACCELERATE THE DEVELOPMENT
OF HETHESE THERAPEUTICS AND ENHE
SAFETY BECAUSE WE IDENTIFY THESE
VARIANTS IN PEOPLE WHO LIVE TO
AGE 100 THEY'RE NOT HARMFUL.
SO WHAT DO WE KNOW ABOUT SUPER
AGERS ACROSS THE WORLD AND THE
U.S.
IT HAPPENS TO BE THAT JAPAN HAS
THE GREATEST PREPORTION THESE
ARE THE TWO BOUNDARIES COUNTRIE
GREATEST TERMS OF CENTENARIANS
BUT IN NUMBERS THE UNITED STATES
HAS MORE CENTENARIANS BECAUSE
OUR POPULATION IS GREATER AND
THERE'S SOME STATES THAT ARE
MORE HOS PIT ABLE TO
CENTENARIANS.
AGAIN, THESE ARE THE STATES THAT
HAVE A LARGE POPULATION.
SO IN ORDER TO INCREASE OUR
CENTENARIAN WITH THE DISCOVERY
OF THESE PROTECTIVE GENETIC
VARIANTS, WE LAUNCHED IN
COLLABORATION WITH AMERICAN
FEDERATION AGING RESEARCH AND
VIBRANT HEALTH AND REGION A RON
A BRAND NEW STUDY CALLED SUPER
AGER FAMILY STUDY WITH A GOAL OF
ENROLLING 10,000 SUPER AGERS OR
PEOPLE 95 AND OLDER SO THAT WE
CAN INCREASE THE NUMBER OF
PEOPLE IN OUR COHORT OF SUPER
AGERS IN ORDER TO ACCELERATE THE
DISCOVERY OF PROTECTIVE GENETIC
VARIANTS AND THIS STUDY IS ALL
DONE REMOTELY AND INDIVIDUALS
SIGN ON-LINE AND THE ANSWER
QUESTIONNAIRE AND WE MALE THEM A
SALIVA KIT AND WE EXTRACT DNA
AND IT'S TO ESTABLISH A
GEROSCIENCE RESOURCE BECAUSE
WHEN WE ENROLL THESE PEOPLE,
WE'RE GOING TO MAKE ALL THE DATA
AND ALL THE GENETIC INFORMATION
PUBLICLY AVAILABLE TO ALL THE
RESEARCHERS.
BOTH ACADEMIC AND IN THE
INDUSTRY.
SO THAT EVERYONE CAN COME
TOGETHER AND USE THIS DATA TO
MAKE DISCOVERIES.
IF YOU HAVE SUPER AGERS, IF YOU
KNOW OF, REFER THEM TO US.
CENTENARIANS ARE A MODEL BY AGE
AND THEIR OFFSPRING ARE VALUABLE
FOR IDENTIFYING GENETIC
DETERMINANTS OF DELAYED AGING
AND IDENTIFICATION OF GENES AND
BIOLOGICAL PATHWAYS THAT PROTECT
FROM AGING CAN BE LEVERAGED TO
DEVELOP THERAPEUTICS.
A DELAY IN AGING.
WITH THAT I'LL JUST THANK
EVERYONE WHO IS BEEN INVOLVED IN
OUR RESEARCH AND OUR RESEARCH
VOLUNTEERS AND OUR TEAMS AND OUR
FUNDING SOURCES.
[APPLAUSE]
HAPPY TO BE HERE AND LOOK
FORWARD TO FUTURE SESSIONS.
SO, IF WE TOOK ALL OF HUMAN
EXISTENCE AND MAPPED IT ACROSS
SINGLE CALENDER YEAR, PRETTY
MUCH EVERYTHING WE TAKE FOR
GRANTED ABOUT HOW WE LIVE OUR
LIVES WOULD BE SQUEEZED INTO THE
LAST DAY IN FACT, THE DOUGH MESS
INDICATION OF PLANTS AND ANIMALS
CALLED THE KNEW LITHE I CAN
REVOLUTION WON'T OCCUR UNTIL
6:00 A.M. ON THAT LAST DAY AND
THE GROWTH OF CITIES WON'T OCCUR
TO 3:00 P.M. ON THAT LAST DAY
AND INDUSTRIALIZATION JUST SHY
OF MIDNIGHT.
WE'VE BEEN HUNTER-GATHERERS AND
FARMERS FOR MOST OF OUR SPECIES'
EXISTENCE YET WE KNOW NOTHING
ABOUT HEALTH AND AGING OF THESE
POPULATIONS.
ALMOST ALL STUDIES OF HEALTH AND
AGING ARE URBAN CONTEXT OF THE
GLOBAL NORTH.
SO CONTEMPORARY HUNTER GATHERERS
AND FARMERS THEY'RE CERTAINLY
NOT LIVING RELICS OR LIVING
FOSSILS BUT THEY OFFER THE
CLOSEST GLIMPSE OF WHAT HEALTH
AND AGING MIGHT HAVE LOOKED LIKE
IN THE PAST AND THEY OFFER
ALTERNATIVES FOR HOW HEALTH AND
AGING MIGHT LOOK IN THE PRESENT.
AND THESE ARE INDIGENOUS
POPULATIONS THAT ARE LIVING IN
FORESTS, SAVANNAHS, THE DESERTS
OF AFRICA AND BY CERTAIN
STANDARDS AND OF AGING ARE
ABSENT IN THESE GROUPS.
LOWER LIFE EXPECTANCY AS WE
HEARD IN THE FIRST SESSION AND
WE'RE TRADITIONAL LIVELIHOODS
HAVE BEEN LARGELY REPLACED,
WHERE LAND HAS BEEN TRIPPED,
WHERE THERE'S DISCRIMINATION AND
OTHER CONSEQUENCES OF DOLL
ONALLISM WE SEE MORE OBESITY,
DIABETES, HEART DISEASE, LOWER
EDUCATIONAL ATTAINMENT, ET
CETERA AND OF COURSE HIGHER
DEATH RATES FROM COVID.
MY APPROACH WITH IF IT'S 509
OPPORTUNITY TO LEARN A LOT ABOUT
HEALTH AND AGE SEWING IN
PARTICULAR, AGING IN THE ABSENCE
OF THE USUAL COMMON CHRONIC
DISEASES OF AGING AND WITH WORK
I'LL TALK ABOUT TODAY AND OTHER
GROUPS I'LL COLLECT THE SAME RIN
PHENOTYPE DATA, SCIO DEMOGRAPHIC
AND AS WELL AS EPI GENOMIC DATA
IN THESE KINDS OF CONTEXT IS
VERY RARE AND RICH OPPORTUNITIES
AND ON THE
CONNECTEDNESS, COMMUNITY,
INFECTIOUS BURDEN AS WE'LL SEE
BOTH SOME POSITIVE AND NEGATIVE
ASPECTS, BUT HEAVY INFECTIOUS
BURDENS AND A VERY DIFFERENT
KIND OF BACKGROUND AND NATURAL
FERTILITY SO HIGH FERTILITY
POPULATIONS THAT USING EFFECTIVE
BIRTH CONTROL AND MORE.
AND SO WE CAN GET NEW INSIGHTS
PERHAPS EVEN NOT JUST I KNOW THE
GEROSCIENCE HYPOTHESIS CENTERED
ON AGING SPECIFICALLY BUT ON
ALSO THE NON COMMUNICATIVE
DISEASE OF AGING CAN WE GAIN
MORE IN SIGHT INTO THOSE
SPECIFIC ASPECTS, THE ROLE OF
MISMATCH BETWEEN OUR GENOME AND
OUR CURRENT ENVIRONMENTS AND
LIFESTYLES THAT WE FIND
OURSELVES IN TODAY AND SOME GENE
BINE AND ET CETERA AND ACROSS
GEOGRAPHY AND CULTURE AND ALSO
THERE'S A SCIENTIFIC LESSONS
THAT CAN BE LEARNED FROM LOOKING
OUTSIDE OF THE USUAL KINDS OF
STUDY SAMPLES AND ALSO, I WANT
TO MAKE EMPHASIZE THAT RAPID
SOCIOECONOMIC CHANGES ARE A FOOD
IN ALL THESE INDIGENOUS
POPULATIONS AND SO THAT PROVIDES
A RICH QUASI EXPERIMENT FOR
LOOKING AT THE EFFECTS OF
MODERNIZATION ON HEALTH AND
AGING AND ALSO, TRYING TO BE
WEARY OF THE KINDS OF CONDITIONS
TA INDIGENOUS POPULATIONS FIND
THEMSELVES TODAY, HOW TO PREVENT
THOSE EPIDEMIOLOGICAL ADVERSE
SEE ON THESE POPULATIONS AS THY
UNDERGO CHANGE.
AND NOW OPERATING OVER TWO
DECADES AND YOU CAN TALK ABOUT
THE ETHICS AND THE TRUST
BUILDING THAT OCCURRED OVER, IT
TOOK THREE YEARS OR FOUR YEARS
BEFORE I TOOK A SINGLE SAMPLE OF
BLOOD, AFTER I LEARNED THE
LANGUAGE AND GAINED TRUST, IT'SA
LARGE POPULATION, 17,000 FOR
EDGERS FARMERS AND WE'VE BEEN
FOCUSING ON AGING IN THE CONTEXT
OF INFECTION AND OTHER TYPES OF
AREAS WITH EXPOSOME AS I
MENTIONED AND THE PROCESS OF A
CULTURATION, AND MODERNIZATION
AND WHAT EFFECTS THAT MIGHT BE
HAVING IT'S A LONGITUDINAL
DESIGN AND I ENCOURAGE YOU IF
YOU ARE IN ANYTHING YOU HEAR
TODAY TO LOOK AT THE WEBSITE FOR
ACCESS TO ALL OF OUR
PUBLICATIONS AND THIS WORK HAS
BEEN FUNDED BY NIA.
SO JUST VERY BRIEFLY, THE
LIFESTYLE SO THERE'S SLASH AND
BURN HORTICULTURALIST.
NO SUPER MARKETS, NO BANK
ACCOUNTS, NO FORMAL INSURANCE
AND SO ALL THE FOOD THEY GET
COMES FROM THEIR FIELDS THROUGH
HEAVY WORK ERT AND ALSO
SUPPLEMENTED BY HUNTING AND
FISHING AND GATHERING AND SO
UNTREATED WATER AND WASTE.
AND WHAT I WANT TO DO FOR THE
REST OF THE TALK, JUST A FEW
HIGHLIGHTS.
SOME GREATEST HITS OF SOME OF
SALELY ENTER FINDINGS THAT
SUGGEST POTENTIALS WHEN WE LOOK
AT THESE POPULATIONS.
WE HAVE LOW INCREASES IN BLOOD
PRESSURE WITH AGE, NO ARTERIAL
DISEASE AND NO A TREAL
DEFIBRILLATION AND COLLABORATING
WITH FOLKS FROM THE HORACE STUDY
WE DID A CT STUDY THAT LOOKS AT
CALCIFICATION AND WE SAW RATES
OF CORONARY ARTERY CALCIFICATION
AND DESPITE THE CHEW MANNY
HAVING HIGH LEVELS OF CHRONIC
INFLAMMATION AND SO AGE STANDARD
IS ABOUT 15% COMPARED TO 86% FOR
ADULTS AGE 45 OR 50.
U.S. IS FIVE AND A HALF TIMES
HIGHER LEVELS THAN THE CHUMANE
FOR MAD RAT LEVELS IT'S 18 TIMES
HIGHER IN THE U.S. AND NOT THAT
I WEAR THAT NUMBER OF 4,000
BOWERS 4,000BECAUSE WE'RE GETTIL
NUMBERS BUT NO ONE HAD HIGH
LEVELS OF CORONARY LEVELS OF
CALCIFICATION.
WE LOOKED WHY.
THIS IS A WORK IN REGULAR.
THEY'RE PHYSICALLY ACTIVE AND
THE AVERAGE NUMBER OF STEPS IF
APPROXIMATE YOU LOOK AT YOUR FIT
BIT TODAY AND IB WE'RE ALL
SITTING HERE AND YOU GOT LESS
THAN 2 THOUGH AND ESPECIALLY IF
WE TOOK A SHUTTLE THIS MORNING.
THE AVERAGE GETS 17,000 STEPS A
DAY AND IT DOESN'T DIMINISH IN
LATER AGES.
THEY'RE NOT VERY VIGOROUSLY
ACTIVE.
THEY'RE NOT SEDENTARY.
ALSO VERY MINIMAL TOBACCO
SMOKING AND THE DIET FOR ALL THE
PALEO PEOPLE OUT THERE IN THE
AUDIENCE, IT'S VERY HEAVY IN
CARBS.
OVER TWO-THIRDS OF THE CALORIES
FROM THEIR DIET ARE COMING FROM
CARBS SO IT'S LOW IN SATURATED
FAT AND HIGHER IN PROTEIN,
TYPICAL BUT LOWER IN FAT AND SO
BY SOME OF THEIR METRICS HERE,
WRONG LOW LDL AND LOW BLOOD
PRESSURE AND LOW MORNING FASTING
BLOOD GLUCOSE AND THERE'S VERY
LITTLE IRE POLLUTION AND I LIVE
NOT FAR FROM L.A.
IN L.A. IT'S ALL SMOG, WE SAY IN
SANTA BARBARA IT'S FOG.
BUT YEAH, ALSO SOME OTHER
POTENTIAL PROTECTIVE EFFECTS,
NOT ALL INFECTIONS TREAT THE
BODY EQUALLY SO MAYBE HELMETS
MIGHT HAVE PROTECTIVE FACTORS SO
WE'RE DOING ON GOING STUDIES ON
THAT AND COMBINED, THE EXPOSOME
LEADS TO MINIMAL OR INARY ARTERY
THROUGHOUT LIFE AND OTHER
ASPECTS OF CARDIOMETABOLIC
HEALTH SO MORE RECENTLY WE'RE
LOOKING AT BRAIN AGING AND THEY
ALSO SHOW SLOWER RATES OF BRAIN
AGING AND MINIMALEL ALZHEIMER'S.
SO WE'VE LOOKED AT BOTH IN TERMS
OF CEREBRAL VALUE, SLOWER RATE,
CROSS SECTIONALLY, AND BRAIN
VOLUME COMPARED TO POPULATIONS
USING SIMILAR METHODOLOGY AND
THIS ALSO TRANSLATES INTO
COGNITIVE DEFICITS WHEN WE LOOK
AT COGNITIVE PERFORMANCE WITH
AGE ON A NUMBER OF BATTERY OF
DIFFERENT TYPES OF TASKS THAT
WE'VE DONE AND ALSO WITH
CONSENSUS ANALYSIS FOR
DIAGNOSING DEMENTIA WE HAVE
FOUND SIX CASES SO WHEN WE LOOK
AT THE COMPARABLE AGE
STANDARDIZED RATES IN THE
TSIMANE AND THE SISTER
POPULATION WHICH IS VERY SIMILAR
TO THE TSIMANE BUT CULTURATED
THEY HAVE SOME OF THE LOWEST
RATES COMPARED TO OTHER
POPULATIONS BOTH INDIGENOUS AND
OTHER COUNTRIES AND ALSO U.S.,
EUROPE AT LARGE.
SO WHEN WE MOVE AWAY FROM
DISEASE, THEN IT GETS A LITTLE
BIT MORE SPECULATIVE SO
DIFFERENT ASPECTS OF BIOLOGICAL
AGE.
IT'S HARD TO CONCLUDE, ONE
INITIAL IS IN THIS AREA AND ALAN
IS IN THE AUDIENCE, USING
METRICS THAT HE POPULARIZED IN
THE DISTANCE AND BASICALLY IT'S
TO COMPOSITE OF LOTS OF
DIFFERENT BIOMARKERS AND MULTI
DIMENSIONAL SPACE TO SEE HOW
INDIVIDUALS DEPART FROM A
HEALTHY STATE WITH AGE AND
BASICALLY WE FIND A SIMILAR
LEVEL OF A SLOPE, A RATE OF
INCREASE OF DISREGULATION AS
MEASURED BY THIS METRIC WITH AGE
COMPARED TO THE U.S. AND
CANADIAN POPULATIONS BUT WHEN WE
LOOK AT METHYLATION, THIS IS
EARLIER GENERATION OF
METHYLATION AGE FROM THE CLOCKS
THAT STEVE HORVATH CAME UP WITH
SO BY ONE METRIC IT'S MORE
HOLISTIC THAT THE TSUMANE SEEMS
YOUNGER THAN HISPANICS AND WHITE
CAUCASIANS BUT ANOTHER METRIC
FOCUSING ON CELL TYPES,
ESPECIALLY IMMUNE CELL TYPES
LIKE CD8s, THE TSIMANE
APPEARED OLDER SO COR OBJECT RA
TIVE FROM THE FIRST SESSION THAT
NOT ALL CLOCKS, NOT ALL ORGANS
AND SYSTEMS MIGHT BE AT THE SAME
RATE.
THESE ARE INDIVIDUAL SLOPES
DISTANCE MEASURE FROM OUR
LONGITUDINAL WORK WHEN WE ASKED
YOU TO LOOK AT MORE RECENT
TIMES, THE EFFECTS OF A
CULTURATION, THE INTERCEPTS ARE
A LITTLE BIT DIFFERENT BUT THE
SLOPES ARE THE SAME.
AGING HASN'T CHANGED BUT
EVERYONE IS IN A BETTER
CONDITION COMPARED TO IN THE
PAST.
EVEN OVER THE DURATION OF THE
PAST 15 YEARS SO ANOTHER
INTERESTING STUDY WE LOOKED AT
E4 SO THE HIGHEST, STRONGEST
GENETIC RISK FACTOR FOR
ALZHEIMER'S DISEASE AND LINKED
TO COGNITIVE AGING MORE
GENERALLY AND CARDIOVASCULAR
DISEASE SO IT'S ASSOCIATED WITH
WORSE COGNITIVE FUNCTION BUT
IT'S ASSOCIATED WITH IMPROVED
COGNITIVE FUNCTION AMONG THOSE
FOLKS THAT HIGH BURDEN SO THE
IDEA E4 MIGHT OPERATE
DIFFERENTLY IN A DIFFERENT
CONTEXT A HIGH PATHOGEN CONTEXT,
IT'S SOMETHING THAT HAS BEEN
SUGGESTED BEFORE WHERE E4 MIGHT
HELP WITH CLEARANCE OF BACTERIA,
AND VIRAL HEPATITIS C BUT THEY
HADN'T BEEN LOOKED AT TOO
SYSTEMATICALLY BEFORE SO THE
IDEA THAT AND 84% OF TSIMAIN
HAVE EOSINO AND A NUMBER OF
DIFFERENT TASKS WHERE IF THEY
WERE WHERE THEY HAD LOW COUNTS
THEY WERE DOING MUCH WORSE AND
LIKE TWO CHILDREN MORE AND IT'S
A GOOD EFFECT ALL CONSIDERING.
AND THE LAST RESULT IS IF WE
LOOK AT BENIGN PROSTATE HYPER
PLASIA NOT LETHAL BUT A CONTINUE
THAT'S BEEN DEEMED UNIVERSAL MEN
HAVE LOW TESTOSTERONE, NO ANGIEE
RELATED WHEN LOOKED AT THE PATH
TO GET THERE AND THE BROADER
EXPOSOME THAT MIGHT HAVE EFFECTS
ON ALL THESE THINGS.
THANK YOU SO MUCH FOR YOUR TIME
AND I LOOK FORWARD TO THE
DISCUSSION SESSION.
[APPLAUSE]
>>I'M A MEDICAL ONCOLOGIST IN
LOS ANGELES AT CITY OF HOPE.
AND I THINK THAT THE ORGANIZERS
FOR HAVING ME TODAY AND I'M
GOING TO TALK ABOUT CANCER AND
ACCELERATED AGING.
WE START
WITH SOMETHING WE'VE HEARD ABOUT
ALREADY THAT AGING IS THE
LARGEST RISK FACTOR FOR ALL
ADULT CANCERS THERE'S BEEN A
DECLINE IN A NUMBER OF DEATHS
FROM CANCER THAT'S THE BLACK
LINE GOING DOWN OVER TIME.
BUT THAT MEANS WE ALSO HAVE AN
INCREASE NUMBER OF PEOPLE LIVING
AFTER THEIR CANCER DIAGNOSIS AND
THE BAR GRAPH HERE SHOWS YOU THE
NUMBER OF YEARS THAT PEOPLE OUT
ARE LIVING OUT FROM THEIR CANCER
DIAGNOSIS YOU CAN SEE OVER THE
LAST TWO DECADES, MORE AND MORE
PEOPLE ARE LIVING FIVE, 10, 15
PLUS YEARS FROM CANCER.
AND THIS IS A GREAT PROGRESS.
BUT WHAT THIS ALSO MEANS, IT'S
THAT A LOT OF THE CO MORBID
CONDITIONS THAT THE PATIENTS HAD
AT THE TIME OF THEIR DIAGNOSIS,
ARE OFTEN AMPLIFIED AFTER THE
EXPOSURE TO CANCER AND CANCER
TREATMENT AND CITY OF HOPE WE
HAD A COHORT OF BONE NARROW
TRANSPLANT PATIENTS AND WE HAD
THE OPPORTUNITY TO LONGITUDE
KNEE FOLLOW THEM OVER TIME AND
WHAT WE SAW IS EVEN AFTER THE
BONE NARROW TRANSPLANT AND THEIR
CANCER DIAGNOSIS THEY DEVELOPED
A LOT OF CHRONIC CO MORBID
CONDITIONS AND THIS INCREASED AN
INTENSITY AND FREQUENCY IN CO
MORBID CONDITIONS THAT WAS NOT
LARGER THAN THE GENERAL
POPULATION SO, THEY'RE HAVING
DISEASES LIKE WE SEE IN THE
GENERAL POPULATION BUT THE
INTENSITY AND FREQUENCY OF THESE
DISEASES ARE HAPPENING FASTER.
NOT ONLY DID WE SEE AN INCREASE
IN PREMATURE MORBIDITY WHAT ARE
THE FUNDAMENTAL PROCESSES THAT
DRIVE AGING.
WE KNOW THAT THERE ARE CERTAIN
KEY PILLARS OR HALLMARKS AND
PROCESSES THAT THE MOLECULAR
CELLULAR LEVEL DRIVE THE WAY
THAT WE RATE OF OUR RATE OF OUR
BIOLOGICAL AGING HOW DOES AND
WHEN A PATIENT IS DIAGNOSED WITH
CANCER AND EXPOSED TO ALL
DIFFERENT TYPES OF CANCER
TREATMENTS THAT WE USE TO
ACHIEVE A CURE.
SO FOR THE LAST FEW YEARS, WE'VE
BEEN REALLY THINKING ABOUT WHAT
IS THE RELATIONSHIP BETWEEN
CANCER AND AGING AND IT'S JUST
THIS PAST YEAR, Dr. HARVEY
COHEN AND I HAD THE OPPORTUNITY
TO WRITE A PAPER TO DESCRIBE
THIS RELATIONSHIP AS A CYCLE.
SO I'M GOING TO SHARE WITH YOU
HOW I THINK ABOUT CANCER AND
AGING.
WE KNOW THAT AGING IS DRIVEN BY
THESE FUNDAMENTAL AGING
PROCESSES.
THEY LEAD TO AN INCREASE, A
DECLINE IN RESILIENCE, A
DECREASE IN IMPAIRED FUNCTION
AND CO MORBID CONTINUE INCLUDING
CANCER AND MORE FRAILTY AND IT
LEADS TO CANCER AND CANCER AND
AFTER A PERSON HAS CANCER, AND
THEN DEVELOPS CANCER TREATMENT,
BUT IT DOES IS THE CANCER AND
THE KANTER TREATMENT ACTS ON THE
FUNDAMENTAL AGING PROCESSES.
DRIVING EX ACCELERATED AGING
STATES AT THE WE SEE A DECREASE
IN RESILIENCE AND A INCREASE IN
COGNITIVE AND PHYSICAL
IMPAIRMENT AND MORE MULTI
MORBIDITY AND CHRONIC DISEASES
IN THEIR YEARS AFTER THEIR
CANCER DIAGNOSIS AND A
SIGNIFICANTLY HIGHER NUMBER OF
FRAILTY AS COMPARED TO THE
GENERAL POPULATION.
AND THE THE BETTER WE CAN
ACHIEVE TRUE PRECISION MEDICINE.
THERE ARE MULTIPLE WAYS WE CAN
LOOK AT THESE FUNDAMENTAL PROSES
FROM A CANCER AND AGING LENS AND
THERE'S A LOT OF WORK THAT IS ON
GOING.
ONE THAT IS PARTICULARLY
RELEVANT, TO BOTH, IS CELLULAR
SIN ESSENCE.
IT'S A CELLEL FATE.
CELLS UNDERGO THIS STATE OF
REVERSIBLE GROWTH ARREST IN THE
CONTEXT OF VARIOUS STIMULI,
VARIOUS DIFFERENT CUES.
SOME OF THESE CUES HAPPEN IN
DEVELOPMENTALLY AND AND OVER 400
DIFFERENT MOLECULES THAT CAN BE
SECRETED BY THESE CELLS, AND
WHAT WE KNOW IS THAT THESE
MOLECULES, THE SEN ESSENCE CELLS
ARE AN IMPORTANT PART OF NATURAL
PROCESSES OF WOUND REGENERATION.
TO CLAR SENESCENCE CELLS.
AS WE AGE AND ACCUMULATE MORE
AND MORE OF THESE SENESCENCE
CELLS AND WE HAVE HIGHER LEVELS
OF THESE MOL TOOLS WE LEAD TO AS
WE AGE THE NUMBER OF SENESCENCE
CELLS INCREASES THROUGHOUT
MULTIPLE TISSUES IN OUR BODY.
WE ALSO KNOW THERE'S A LOT OF
DIFFERENT AGE RELATED DISEASES
THAT HAVE BEEN SHOWN TO HAVE
SENESCENCE CELLS.
FOR EXAMPLE, ASTRO SITES IN
ALZHEIMER'S BRAIN HAVE LARGER
LEVELS OF SENESCENCE CELLS
COMPARED TO A NORMAL BRAIN SO
THERE'S AN OVERWHELMING AND
LARGE COMPELLING DATA TO SHOW
THAT SENESCENCE AND THE
SENESCENCE CELLS AND THE
ASSOCIATED PHENOTYPE PLAY A KEY
CONTRIBUTE OR IN THE DEVELOPMENT
OF AGING AND AGE RELATED
PATHOLOGIES.
MARCO DeMARIA AND JUDITH
SHOWED THAT THE CHEMOTHERAPY
THAT WE USE TO CURE PATIENTS
FROM THEIR CANCER, INDUCES
SENESCENCE CELLS WHERE THEY
LOOKED AT P16, WHICH IS A MARKER
OF CELLULAR SENESCENCE AND THEY
SHOWED THAT WHAT THEY SEE IS
THAT WHEN THE MICE WERE GIVEN
THE CHEMOTHERAPY THE CELL BURDEN
INCREASED AND IT DIDN'T REALLY
GO AWAY COMPLETELY OVER TIME.
WE KNOW THAT CHEMOTHERAPY AND
RADIATION AND OTHER KEY MODALITY
AND IT'S GOOD BECAUSE THAT HALTS
THE TUMOR GROWTH.
THEY ALSO INDUCE SENESCENCE
WHICH IS GOOD BECAUSE ON SOME
LEVEL, THE SENESCENCE AND THE
DOWNSTREAM SENESCENCE ASSOCIATED
PHENOTYPE DECREASES AND PREVENTS
TUMOR PROGRESSION AND HALTS
TUMOR GROWTH.
HOWEVER, OVER TIME, WHAT WE SEE
IS THAT THERE'S TILL LA THEY ARE
YUS EFFECTS OF THIS IN CANCER DF
THIS IN CANCER PATIENTS.
THIS IS NEGATIVE THAT SENESCENCE
CELLS, LEAD TO INCREASED ANGIO
GENESIS AND DRIVE TUMOR
RESISTANCE AND TUMOR METASTASIS
AND ALSO MARCO DeMARIA AND
JUDITH AND OTHERS HAVE SHOWN
THAT THEY ALSO DRIVE THE
ACCELERATED AGING STATE THAT WE
SEE.
THEY EFFECT CARDIOVASCULAR
DYSFUNCTION AND THEY SHORTEN
REJECTION FRACTION AND THEY LEAD
TO FATIGUE AS WELL AS COGNITIVE
IMPAIRMENT AND BONE HEALTH AND
SO, WE BELIEVE THAT THIS MAY BE
AN IMPORTANT PATHWAY AS WE THINK
ABOUT CANCER.
THERE'S BEEN A LOT OF PROPOSAL
OUT THERE THAT PERHAPS IN
ESSENCE MAY BE A WAY TO IMPROVE
THE WAY THAT WE CARE FOR CANCER
PATIENTS.
THERE'S A PARADIGM CALLED THE
ONE-TWO-PUNCH APPROACH.
WE GIVE OUR PATIENTS
CHEMOTHERAPY, RADIATION, WE GIVE
THEM THE TREATMENTS WE KNOW ARE
USED TO CURE CANCER IN THE
SECOND PUNCH, WE COULD GIVE THEM
A AGENT OF DIMINISH THE
DOWNSTREAM SENESCENCE ASSOCIATED
PHENOTYPE AND BY DOING THAT WE
MAY BE ABLE TO ACHIEVE GREATER
EFFICACY OF OUR CANCER TREATMENT
AND DECREASING SOME OF THE
ADVERSE EFFECTS THAT ARE RELATED
TO TUMOR GENESIS AND CANCER
PROGRESSION AND ALSO IMPROVE THE
DELIVERY OF THE TREATMENT BY
DECREASING THE ACCELERATED AGING
DECLINE AND DYSFUNCTION THAT IS
ON OUR CANCER SURVIVOR SO I WAS
HAPPY TO SEE THAT THE NCI HAD A
CALL OUT THAT JUST ENDED TO
INNOVATIVE COMPANIES AND TO
DEVELOP NOVEL AGES THIS
HYPOTHESIS AND SEE HOW WE CAN
IMPROVE ACCELERATED AGING AND
DECREASED CANCER AND LEVERAGING
OR CARN HE ISING AND CON SEX OF
CANCER.
ADDS I TOLD YOU BEFORE, AS WE
GET OLDER, THE HEALTHY FI TISSU,
WE HAVE MORE AND MORE AGING
TISSUE AND SENESCENCE CELLS AND
THERE'S A LOT OF WAYS OF PEOPLE
THINK ABOUT TARGETING AND AND
EXERCISE HAS BEEN SHOWN TO BE A
WAY TO REDUCE SENESCENCE CELL
BURDEN AND SO AS CALORIC
RESTRICTION, SIN A LET TICKS AND
AND THAT THEY TARGET THE
SENESCENCE CELLS THEMSELVES AND
DOWNSTREAM AND PATHWAY AND WORK
BY Dr. KIRKLAND AND ARE LOOK
TO GO SEE WELL AND HOW WE CAN
GET THEM TO INDUCE IT AND
THEY'VE EY IDENTIFIED KEY MOLECR
PATHWAYS THAT CAN BE USED AND
INDUCING IN THE SENESCENCE CELLS
AND THEY'VE DONE A LOT OF WORK
AND BOTH USING RE-PURPOSE AGENTS
AS WELL AS NEW AGENTS SO WE CAN
THINK ABOUT THESE AGENTS AS SORT
OF FIRST CLASS AGENTS AND THOSE
ARE THOSE WERE RECOVERED BY
IDENTIFYING THIS SENESCENCE
ASSOCIATED ANTI A POP AT THAT
TIME I CAN PATHWAYS AND LOOKING
FOR SOME OF THE KNOWN DRUGS OUT
THERE AND THE TARGET THESE
PATHWAYS.
LOOKING AT HIGH THOROUGH PUT FOR
SECOND GENERATION AND THERE'S
EVEN SOME REALLY EXCITING WORK
TO THINK ABOUT IMMUNO MODULATOR
AND CAR T CELLS AS A WAY TO
TARGET SENESCENCE CELLS AND
REDUCE SOME OF THE EFFECTS THAT
I JUST DISCUSSED.
THE WORKOUT THERE AND HAS BEEN
IN THE FIRST-GENERATION
PRIMARILY WITH THREE KEY DRUGS.
AND THE COMBINATION OF THE HAS
BEEN STUDIED IN MULTIPLE ANIMAL
MODELS AND THERE'S A LOT OF
COMPELLING AND THERE'S HUMAN
DATA IN EARLY PHASE STUDIES TO
SHE THIS COCKTAIL OF THESE TWO
AGENTS SKI CREASES IN ADD A POST
TISSUE IN THE BEGIN AND
DECREASES INFLAMMATION AND
THERE'S ALSO EARLY DATA IN I HAD
YO PATHIC PULMONARY FIE BROW
PATIENT THAT IMPROVES WALKING
SPEED AND PHYSICAL FUNCTION AND
THE SIXTH MINUTE WALK TEST AND
GATE SPEED, TIME CHAIR AND THE
SPP SCORE SO THIS REPRESENTS AND
WE WERE FLAG ANOTHER COMPOUND
AND IT'S A NATURAL FLAVONOIDS
FOUND THIS STRAWBERRIES AND
OTHER FRUITS AND SHOWING THIS
ASIAN CAN REDUCE CELLULAR
SENESCENCE CELL BURDEN IN MICE
AND THIS REDUCTION IN SENESCENCE
IS CONSISTENT AND PERSIST
APARTMENT OVER TIME AND IT'S
ASSOCIATED WITH A DECREASE AND
FRAILTY AND EVEN IN HUMANS
THERE'S SIGNALS IT CAN REDUCE
CELLULAR.
AND SO WE WANTED TO BEGIN
THINKING ABOUT THAT AND NED
SHARPLESS DID WORK LOOKING AT
BREAST CANCER PATIENTS AND THEY
SHOWED THAT P16 WHICH IS FOUND
IN CD3 POSITIVE T CELLS
INCREASES WITH AGE.
IT ALSO IN THE RED LINE HERE
THOSE ARE THE PEOPLE THAT GOT
CHEMOTHERAPY IN THE TOP FIGURE,
IT GOES UP AND IT REMAINS
ELEVATED OVER TIME AND IT
DOESN'T REALLY COME BACK DOWN AS
FAR AS THIS IS A 12-MONTH AND
WE'VE SHOWN THAT IN TWO TO THREE
YEARS LATER YOUR SENESCENCE CELL
BURDEN IS HIGH.
MORE RECENTLY IN OLDER WOMEN
WITH BREAST CANCER WE SHOWED THE
P16 WAS HIGHLY ASSOCIATED WITH
FRAILTY.
WE ALSO SHOW THAT SOME OF THE
SENESCENCE ASSOCIATED MARKERS
LIKE IL6 AND CRP WERE NOT ONLY
INDICATIVE BUT PREDICTIVE OF WHO
DEVELOPED FRAILTY AFTER WE HAVE
SEEN THAT COMPARED TO CONTROL,
SURVIVORS HAVE THEIR PHYSICAL
LOGIC RESERVE.
AS WE GET OLDER WE GO FROM
ROBUST TO FRAIL AND WE SEE WHEN
A WOMAN IS DIAGNOSED WITH BREAST
CANCER, FROM THE MOMENT THAT
SHE'S DIAGNOSED, THE MOMENT THAT
SHE GETS TREATMENT AND THE YEARS
THAT SHE HAS TO LIVE AFTER
TREATMENT, MANY OF THESE WOMEN
DEVELOP THIS TRAJECTORY WHERE
THEY BECOME AGING AT A FASTER
RATE THAN A HEALTHY CONTROL AND
WHAT OUR GOAL IS, IS TO IDENTIFY
WHO IS ON THAT TRAJECTORY AND
WHAT CAN WE DO ABOUT IT.
CAN WE INCREASE, CAN WE PREVENT
IT SO WE WERE REALLY INTERESTED
IN THE SURVIVORSHIP IN THE WOMEN
WHO WERE PRE FRAIL AND THOSE
WERE WERE FRAIL.
WE WANTED ASK THE QUESTION, CAN
WE BEGIN TESTING SEN A LIT TICKS
IN THIS POPULATION SO WE'RE
DOING A MULTI SENSOR STUDY AT
UNIVERSITY OF CONNECTICUT AND
HOW MUSS AT UNC AND JIM KIRKLAND
LOOKING AT POST MENOPAUSAL WOMEN
WITH EARLY STAGE BREAST CANCER
WHO HAVE RECEIVED CHEMOTHERAPY
AND ARE DEVELOPING PRE FRAILTY
STATUS AND WE'RE DOING IT TWO BY
TWO NOT FACTORIAL DESIGN TO LOOK
AT EXERCISE PLUS SEN A LET TICK
AND EXERCISE ALONE AND NO
EXERCISE -- IT'S A SIX MINUTE
WALK TEST AND A LOT OF
BIOLOGICAL COREL TIVES AND WOMEN
DIFFERENT THAN THE RO1 WHO HAVE
ACHIEVED FRAILTY AND THOSE WOMEN
WHO CENTERINGEL WITH EXERCISE
AND LOOKING AT PLACEBO ALONE BUT
USING THE SAME IDEA TO TRY TO
UNDERSTAND IF WE CAN IMPROVE
PHYSICAL FUNCTION.
THERE'S ALSO ANOTHER STUDY
THAT'S BEING DONE IN CHILDHOOD
CANCER SURVIVORS AND IT'S
LOOKING AT THE COR SETTEN VERSUS
PRO SETTEN IN FRAIL OPERATION OF
CHILDHOOD CANCER SURVIVOR AND
THIS IS A UO1 THAT'S DONE
THROUGH SAINT JUDE WITH JIM
KIRKLAND SO AS I FINISH HERE, I
WANT TO JUST SHOW YOU THAT WE
CAN LEARN FROM THE AGING
COMMUNITY.
WE CAN LEARN ABOUT STUDYING
DIFFERENT AGING OUTCOMES AND
FOCUS ON STUDYING, TRIALS WITH
BREAST CANCER BUT WE CAN DO THIS
IN OTHER CANCER SURVIVORSHIP AND
MOVE OTHER DISEASES AND I THINK
THERE'S REPORTED TO NOTE THAT AS
WE ARE STUDYING THIS, IN THE
CONTEXT OF CANCER AND THERE'S AN
OPPORTUNITY TO LEARN MORE AND TO
THINK ABOUT OTHER PROCESSES.
I WILL JUST SORT OF SAFE TOO
THAT I HAVE ONLY FOCUSED ON THE
LEFT SIDE OF THE CIRCLE.
THERE'S A RIGHT SIDE OF THE
CIRCLE WHERE AGING IS AN
MODULATES CANCER AND THERE'S A
LOT OF WORK LIKE DONE BY MARK LA
BARGE LOOKING AT STRUCTURAL AND
AGING RELATED CHANGES THAT LEAD
TO THE DEVELOPMENT OF CANCER AND
THERE'S A LOT THAT THE
GEROSCIENCE CAN BRING TO THE
UNDERSTANDING OF CANCER AND
CHEMO PREVENTION AS WE MOVE
FORWARD SO CANCER AND AGING IS
JUST ONE OF THE MANY THINGS THAT
WE CAN LEARN AS WE THINK ABOUT
ALL THESE DIFFERENT PARADIGMS
AND ULTIMATELY, THE MORE WE
UNDERSTAND THESE PROCESSES, THE
BETTER THAT WE'LL BE ABLE TO
TREAT NOT JUST CANCER BUT MANY
OF UNDERLYING FUNDAMENTAL
PROCESSES WE CAN POTENTIALLY
MAKE A DIFFERENCE IN MULTIPLE
AREAS AND LEAD TO AN IMPROVEMENT
AND SO, CANCER SURVIVORS ARE
LIVING LONGER AND THEY ARE --
THERE'S A DYNAMIC INTER PLAY
BETWEEN CANCER AND AGING EX WE
NEED TO DEVELOP A COMPREHENSIVE
APPROACH TO UNDERSTANDING THE
FUNDAMENTAL PROCESSES AND THAT
WE CAN TRANSLATE THESE FINDINGS
ULTIMATELY INTO GEROSCIENCE OWE
INTERVENTIONS THAT CAN PREVENT
ACCELERATED AGING AND ALSO
PREVENT CANCER EMERGENCE AND
PROGRESSION AND THE MORE WE USE
CANCER AS A MODEL TO UNDERSTAND
THESE PROCESSES, I THINK THAT
WILL HELP US ALSO TO TRANSLATE
THIS AND MAKE POSITIVE IMPACT
ELSEWHERE.
THAT'S ALL I HAVE.
THANK YOU.
[APPLAUSE]
>>GOOD AFTERNOON, MY SLIDES ARE
UP NOW.
I APOLOGIZE.
AS MENTIONED IN THE
INTRODUCTION, I'M AN INFECTIOUS
DISEASE CLINICIAN AND
RESEARCHERS AND I HAD SPEND THE
MAJORITY OF CARING FOR PATIENTS
WITH HIV OR RESEARCHING PATIENTS
WITH HIV.
IN CONTRAST TO WHAT I SAW
PROBABLY 20 SOMETHING YEARS AGO
IN MEDICAL SCHOOL, THE MAJORITY
OF PEOPLE WITH HIV ARE NOW AGE
50 YEARS OR OLDER.
WE CONTINUE TO SEE, I SPEND MOST
OF MY TIME IN CLINICS TAKING
CARE OF CO MORBID TEASE, TALKING
ABOUT POLY PHARMACY, ADDRESSING
ADVANCE DIRECTIVES RATHER THAN
TALKING ABOUT OPPORTUNITY IS
TICK INFECTION OR TALKING THAT
MUCH ABOUT ANTI RETRO VIRAL
THERAPY.
IT'S THE RESULT OF THE
REMARKABLE SUCCESSES OF ANTI-THE
RETRO VIRAL THERAPY OVER THE
LAST 25-30 YEARS.
WE CONTINUE TO SEE NEW DIAGNOSIS
OF HIV IN OLDER ADULTS AND IN
FACT THE INCIDENTS OF HIV HAS
ACTUALLY REMAINED FAIRLY STABLE
AND IN POPULATIONS 55 OR OLDER
AND WE'VE HAD SOME SUCCESSES AND
DECREASING THE INCIDENTS OF NEW
HIV DIAGNOSIS IN YOUNGER
POPULATIONS.
THE PURSE PORTION OF PEOPLE WITH
HIV THAT ARE AGE 50 OR OLDER
LIVING IN THE U.S. IS EXPECTED
TO REACH ABOUT 75% BY THE YEAR
2030.
THE PREPORTION OF OLDER ADULTS
LIVING WITH HIV IN LOW AND
MIDDLE INCOME COUNTRIES HAS
CERTAINLY LAGGED HYPED AND IT'S
PROBLEM JUST A FRACTION OF THE
PERCENT OF THE -- A SMALL
PERCENT OF THE POPULATION IN
OTHER COUNTRY HOWEVER THIS MAKES
UP A DRASTIC NUMBER OF PATIENTS
JUST DUE TO THE SCHEER BURDEN OF
HIV AND MANY OF THESE COUNTRIES.
AND THIS HAS BEEN COMPLICATED BY
SLOWER ROLLOUT OF ANTI RETRO
VIRAL THERAPY AND AVAILABLE OF
ANTI RETRO VIABLE THERAPY BUT A
MAJOR HEALTH CRISIS IN THE
UPCOMING DECADES.
IT'S ALSO COMPLICATED BY A LACK
OF INFRASTRUCTURE FOR LONG-TERM
CO-MORBIDITY MANAGEMENT AND MANY
OF THESE COUNTRY.
THE LIFE EXPECTANCY OF PEOPLE
LIVING WITH HIV HAS IMPROVED
DRASTICALLY OVER THE LAST 40
YEARS NOW OF THE HIV EPIDEMIC
AND AS YOU CAN SEE BY THE TOP
TWO LINES, THE LIFE EXPECTANCY
OF SOMEONE WITH HIV ACTUALLY NOW
NEARS THAT OF A PERSON WITH OUT
HIV.
THERE'S STILL A GAP.
THIS GAP IS WHAT WE THINK MIGHT
BE CAUSED BY ACCELERATED AGING
THAT WE'VE SEEN IN PEOPLE WITH
HIV.
IF YOU LOOK AT THE TWO LINES AT
THE BOTTOM OF THIS FIGURE, IT
SHOWS THE EXPECTED TIME FOR A
21-YEAR-OLD TO DEVELOP AN
ADDITIONAL CO-MORBIDITY AND FOR
SOMEONE WITHOUT HIV, THAT MAY BE
ABOUT 30 YEARS AND IN CONTRAST,
WE EXPECT A 21-YEAR-OLD WITH HIV
WILL PROBABLY DEVELOP ANOTHER
CO-MORBIDITY WITHIN 10 YEARS.
IN FACT WHEN WE LOOK AT COHORTS
THAT PEOPLE WITH AND WITHOUT HIV
THAT ARE MATCHED FOR DEMOGRAPHIC
DIFFERENCES, PEOPLE WITH HIV
EXPERIENCE A MUCH GREATER CO
MORBID BURDEN ACROSS THE
LIFESPAN.
FOR EXAMPLE, THE TWO BOXES I
HAVE OUTLINED IN RED, PEOPLE
WITH HIV ABOUT 80% OF PEOPLE IN
THEIR 50s OR 59 AGE RANGE HAVE
ONE CO-MORBIDITY IN CONTRAST TO
40% OF PEOPLE WITHOUT HIV.
IN FACT WE SEE INCREASED RISK OF
MANY DIFFERENT CO MORBID TEASE
SUCH AS CARDIOVASCULAR DIS TEASE
AND COGNITIVE IMPAIRMENT AND
DIABETES.
THERE'S INTRAVENOUS DRUG USERS
WITH AND WITHOUT HIV SO WE CAN A
IT TEMPT TO HAVE THIS SAME SCIO
DEMOGRAPHIC DIFFERENCES BETWEEN
THE TWO PARTICIPATIONS AND TEASE
OUT THE EFFEPAP POPULATIONS.CARS
50% HIGHER AMONG PEOPLE WITH HIV
AND CARDIOVASCULAR DISEASE
RELATED MORTALITY IS A LEADING
NON AIDS CAUSES OF DEATH.
AS YOU CAN SEE IN THE BOTTOM
FIGURE WITH OLDER DATA FROM THE
PARTNERS HEALTH COHORT IN BOSTON
THE RATE OF CARDIOVASCULAR
DISEASE ACCELERATES AMONG PEOPLE
WITH HIV STARTING AT ABOUT AGE
45 COMPARED TO CONTROL
POPULATIONS.
WITH OTHER CARDIOVASCULAR
DISEASES SUCH AS CONGESTION
HEART FAILURE OR SUDDEN CARDIAC
DEATH WE SEE VERY HIGH RATES IN
PEOPLE WITH HIV AS YOUNG AS
THEIR 30s AND 20s 24 THAT LEVEL
OUT WITH AGING.
THESE CARDIOVASCULAR EVENTS
OCCUR AFTER RISK FACTORS AND OUR
RISK SCORE CALCULATOR DON'T
ESTIMATE THIS RISK PARTICULARLY
WELL.
THIS LED TO THE DEVELOPMENT OF
WHAT IS NOW A LANDMARK TRIAL
CALLED REPRIEVE AND REPRIEVE
ENROLLED OVER 7,000 PARTICIPANTS
FROM AROU AROUND THE WORLD INCLG
LOW AND MIDDLE INEX COUNTRIES
AND RANDOMIZED PARTICIPANTS WITH
LOW RISK TO A STATEN THAT
DOESN'T HAVE DRUG INTERACTIONS
WITH OUR HIV MEDICATIONS OR A
PLACEBO AND JUST WITHIN THE LAST
COUPLE OF WEEKS WE HAD A PRESS
RELEASE AFTER SEVEN YEARS OF
FOLLOW-UP THAT THE DECREASE
DISEASE EVENTS BY 35% IN PEOPLE
WITH HIV HOPING TO DECREASE THIS
CO MORBID BURDEN WITH PEOPLE IN
HIV.
WE ALSO SEE INCREASED RISK OF
OSTEOPOROSIS, FALLS AND
ACCIDENTALLY FRACTURED IN A
OLDER ADULT POPULATION.
WITH PEOPLE WITH HIV TEND TO
EXPERIENCE ABOUT A TWO TO FOUR
PERCENT DECLINE IN THEIR BONE
MINERAL DENSITY IN THE FIRST
YEAR OF THERAPY.
THIS VARIES DEPENDING ON THE
THERAPY AND HOW TOXIC THE
TREATMENT MIGHT BE.
THERE'S PROBABLY SOME STABLATION
BUT AS YOU CAN SEE THERE'S A
DECLINE IN BONE MINERAL DENSITY
OVER TIME ANTI RETRO VIRAL
THERAPY AND THIS IS A THIGH RATE
OF FALLS IN PEOPLE WITH HIV AND
EVEN AT 50 WE SEE RATES OF FALLS
THAT ARE SIMILAR TO POPULATIONS
65 OR OLDER AND WITH UP TO 40%
OF PEOPLE EXPERIENCING ANY FALL
AND UP TO 25% AND WE CAN SEE
FROM SOME OLDER ANTI RETRO
MULTIPLE DIFFERENT
CO-MORBIDITIES AND NEURO
COGNITIVE HE H PAIRMENTMENT AND
WE SEE A HIGH RATE OF FRACTURES
AND WOMEN AND MEN INCREASES AS
SHOWN IN THE FIGURE BELOW
STARTING AT AGE 40 OR 50.
AND LASTLY I WANT TODAY
HIGHLIGHT THE CURES OF OTHER
GERIATRIC AND PEOPLE WITH HIV
AND COMPARED TO THOSE WITHOUT
HIV AND ACROSS THE AGE SPECTRUM
DEMOGRAPHIC CONTROL GROUP WITH A
DECLINE STARTING AT AGE 50 OR 60
IN THOSE WITH HIV AS INDICATED
IN THE RED LINE.
SO WE ARE OBSERVING WHAT WE
MIGHT CALL AN ACCELERATED OR AT
LEAST AN EX SEN YOUATED PROCESS
WITH PEOPLE IN HIV ON THE LEFT
SIDE OF THE SPEAKER YOU CAN SEE
A INCREASE IN THE AGING PROCESS
AND THE BIOLOGICAL AGE.
WITH ANTI RETRO VIRAL THERAPY
THAT MAY CONTINUE TO ACCELERATE
OVER TIME AND WE MAY BE ABLE TO
DECREASE THAT AND JUST HAVE AN
EX SEN TO YOUATED AGING PROCESS
OVER TIME.
DIFFERENT MECHANISMS CONTRIBUTE
TO THE AGE ACCELERATION IN HIV
OVERLAPPING WITH WHAT WE HEARD
IN THE CANCER POPULATION AND IF
MIGHT BE LOSS OF REGULATORY T
CELLS AND WE CONTINUE TO SEE
REPLICATION WHEN WE HAVE
PATIENTS ON RETRO VIRAL THERAPY
AND WE TOX SIT TEE FROM THERAPY
AND HEPATITIS C AND SYPHILIS AND
THERE'S A PURCHASED OF MICROBIAL
TRANCE LOCATION WITH DIFFERENT
ORGANISMS AND METABOLIC FACTORS
TO INFLAMMATION AND IMMUNE
DISREGULATION OF INCREASED
CO-MORBIDITIES EXPERIENCED IN
HIV.
TO FOLLOW-UP ON THIS MORNING'S
PRESENTATION, IT'S CRITICAL TO
NOTE THAT PEOPLE WITH HIV
PROBABLY 50 TO 60% AT MINIMUM,
PARTICULARLY OF OUR OLDER
POPULATION ARE INDIVIDUALS OF
ALCOHOL AND UNDER REPRESENTED
POPULATIONS, OR GENDER MINE TORR
TEE THAT MAY HAVE MANY DIFFERENT
TYPES OF STRUCTURAL INKILOMETRES
THAT THEY MACE IN THEIR
DAY-TO-DAY LIFE AND THESE
FACTORS MAY BE COMPLICATED BY
BIOBEHAVIORAL FACTORS SUCH AS A
HIGH RATE OF SUBSTANCE USE OR
DIET, LOW PHYSICAL ACTIVITY, AND
STIGMA BOTH RELATED TO AGING AND
HIV.
IN COMBINATION THESE FACTORS
CONTRIBUTE TO THAT ACCELERATED
AGE TAG WE SEE IN HIV WITH ANTI
RETRO VIRAL THERAPY.
IF WE GO BACK TO AGING IN THE
RIGHT UPPER CORNER, WE CAN SEE
THAT THE IMPACT OF HIV FAIRLY
BROADLY ACROSS NEARLY ALL OF THE
CRITICAL PATHWAYS THAT SEEM TO
DRIVE AGING OR BE CRITICAL
PATHWAYS AND AGING PROCESS.
SEVERAL HAVE SHOWN THAT PEOPLE
WITH HIV HAVE ACCELERATED
EPIGENETIC AGING SHOWN IN THE
RED LINE ON THIS FIGURE AND SOME
IS REVERSED OR DECREASED IN THE
ANTI RETRO VIRAL THERAPY BUT
THERE'S SOME ADVANCEMENT OF EP
DEN GEPIGENETIC AGE AND ALL KNOE
THIS REVERSES SOMEWHAT WITH
EFFECTIVE ANTI AND THERAPY WE
STILL SEE SOME DECLINE IN
CERTAIN POPULATIONS, WOMEN, FOR
EXAMPLE, SHOWN HERE.
AND THEN LASTLY MITOCHONDRIAL
DYSFUNCTION HAS BEEN RECOGNIZED
AS A CONSEQUENCE OF HIV AND OF
MANY OF OUR ANTI RETRO VIRAL
THERAPIES AND OUR NEW THERAPY
THAT WE THINK ARE MUCH MORE
SAFE.
STUDIES HAVE DEMONSTRATED I
OBJECT CREASED INFLAMMATION,
IMMUNE SENESCENCE DID METABOLIC
AND LOSS OF PRO TEE OWE AND
AGING AND COULD LEAD TO AN
ADVANCEMENT OR ACCELERATION IN
AGING AND PEOPLE WITH HIV.
I WANT TO COMMENT THE REMARKABLE
TIMELINE OF HIV RECOGNITION AND
TREATMENT OVER THE LAST 40 YEARS
REALLY COMPLICATES HOW WE PLAN
TO THINK ABOUT AGING AND PEOPLE
WITH HIV.
FOR PEOPLE I AM FACTED BACK IN
THE EARLY 780s, MANY OF THEM
HAD A PROFOUND PERIOD OF IMMUNE
SUPPRESSION AND REMARKABLE
WASTING THAT CONTINUES TO LONG
LASTING IMPACTS AND MUCH OF
WHICH IS NOT REVERSIBLE.
FOR EXAMPLE, WE HAVE PREVIOUSLY
SHOWN THAT HAVING ANY HISTORY OF
WASTING CAN HAVE AN GOING
IMPACTS OF PHYSICAL FUNCTION
MARKERS SUCH AS GRIP STRENGTH,
AND GATE SPEED OVER TIME AND
EASY WAS INTRODUCED IN THE LATE
80s AND REALLY PROMISED WAS
THE FIRST PROMISE WE HAD OF SOME
SORT OF ANTIRETROVIRAL THERAPY
THAT MAY SUPPRESS VIRUS
UNFORTUNATELY ALONE IT DIDN'T
WORK VERY WELL BUT IT DID CAUSE
MIGHT MIGHT OWE CON AGREAL WHICE
I AM REVERSIBLE AND WE SAW
HIGHLY ACTIVE THERAPY OR
COMBINATION THERAPY AND THIS IS
CERTAINLY TRANSFORMED OUR
TREATMENT AND OUR PROGNOSIS OF
HIV AND HOWEVER THESE TREATMENTI
WANTED TO MENTION THAT THERE'S
ALSO BEEN A GROWING INTEREST IN
USING THE GEROSCIENCE SCIENCE
APPROACH TO THE TREATMENT OF
AGING IN PEOPLE WITH HIV.
PEOPLE WITH HIV ARE CERTAINLY A
POPULATION THAT WE THINK MIGHT
BENEFIT MOST FROM SOME OF THESE
TREATMENTS ESPECIALLY AS WE SAW
HOW HIV CAN BE IMPACTED BY THE
PILLARS OF AGING AND THE CURVE
THAT WE THINK SOMEONE FOLLOWS
THIS NORMAL CURVE OF AGING WE
BELIEVE AGING WITH HIV MAY SHIFT
PEOPLE FURTHER AWAY FROM THAT
CURVE AND CERTAINLY JUST THE
INITIATION OF ANTI RETRO VIRAL
THERAPY COULD HELP MOVE THEM
CLOSER TO THE AGING CURVE BUT
THERE'S MANY OTHER MECHANISMS
THAT WILL KEEP PEOPLE AGING WITH
HIV FROM OFTEN TIMES HAVING THAT
NORMAL AGING PROCESS.
WE HAVE BEEN INTERESTED IN
LIFESTYLE MODIFICATION AND
EXERCISE CAN INCREASE OR IMPROVE
MANY OF THE AGING MECHANISMS
THAT WE SEE DIRECTLY IN SKELETAL
MUSCLE AND WE'VE SHOWN
IMPROVEMENTS IN PHYSICAL
FUNCTION AND AND ACCELERATED
WITH SOMEWHAT LIMITED SUCK IS
CEASE AND POPULATIONS WITH HIV
AND I THINK AS WE'VE SEEN
RESULTS FROM THE REPRIEVE TRIAL
ROLLOUT OVER THE NEXT SEVERAL
MONTHS TO YEARS, WE CAN
CERTAINLY LEARN A LOT ABOUT
POTENTIAL MECHANISMS THAT THEY
MAY HAVE ON THOSE AGING
PROCESSES AND SOME OF THE SIL
ARREST OF AGING AND I'M EXCITED
TO CONTRIBUTE TO A TEAM
INVESTIGATE A DRUGS THAT WE JUST
HEARD ABOUT AND ON PHYSICAL
FUNCTION AND PEOPLE WITH HIV AND
LED OR SUPPORTED BY THE NATIONAL
INSTITUTE ON AGING AND WITHIN
THE AIDS CLINICAL TRIALS GROUP.
SO MANY PEOPLE WITH HIV
EXPERIENCE AN EXCEL RACE OF THE
AGING POP AND COMPLICATED BY
YEARS OF IMMUNE SUPPRESSION AND
SOCIAL AND BEHAVIORAL STRESSORS
AND THERAPY RELATED TOX SIT TEE
AND PEOPLE WITH HIV MAY BENEFIT
FROM GEROSCIENCE APPROACHES TO
SLOW OR REVERSE THE AGING
PROCESS.
I WANTED TO ACKNOWLEDGING SOME
OF THE ORGANIZATIONS I WORKED
WITHIN AND MY FUNDING AGENCIES
THROUGH THE NATIONAL INSTITUTE
ON AGING AND TO ACKNOWLEDGE THE
PEOPLE WITH HIV WHO HAVE TIME.
THANK YOU FOR YOUR TIME.
>>GOOD AFTER, EVERYONE.
I'M FROM OHIO STATE AND I'M AN
AGING FOCUS AND I'M GOING TO
TALK ABOUT OUR WORK TO STUDY
LONG-TERM OUTCOMES AND HOW THAT
MAY SUGGEST THAT SURVIVORS OF
ILLNESS HAVE A PHENOTYPE OF
ACCELERATED AGING.
SO THIS IS A ICU ROOM AT THE
OHIO STATE MEDICAL CENTER AND IN
THIS ROOM, IN THE 85,000 ACROSS
IT IN THE UNITED STATES ARE
ADMITTED AND PEOPLE'S WHO LIFE
ANG IN THE BALANCE AND 6 MILLION
ARE ADMITTED TO AN ICU EVERY
YEAR THAT MEANS FOR EACH OF US,
ON AVERAGE, WE'LL BE ADMITTED TO
AN ICU ONCE IN YOU ARE LIVES.
THE GOOD NEWS IS THAT OVER THE
LAST 25 YEARS ADVANCED IN
CRITICAL CARE MEDICINE HAVE LED
TO IMPROVEMENTS IN SURVIVAL AND
IN FACT, SURVIVORSHIP IS ROUGHLY
DOUBLE WHAT IT WAS IN THE YEAR
2000.
TODAY IN THE UNITED STATES IT'S
ESTIMATED THAT THREE AND A HALF
MILLION AMERICANS WILL SURVIVE A
CRITICAL ILLNESS EACH YEAR AND
AS OPTIMISM FROM CRITICAL
ILLNESS IS TEMPERED BY GROWING
KNOWLEDGE THAT THEY WILL SUFFER
FROM SEVERITY FROM FATIGUE AND
MUSCLE WEAKNESS AND ALL THE WAY
UP TO SEVERE DISABILITIES IN THE
INABILITY TO CARE FOR THEMSELVES
AND SIMILAR PREPORTION ALSO HAVE
COGNITIVE IMPAIRMENT RANGING
FROM THINKING IN MEMORY OF THE
BRAIN FOG WE'RE HEARING ABOUT IN
COVID SURVIVORS UP TO
ALZHEIMER'S LIKE DEMENTIA.
EYE SMALL YOU ARE PREPORTION
SUFFERED IN NEW ANXIETY AND
STRESS DISORDER AND SO THE
QUESTION TODAY IS, DOES CRITICAL
ILLNESS LEAD TO ACCELERATED
AGING?
GOOD START FIRST WITH THE MOST
ROBUST BODY OF DATA THE CLINICAL
PERSPECTIVE.
I'LL SHARE WITH YOU DATA FROM
OUR GROUPS BRAIN ICU COHORT
STUDY PUBLISHED IN NEW ENGLAND
JOURNAL A DECADE AGO AND THE
BRAIN ICU STUDY WE WERE
INTERESTED IN THE EFFECTS OF
CRITICAL ILLNESS ON MEMORY, COG
ANYTHING SO WE ENROLLED 821
PATIENTS WITH CRITICAL ILLNESS
AND THEY WERE RECEIVING BASE
OPPRESSORS FOR SHOCK AND WE
EXCLUDED THOSE WITH A KNOWN
DIAGNOSIS OF DEMENTIA AND WENT
THROUGH A CENTER STEP PROCESS TO
QUANTIFY THE AMOUNT OF ANY
COGNITIVE IMPAIRMENT USING THE
IQ CODE AND THE RATING SCALES
AND IN FACT ONLY 6% OF PATIENTS
ENROLLED IN THIS POPULATION HAD
ANY EVIDENCE OF COGNITIVE
IMPAIRMENT.
THEN AMONG SURVIVORS AT THREE
AND 12 MONTHS, THEY USED TEST
CALLED THE REPEATED FOR THE
ASSETMENT OF NEUROPHYSIOLOGICAL
STATUS AND ABOUT WHAT I'M
SHOWING YOU HERE IS FOLLOW-UP
DATA SO IT'S THE GLOBAL AND THAT
HAS AN AGE ADJUSTED NEED OF 100
END INDICATED BY THE JELL-O AND
IT'S 15 POINTS ON EITHER SIDE
AND INDICATED BY THE GRAY BOX
AND WE'VE BROKEN THIS DOWN INTO
AGE GROUPS SO WE HAVE THE OVER
65 ON THE RIGHT AND 50 AND 60 IN
THE MIDDLE AND 30 AND
40-YEAR-OLDS ON THE LEFT SIDE
THERE.
THREE MONTH DATA ARE IN THE RED
BOXES AND 12 MONTH DATA IN THE
BLUE AND THE TOP OF THE BOX
REPRESENTS THE MOST HAVE SCORES
THAT ARE ONE STANDARD DEVIATION
BELOW WHAT WE COULD PECK.
KEEP IN MIND THOSE ARE PEOPLE
WITHOUT EXITING COGNITIVE
IMPAIRMENT AND WE HAVE
COMPARISON GROUPS FOR OTHER
FORMS OF BRAIN INJURIES.
AND YOU CAN SEE THAT ABOUT A
THIRD OF PATIENTS REGARDLESS OF
AGE, FALL BELOW THE CBI LEVEL
AND A QUARTER FALL BELOW THE
ALZHEIMER'S.
WE THOUGHT THOSE 30 AND
40-YEAR-OLD WE KNOW THEM WITH
CONTROLLED DIABETES AND THEY'RE
ON DIALYSIS AND THEY HAVE A LOT
OF CO-MORBIDITIES SO WE BROKE
THIS OUT FURTHER, ACCORDING TO
THE NUMBER OF CO-MORBIDITY AND
I'M SHOWING YOU IT'S BROKEN DOWN
WHETHER YOU HAVE NO CO-MORBIDITY
AND OR THREE CO-MORBIDITY AND
THE BOTTOM, RIGHT OF THIS SLIDE
WOULD NOT BE SURPRISING TO
ANYBODY.
OLDER ADULTS WITH LOTS OF
CO-MORBIDITY WHO GET ILL MAYBE
WE'RE UNMASKING A PREEXISTING
COGNITIVE.
I WANT TO DRAW WHY ATTENTION TO
THE UPPER LEFT.
THE 30 AND 40-YEAR-OLDS WITH NO
CO-MORBIDITY AND WEARING SHOWING
ONE STANDARD DEVIATION.
THIS SUGGESTS CLINICAL ILLNESS
IS LEADING TO THE NEWLY ACQUIRED
COGNITIVE APPROACH AND ON THAT
SAME COHORT WE ALSO LOOKED AT
FRAILTY AMONG OUR PATIENTS 18
AND UP USING THE CLINICAL
FRAILTY SKILL AND WE CHOSE THAT
BECAUSE OUR PATIENTS ARE
CRITICALLY ILL AND NONE OF THEM
ARE PLANNING TO GET PNEUMONIA
AND GET SEPTIC AND LAY ON A
VENTILATOR AND THEY CAN'T
PERFORM PHYSICAL PERFORMANCE
MEASURES NEEDED TO DO THE FAIL
AND WE USE THE CLINICAL TRAIL
TEE SCALE.
PUBLISHED THIS DATA IN CRITICAL
CARE MEDICINE AND WHAT I'M
SHOWING YOU HERE IS PREPORTION
OF PATIENTS GOING INTO THREE
DIFFERENT CATEGORIES AND
ACCORDING TO THE FRAILTY SCALES
FOR THEIR CRITICAL ILLNESS THE
BEST WE COULD OBTAIN -- THOSE AE
MOST ROBUST PATIENTS AND FOUR
VULNERABLE PATIENTS AND AND IN
THIS POPULATION A QUARTER OF
PATIENTS, FRAILTY AND THAT
NUMBER INCREASES AND ALMOST
DOUBLED AND 45% AT THREE MONTHS
AND STAYED HIGH AND 40% OF
SURVIVORS AT A YEAR.
IF YOU LOOK AT THE NUMBER OF
PATIENTS WITH FRAILTY AT THREE
AND 12 MONTHS, 60% WERE NOT
FRAIL BEFORE THEY WERE NO AND
WE'VE BROKEN OUT THESE RAW
SCORES HERE AGAIN BY AGE GROUPS
OVER 65 AND 30 AND 40-YEAR-OLDS
AT THREE AND 12 MONTHS AND WHAT
YOU CAN SEE IN THE UPPER LEFT
AND WE HAVE YOUNGER SURVIVORS
WHO SEALED FRAILTY SO 50 AND
60-YEAR-OLDS AND 30 AND 40 WITH
FRAILTY OF THEIR CRITICAL
ILLNESS AND SUGGESTING AGAIN
THAT IT LEADS TO AN ACCELERATED
AGING PHENOTYPE AND SOME NEW
DATA FROM A MORE RESENT COHORT
AND THE AWARD WHICH JUST
COMPLETED AS PART OF MY AWARD WE
LOOKED MORE AT PHYSICAL
FUNCTION.
APPROXIMATE APPROXIMATE IF
REPEAT THE SHORT PHYSICAL
PERFORMANCE BATTERY AND WE DON'T
HAVE BASELINE DATA ON THOSE
FOLKS BECAUSE THEY'RE CRITICALLY
ILL.
AS WE BREAK THESE OUT BY AGE,
YOU CAN SEE THESE NUMBERS ARE
LOW COMPARED TO POPULATION IF WE
TAKE YOUNGER FOLKS THERE'S A
COUPLE OF POPULATION COHORTS ONE
FROM NORWAY AND SINGAPORE AND
THE 40 AND 40-YEAR-OLD WERE
SCORING PERFECT AND IT'S PRETTY
SIGNIFICANT DIFFERENT SCORES.
OVER 65 WAS SIMILARLY AND THESE
ARE PATIENTS NOW THAT ARE
CONSIDERED AT HIGH-RISK, RIGHT.
THEY WOULD HAVE BEEN MET
INCLUSION CRITERIA FOR OUR
STUDIES TO REDUCE DISABILITY IN
OLDER ADULTS.
SO INVESTIGATE THAT SURVIVOR OF
CRITICAL ILLNESS HAS
SIGNIFICANTLY IMPAIRED PHYSICAL
FUNCTTHAT.
LET'S LOOK AT THE BIOLOGICAL
PERSPECTIVES.
THIS SERIES OF DATA IS MUCH LESS
WELL DEVELOPED THAN THE CLINICAL
COHORTS BUT THERE'S SEVERAL
LINES OF DATA THAT INDICATE THAT
PERHAPS CRITICAL ILLNESS IS
LEADING TO SOME OF THESE
BIOLOGICAL HALLMARKS OF AGING
WHICH WOULD GO ALONG WITH THE
CLINICAL DATA THAT I JUST SHOWED
YOU.
HE ENROLLED OVER 400 ADULT S
WITH PNEUMONIA AND BEEN IN THE
HOSPITAL WITH PNEUMONIA AND HE
DREW BLOOD AROUND THE TIME OF
HOSPITAL ADMISSION AND ABOUT A
WEEK LATER BEFORE THE PATIENTS
WENT HOME AND AT THREE, SIX AND
12 MONTHS LATER AND THE DOTTED
LINE REPRESENTS THE 95% FOR THE
NORMAL VALUE OF IL6 AND THE
CLINICAL LAB.
DURING THE ACUTE INFECTION,
WHICH IS NOT SURPRISING TO
ANYBODY, THOSE VALUES ARE
ELEVATED.
BUT AT THREE, SIX AND A YEAR
LATER, OVER HALF OF THOSE
PATIENTS, THEY HAVE ELEVATED
I'LL SIX SUGGESTING THAT
INFECTION IS LEADING TO A FORM
OF CHRONIC INFORMATION AND THEY
HAVE ACUTE INFECTION AS A
RESULT.
SECOND, SMALLER COHORT SCUDDY
OUT OF TORONTO AND LOOKED AT
SURVIVORS THE ACUTE RESPIRATORY
OR SEVERE MA KNOWNIA AND
VENTILATORS WAS THIS CALLING IT
ARDS AND WHAT THEY LOOKED AT IN
THIS COHORT OF 15 PATIENTS THE
AVERAGE AGE WAS IN THE LATE
40s AND EARLY 50s AND THEY
LOOKED AT MUSCLE BU BIOPSIES ANN
THE LEFT THERE IS A TWO-PAGES.
ONE ON THE TOP OF MUSCLE ATROPHY
AND ONE ON THE BOTTOM WITH
NORMAL MUSCLES AND WHAT THEY'RE
POINTING OUT TO YOU ARE
SATELLITE CELLS OR MUSCLE STEM
CELLS AND YOU CAN SEE IN THE TOP
THE MUSCLE AND AND THE VYING ANT
AND A CROP I CAN AND NORMAL AT
SEVEN DAYS AND SIX MONTHS AND
YOU CAN HE SEE AND AND THE
NUMBER OF SATELLITE CELLS IS
MARKETING REDUCED AND THESE ARE
YOUNGER FOLKS BUT SUGGESTING
THAT ARDS RELATES TO OTHER.
OUR GROUP PERFORMED EXERCISE
TESTING SURVIVORS AND CRITICAL
ILLNESS FROM OUR MOSAIC COHORT
AND WE HAD 14 PEOPLE COME BACK
TO OUR LAB AND GET ON THE FULL
CP I WANT TO SHOW YOU A COUPLE
OF THINGS RELATED TO
MITOCHONDRIAL AND ALMOST ALL OF
THESE PATIENTS HAD CARDIO
RESPIRATORY FITNESS BELOW 20
PLACING THEM PATIENTS WITH
SEVERE END-STAGE.
NONE HAD LUNG OR HEART DISEASE.
THEY HAD RESISTING CARDIO
PULMONARY DISEASE SO WHAT WE'RE
SHOWING YOU IS THE RELATIONSHIP
BETWEEN TWO MEASURES OF
EFFICIENCY AND DURING CONSIDER
THE WORK RATE AND ON THE RIGHT
SO WHAT YOU CAN SEE AND AND HAVE
THE WORST MITOCHONDRIA LOWY
EFFICIENCY DURING RECOVER THEY
HAVE THE LONGEST RECOVERY TIME
SO THIS IS SUGGESTING
MITOCHONDRIAL UNDERLIES SOME OF
THE AND IT'S THREE DIFFERENT
BIOMARKERS AND AS MUCH AND
CANCER AND HIV AND THE OTHER
THING TO CONSIDER IN TERMS OF
UNDERSTANDING WHETHER CRITICAL
ILLNESS LEADS TO ACCELERATED
AGING IS THE RELATIONSHIP AND
BIDIRECTIONAL RELATIONSHIP PREN
MENTAL ILLNESS AND RELATIONSHIP
AGING AND ARDS AND SEVERE
RESPIRATORY FAILURE AND
VENTILATOR AND THE SINGLE
BIGGEST RISK FACTORS.
BUT DEMENTIA CAN LEAD TO SEVERE
SEPSIS WHICH IS THE LEADING
CAUSE OF HOSPITAL ADMISSION IN
OLDER ADULTS.
THIS IS DATA FROM THE
CARDIOVASCULAR HEALTH STUDY OUT
OF PITTSBURG AND THEY LOOKED AT
THE RISK OF THE INFECTION AND
THE SEVERE H SEVERITY OF THAT
INFECTION SO SHOWN ARE THREE
DIFFERENT TRAJECTORIES OF
COGNITION, YELLOW SHOWING NO
DECLINE AND BLUE MINIMAL DECLINE
AND RED SHOWING SEVERE DECLINE
AND WHAT YOU CAN SEE IS THAT
THOSE WITH NO INFECTION, ON THE
LEFT, AS WE WORK LEFT AND RIGHT,
THE SEVERITY OF INFECTION GOES
UP SO NO INFECTION AND ANY
INFECTION AND SEPSIS SO THOSE
WITH NO DECLINE IN COGNITION
HAVE LOWER RATES OF NOT BEING
INFECTED AND LOWER RATES OF
HAVING SEVERE SUBSTANCE AND
MINIMAL DECLINE HAVE INCREASING
RATES OF SEVERE SUGGESTING THAT
THERE'S A CLINICAL PHENOTYPE OF
ACCELERATING AGING WITH HIGH
RATES OF COGNITIVE IMPAIRMENT
INCLUDING THOSE YOUNGER ADULTS
AND PHYSICAL IMPAIRMENTS AND
FRAILTY AND SOME EARLY DATA,
REALLY VERY EARLY DATA OF
DIFFERENT BIOLOGICAL PROCESSES
AND OF AGING AND PRESENT IN ICU
SURVIVORS AND IT'S AN AREA RIGHT
FOR FURTHER STUDY AND IN THE
MEANTIME, WE HAVE TO TEASE OUT
THIS BIDIRECTIONAL RELATIONSHIP
AND UNDERSTAND WAYS TO
UNDERSTAND HOW PEOPLE WERE DOING
MONTHS AND YEARS BEFORE THEIR
ILLNESS AND IF WE LOOKED AT
SOMEONE WHO WAS OR NOT AN
ALREADY ACCELERATED AGING
TRAJECTORY AND CATCH THEM AT ICU
ADMISSION WE MAY CONSUME THAT
THEY (INAUDIBLE).
SO THANK YOU AND IT'S TIME FOR
OUR PANEL.
>>GOOD AFTERNOON.
ANOTHER BUCK EYE PRESENTING THIS
AFTERNOON.
I WAS JUST MINDING MY OWN
BUSINESS AND RECEIVED AN E-MAIL
FROM NIH AND ASKING IF YOU WOULD
LIKE TO PARTICIPATE IN THE
GEROSCIENCE SUMMIT AND I WAS
HOPPERED TO ACCEPT THAT
INVITATION AND I'LL MAKE
COMMENTS ABOUT A PERSPECTIVE
FROM A FAMILY PHYSICIAN SERVING
IN MOSTLY AFRICAN AMERICAN
COMMUNITIES ON THE NEAR EASTSIDE
OF COLUMBUS AND PAST PRESIDENT
OF THE NATIONAL MEDICAL
ASSOCIATIONS AND SO LET'S GET
STARTED.
MY OBJECTIVES WILL BE TO SPEAK
TO THE CONCEPT OF A FIVE DAYS OF
ACCESS AND THE FULFILLMENT OF
THE PROMISE OF TRANSLATIONAL
RESEARCH FOR OLDER PERSONS AND
GOING TO SPEAK TO THE CONCEPT OF
WHOLE HEALTH AND WHOLE
HEALTH-WHO PERSON HEALTH SCA SCE
AND THE WHOLE HEART OF WHERE
WEATHERING.
ANYONE KNOW WHO THESE GENTLEMAN
ARE HERE?
AND THIS IS Dr. WILLIAM THOMAS
THEY PUBLISHED AN ARTICLE
CONCERNING THE FIVE As OF AK
IS CEASE AND T -- THISAS OVER 5L
BRIEFLY GO OVER THIS INFORMATION
WITH YOU.
I KNOW I DON'T HAVE A LOT OF
TIME.
WHEN WE THINK ABOUT GEROSCIENCE
AND GOING FROM BENCH AND BEDSIDE
AND A LOT OF DIFFERENT AND
METRICS AND AGING AND SPEAKING
TO THE MECHANISMS FOR AGING ON
THE NEAR EASTSIDE OF COLUMBUS,
I'M CONCERNED HOW THIS
INFORMATION AND I WANT TO HELP
THE PATIENTS I SEE ON A DAILY
BASIS.
SO, I WANTED TO BRING THIS
FORMAT AND THIS AND THIS
FRAMEWORK TO DISCUSSION AND
REGARDING THE FIVE As BECAUSE
THEY'RE GOING TO BE IMPORTANT
AND THESE NOVEL CONCEPTS AND
THIS GREAT RESEARCH THAT IS
GOING ON HERE AT THE NATIONAL
INSTITUTES OF AGING AND TO WHERE
THE PEOPLE ARE AT.
MY COLLEAGUES AT OHIO STATE TOOK
THESE FIVE As AND FRAMED THEM
FROM A STAND POINT OF TECH
EQUITY IN TERMS THEY'VE COINED
TO DEALING WITH OUR TELEHEALTH
AND BEING ABLE TO GIVE RANGE THE
BENCH TO THE BEDSIDE TO THE
COMMUNITY.
NOW THIS CONCEPT OF WHOLE I HAVE
JOKES AND I HAVE A SENSE OF
HUMOR SO DON'T THINK THAT IN THE
WRONG WAY.
LOOKING AT CLIENTS AND AND MOVE
FROM THAT PATIENTS IS NOT
COMPLIANT, THEY'RE JUST DON'T
WANT TO DO THAT IT'S REALLY NO
MATTER WHAT COULD BE OTHER
INVOLVED IN THAT SO-CALLED
CLIENTS.
I'M JUST GOING TO BRIEFLY GO
DOWN THE SPEAKING TO THE
PHYSICAL AND THE EMOTIONAL AND
THE RESOURCE AND SOCIAL
ECONOMICS AND I WANT TO BRING
AND SELF-EFFICACY ASPECT OF THIS
AND PARTNERSHIP AND WITH OUR
OLDER PATIENTS AND MANY PEOPLE
THAT ARE SPOKEN TO NUTRITION AND
SO THIS IS A SUMMARY TOOLS FOR
SOCIAL DETERMINANTS OF HEALTH
AND NOW Dr. PEREZ-STABLE AND
HIS TALK THERE WAS A PINNED --
MEASURE HERE BEING USED FOR
EVALUATING CERTAINLY
DETERMINANTS OF HEALTH AND I
JUST WANT TO SHOW YOU SOME
RETABLE AND THE THING ABOUT AND
LEVELS FOR UNDERSTANDING AND
SOCIAL DETERMINANTS OF HEALTH
INCOMPETENT GRATING THAT WITHIN
OUR HEALTH RECORD AND AND THE
WEATHERING ALSO ANOTHER CONCEPT
DEVELOPED BY Dr. GERON NAMUS
WHEN INTRODUCED AND SHE ALSO
HAPPENS TO BE AT THE UNIVERSITY
OF MICHIGAN AND SHE'S OUR LAST
AND SO SPEAKING TO THE CONCEPT
OF LOWS AND YOU CAN SEE HERE,
THE PROBABILITY OF A LOW IN POV
FOR BEING PREDICTED BY A RACE OF
BLACK MEN AND WOMEN AND HIGHER
RATED HERE AND THEN SHE ALSO
TOOK INTO ACCOUNT THE POVERTY
INDEX RATE AND THE RATIO LESS
THAN 1.5 OR GREATER THAN 1.85
AND 1.85 IS THE POINT WHERE
PEOPLE QUALIFIED AND IN THE
PROGRAM AND EVEN, WITH
CONTROLLING FOR POVERTY, YOU
STILL HAVE THE DIFFERENCE HERE
IN THE LOW MEASURES BEING FIVE
OR HIGHER SO I THINK I'VE BEEN
ABLE TO KEEP WITHIN MY FIVE TO
SEVEN MINUTES AND THANK YOU FOR
ALLOWING ME TO PRESENT THIS
MORNING.
THANK YOU SO MUCH.
>>AND I THOUGHT I WOULD DO IS
USE A COUPLE OF POINTS THAT I
HAVE BEEN PONDERING ABOUT AS I
KEEP HEARING ABOUT THE REALLY
IMPORTANT SCIENTIFIC DISCOVERIES
THAT WERE BEING PRESENTED TODAY
AND SO FIRST YOU WILL START WITH
THE QUICKLY SUMMARIZING WHAT I
HEARD.
WE HEARD FROM THIS SESSION THAT
CENTENARIANS ARE AN IDEAL COHORT
AND SOMEONE LIVED THAT LONG
THERE ARE THINGS THAT WE CAN
LEARN FROM THE MICE.
I SEE IT DAY IN AND DAY OUT AND
I TALK ABOUT AGING BUT IT'S ALL
TEXTBOOK LEARN AND THEN I SEE MY
PATIENT WHO IS 102-YEARS-OLD
BROUGHT IN BY HIS SON WHO IS 68
AND THEY'RE BICKERING WAS THE
102-YEARS-OLD SEEN THESE YOUNG
PEOPLE THESE DAYS DON'T KNOW
WHAT THEY'RE TALKING ABOUT,
ABOUT HIS SON.
>>17,000 STEPS A DAY AND I
DON'T THINK ANY OF THEM HAVE A
FIT BIT BUT YET HERE THEY ARE
WITH SO MUCH TO TEACH US AND
THIS WAS ALSO A AH-HA MOMENT IT
WAS A STRESS STRESS AND WE PUT
IT ON THE TREADMILL WE FOUND
THAT OUR HEALTH-CARE SYSTEM IS
FAILING THE MOST AND AGAIN,
THERE'S SO MUCH TALK ABOUT THIS
IN TERMS OF HEALTH DIS PAR TIES
SO I WANTED TO PUT IT UP AND
HERE IS AND WE CAN MAKE US ALL
BETTER SO I PUT THAT POINT UP
AND WE LEARN THREE POINTS ABOUT
HAVE AND APPOINTMENTS THAT I
LEARNED AND IT CAN BE A LATINX
PERMENT AND AND DISPROPORTIONATE
AND HOW CANCER IS MOTIVATOR OF
AGE AND GIVEN THAT AGING IS SO
MULTI FACT OR AND IN TERMS OF
HOW THEY ACCELERATING THE AGING
PROCESS AND VICE VERSA AND ALSO
IT GIVES US A PLAN NEW IN SIGHT
AS WE LOOK AT HOW THESE FACTORS
INTER AGENT TO BETTER HOW I CAN
DO MY JOB BETTER THAN SERVING MY
PATIENTS.
I WAS REALLY FASCINATED BY THE
FAUTALK ABOUT THE POST I AM TENI
INTENSIVE CARE AND WE TALK ABOUT
SUBACUTE AND HOW IT IT'S
CONTROLLING AND IT'S AN
INDEPENDENT FACTOR THAT
INCREASES MORTALITY AND OF
COURSE MORBIDITY AND IT'S ALWAYS
THERE.
YOU THINK OF THE SORT STINT IN
THE ICU IT'S IN THE REALM OF
DAYS THAT'S GOING TO.
>>Shannon Zenk: PACT YOUR
IMPACT YOURCOGNITION AND THERE'H
POSSIBLE CAUTIOUS ABOUT SO WITH
THAT, WHAT I'M GOING TO DO, GIVE
US A LITTLE BIT OF LIGHT-HEARTED
MY TAKE ON ALL OF THIS I HAVE MY
PICTURE ON THE NIH AND PICTURE
OF HAVING AS AND BELOW WHAT I
DID I GIVE YOU THE MISSION OF TO
SEEK FUND MEMBER KNOWLEDGE ABOUT
BEHAVIOR AND APPLICATION OF
KNOWLEDGE TO ENHANCE AND LESSON
LIFE AND DISABILITY AND HERE
THIS IS HAVING AS, PROVIDED
HUMANITY AND UNFORGETTABLE
ESCAPE.
A UNIQUE WORLD FILLED WITH
ANTICIPATION AND ENTERTAINMENT
AND UNPARALLEL EXPERIENCES,
RIGHT.
SO THE MISSION THE HUMAN
CONDITION IT'S STILL SIGNIFICANT
REEL SO IS SIGNIFICANTLY
DIFFERENT AND AND ONE THING AND
IT SHOULD BE ABSOLUTELY OPPOSITE
TO DO IT DELIBERATE REAND WE
TALK ABOUT THE VEGAS RULE.
WHAT HAPPENS IN VEGAS STAYS IN
INVESTIGVEGAS, SCIENCE IS TAKINT
APPROACH.
SCIENCE STAYS WITHIN THE WALLS
OF THIS REALLY AMAZING, ICONIC
ABOUT THE.
I WOULD SHOW A PARTICULARTURE OF
THE NIH, RIGHT.
THE AUDIENCE HERE AND PRESENTERS
ARE BRILLIANT BUT A CONCERN I'VE
HAD IS ALL THE KNOWLEDGE STAYS
HERE.
NO ONE KNOWS ABOUT THE 17,000
STEPS.
MEANING, IF THE ONLY WAY YOU IS
DO THAT TO CRACK OPEN "THE NEW
ENGLAND JOURNAL" AND THAT LIVE
ALMOST IN-PERSON AVAILABLE BY
PROVIDED TWO SCIENTISTS WE NEED
TO GET IT OUT TO THE PUBLIC, SO
WITH THAT, MY CALL TO ACTION
TODAY IS I REALLY LOVE THIS
DIAGRAM OF DISSEMINATION AND
IMPLEMENTATION AND SO THIS IS MY
LAST SLIDE AND I'M GOING TO
LEAVE THIS LAST SLIDE WITH YOU
AND THEN INVITE MY PRESIDENT AND
CO PRESENTERS TO A PANEL OF
QUESTIONS BUT I FEEL LIKE WE
REALLY NEED TO THINK ABOUT
EVIDENCE ASSESSMENT AND HOW DO
WE GET THIS INFORMATION TO THE
PEOPLE, HOW MANY CENTENARIANS
KNOW THAT IT WASN'T THEIR
AMAZINGLY HEALTHY LIFESTYLE THAT
GOT THEM TO WHERE THEY ARE AND
THEIR OFF SPRINGS HEALTHY
LIFESTYLE IS NOT A FACTOR.
HOW MANY TIMES WHEN PEOPLE WANT
THEIR LOVED ONES AND THIS IS
GOING TO RESULT IN THE POST ICU
SYNDROME?
DO WE TELL PEOPLE FAMILY MEMBERS
HAVE PTSD AFTERWARDS.
WE KNOW ALL THAT BUT THAT
KNOWLEDGE STAYS WITHIN AND TO
THE AUDIENCE IDENTIFICATION AND
DO YOU DO WE DO THE
IMPLEMENTATION IN A WAY THAT YOU
ARE IDENTIFY WITH IT AND LISTED
ON GOING STAKEHOLDERS AND
INSEMINATION HAPPEN AND HOW DO
WE VALUE WAIT OUR DISSEMINATION
AND THIS SCIENCE GOES TO THE
MILLIONS WHO NEED TO PRACTICE
IT.
IF SCIENCE IS ONLY PRACTICED BY
THE SCIENTISTS, I THINK THAT
MAYBE I'M EXAGGERATING HERE BUT
IT'S A FAILED MISSION, RIGHT.
IF ONLY SCIENTISTS PRACTICE
SCIENCE, HOW DO WE GET THE
KNOWLEDGE TO THE CITIZENS OF THE
WORLD AND HOW DO WE HELP THEM
HELP US.
I'LL LEAVE YOU WITH THAT
QUESTION AND INVITE ALL MY CO
PRESENTERS BACK FOR QUESTIONS.
[APPLAUSE]
>>I DO NOT THINK AS OF RIGHT
NOW, THAT DURING CANCER
TREATMENT THAT THE USE OF
THERAPEUTIC IS RIGHT BECAUSE AS
YOU SAID, SENESCENCE IS A NATURE
TUMOR SUPPRESSISM MECHANISM
HOWEVER THERE'S A LOT OF DATA TO
SHOW THAT THE PATIENTS WHO ARE
GETTING BONE MARROW TRANSPLANT
THERE'S A ROLE FOR SENESCENCE
AND THERAPEUTICS BECAUSE AS I
SAID, WE BELIEVE THAT SENESCENCE
IS ALSO HAS A BAD ASPECT EVEN IN
CANCER PATIENTS BUT NOT DURING
CANCER, NOT DURING ACTIVE
TREATMENT.
>>I REALLY JO REALLY ENJOYED YK
AND ONE THING THAT I HAVE ALSO
NOTICED IN MY OWN STUDIES, I
HAVE NOTICED THAT A LOT OF AGE
RELATED AND SENESCENCE AND I WAS
WONDERING HAVE YOU LOOKED AT
THAT AND THERE'S POTENTIAL IF.
>>THAT IT IS SOMETHING WE ARE
DOING THESE TRIALS AS ONE OF THE
THINGS THAT I'M REALLY LEARNING
IS ON SOME ASPECT THESE DRUGS
ARE STILL NEW.
WE DON'T KNOW ABOUT THEM AND SO
I THINK THAT WE HAVE TO ALSO USE
THE TRIALS TO LEARN MORE ABOUT
THE BIOLOGY.
THERE'S A LOT WE DON'T KNOW
ABOUT SENESCENCE, ESPECIALLY IN
THE COP TEXT OF CANCER.
AND SO I THINK THAT THE TRIALS
ARE GOING TO SERVE AS A PLATFORM
TO GO BACK TO THE LAB TO DO
DISCOVERY AND DO DEEPER DIVE
UNDERSTANDING IN THIS CONTEXT
BUT IT'S A REALLY GOOD QUESTION.
>>IT WOULD BE GREAT TO CONNECT.
>>ABSOLUTELY.
I WOULD BE HAPPY TO.
>>CAN YOU COMMENT OR SHARE YOUR
INSIGHTS ON THE CONTRIBUTION OF
THE PERCENTAGE OF GENETIC
FACTORS VERSUS SOCIAL STRUCTURAL
IN THE CENTENARIAN POPULATION?
>>SO FROM THE GENETIC STUDIES
THAT WE DO HAVE IT SEEMS THAT
SPAN IN GENERAL IS 15 TO 35%
INHERITABLE HOWEVER WHEN IT
COMES TO CENTENARIANS, THE
INHERITABILITY IS MUCH GREATER
THAN THE LIFESPAN IN GENERAL
POPULATIONS AND BECAUSE THE
POPE' TYPE IS EXTREME, THE MORE
CONTRIBUTION GENETICS PLAYS AND
FROM MOST OF THE WORK WE'VE
DONE, WE HAVE NOT SEEN
CONTRIBUTION FROM LIFESTYLE AS
I'SHOWN, HABITS ARE SIMILAR
BETWEEN CENTENARIANS AND GENERAL
POPULATION.
SO GENETICS PLAY A BIGGER ROLE
THAN LIFESTYLE.
>>I HAVE A QUESTION.
THANK YOU TO ALL THE SPEAKER FOR
THE FANTASTIC PRESENTATIONS.
THERE ARE CERTAIN ORGANISMS THAT
LIVE LONG COMPARED TO HUMANS FOR
INSTANCE, MORE CLOSER MOPPING
THE WORK GREEN SHARKS THEY CAN
LIVE UP TO 400 YEARS, GIANT
TORTOISES LIVE UP TO 150 SO MOST
OF THE STUDIES THAT ARE ON THE
BENCH SIDE FOCUSES ON SEA
ELEGANCE AND MAYBE EVEN PRIMATES
AND WE'RE TRYING TO TRANSLATE
THAT TO BEDSIDE TO SEE HOW WE
CAN EXTEND HUMAN LIFESPAN
WITHOUT THE ISSUES OF
CO-MORBIDITIES BUT HAS THERE
BEEN RESEARCH THAT'S TRIED TO
DERIVE IS SOME LESSONS FROM
THESE ORGANISMS THAT LIVE LONG
AND HAVE SOME EXCEPTIONAL
MECHANISMS TO PREVENT DISEASES
LIKE ELEPHANTS ARE RESISTANT TO
DANCED AND MOLE RATS ARE
RESISTARESISTANT TO CANCER SO HE
THERE BEEN ANY LESSONS DERIVED
FROM BENCH TO BEDSIDE FROM
NATURE TO BEDSIDE.
HAS THERE BEEN SU SUBSTANTIAL
TRANSLATION WITH REGARD TO THEE
ORGANISMS, THANK YOU.
>>THAT'S A GREAT QUESTION.
I WANT TO MAKE ONE COMMENT HERE.
I REALLY LIKE THE PHASE
RIDICULOUSLY LONG.
I WOULD SAY THAT LIFESPAN IS
IMPORTANT BUT IT'S ALSO HAS TO
BE LONGEVITY HEALTH SPAN SO
SOMETIMES WHEN I THINK QUALITY
OF LIFE HAS A HUGE IMPACT ON AND
ONE OF THE SPEAKERS THIS MORNING
WAS JIM REESE'S WHERE IT'S NOT
ONLY DO WE INCREASE LIFESPAN AND
WE INCREASE FUNCTIONAL STATUS.
WHAT CAN WE LEARN FROM A TURTLE
PERHAPS.
I'LL OPEN IT UP TO THE PANEL
HERE.
>>I'LL BE QUICK.
ONE I THINK THERE'S A FUTURE
SESSION THAT IS ACTUALLY FOCUSED
A BIT ON DIVERSE SPECIES SO THEY
WOULD HAVE A LOT MORE TO SAY.
ONE THING I CAN SAY, SOME OF
WHAT WE THINK ABOUT HUMAN
UNIQUENESS, OUR BIG BRAINS,
COOPERATION, ET CETERA, THESE
BUNDLES OF TRADES YOU DO SEE IN
MANY LONG LIVED SPECIES AND SO
SOME OF THE LESSONS ARE THAT
WE'RE NOT UNIQUE IN HOW WE
ATTAINED OUR LONG LIFESPAN SO
IT'S BEEN REALLY CONSTRUCTIVE
BUT I AGREE ABOUT THE NAKED MOLE
A LRATS AND CRITTERS THERE ARE E
WORKING ON IT BUT NONE OF US.
>>THANK YOU.
>>HI, I HAVE A QUESTION.
I WAS VERY STRUCK BY THE LACK OF
CARDIOVASCULAR DISEASE IN THE
POPULATION YOU DESCRIBED.
I WONDER HOW GENERALIZABLE IT IS
ACROSS INDIGENOUS POPULATIONS?
>>IT'S FUNNY, WHEN THE MEDIA
FIRST REPORTED ON SOME OF THESE
FINDINGS, AND AND YEAH, THE
LOWEST LEVELS OF HEART DISEASE
ANYWHERE AND WE HAD LEFT BECAUSE
I KNOW AND AND AND DISEASE AND
SO I DO THINK THAT OUR STUDY,
WHICH IS ONE OF THE FIRST TO USE
TECHNOLOGY BUT IT WOULD BE
SUPPLIES EVEN IN THE U.S. IF WE
DID STUDIES IN THE IN TRADES
THAT WOULD SHOW SIMILAR LEVELS
OF LOW HEART DISEASE AS WELL AND
WHAT WE KNOW YOU'VE GROUPS HAVE
LEVELS OF LOW HEART DISEASE.
>>THIS IS A PROVOCATIVE
QUESTION.
LISTENING TO SESSION, I HAVE THE
'EM EXPRESS I AM IF I WAS AN ALN
COMING TO MY TODAY THERE'S MORE
THAN MEDICINE CREATING
GEROSCIENCE BECAUSE ALL THIS
MORBID TEES AND SYNDROMES ARE
HAPPENING AS A RESULT,
QUOTE-UNQUOTE, OF THE SUCCESS OF
MODERN MEDICINE TREATING
DISEASES.
AND YET WE ARE HERE DISCUSSING
CURING NOW THIS DISEASES SO DO
WE NEED RADICAL DIFFERENT
APPROACH OR ARE WE ON THE RIGHT
TRACK ASK THIS IS JUST A PRODUCT
OF OUR SUCCESS TO SOME EXTENT?
BECAUSE WE HAVE ICU AND CANCER
TREATMENT AND HIV AND I DON'T
KNOW, JUST A GENERAL FEELING.
>>I THINK THAT'S A VERY, VERY
PERCEPTIVE COMMENT.
ONE OF MY MENTORS USED TO DO A
TALK AND THE TITLE OF THE TALK
WAS SEATBELTSES ARE CARCINOGENIC
SO IF YOU PUT YOUR SEATBELT AND
DON'T DIE IN A CAR ACCIDENT AND
YOU LIVE LONG YOU AGE AND AGING
IS THE BIGGEST RISK FACT OR FOR
CANCER, RIGHT.
BY SOLVING ONE PROBLEM WE ALWAYS
GET A HIGHER LEVEL OF PROBLEMS
AND SO I HAVE LOOKED AT MY LIFE
AS EVERY TIME I GET A WHITE BELT
AND YELLOW BELT AND NOW I'M LIKE
THE LOWEST IN THE CLASS SO I
HAVE TO ADVANCE AND SO THAT'S
HOW LIFE IS SO I DON'T THINK, I
MEAN THE WORK OF SCIENCE WILL
NEVER STOP AND OUR PATIENTS ARE
VERY SMART AND THEY WILL ALWAYS
KEEP US ON OUR TOES, THOUGH
MATTER HOW SMART THEY ARE THEY
ARE THINKING OF THE NEXT FIVE
THINGS THAT THEY CAN BRING TO US
AND WHEN I GO BACK TO CLINIC ON
MONDAY, THAT WILL BE A
CHALLENGE.
NA MUCH I KNOW.
THAT'S MY TWO CENTS.
>>I WOULD LIKE TO WEIGH IN ON
THAT.
SO I'M A FAMILY PHYSICIAN AND WE
KNOW OUR HEALTH-CARE SYSTEM IS
BROKEN.
AND SO, WE NEED TO AND
FOUNDATIONAL APPROACH WHERE
PRIMARY CARE IS THE FOUNDATION
AND COMMUNITIES SUCH AS THE ONE
THAT I SERVED HAS THE ABILITY TO
BE STUDIED AND REACHING THE AGE
AND SO I THINK FROM A STANDPOINT
AS WE APPROACH AND GEROSCIENCE,
DO KNOW THAT AS I STATED AND
WITH THE PANDEMIC IT WAS STRESS
AND AND IT WAS A FAILED STRESS
EXISFOR THEFIRST COMMUNITIES TOE
DISCOVERY IS FUNDED AND BY THE
NATIONAL INSTITUTE AND THEY ARE
A HIGHER PERCENTAGE OF PRIMARY
CARE POSITIONS HAVE BETTER AND
SO THAT'S MY TAKE AN YOUR
QUESTION AND THAT WAS A VERY
GOOD QUESTION.
>>CAN I ADD TO THAT.
IT'S A REALLY IMPORTANT POINT.
I DO THINK THAT I TALKED A LOT
ABOUT FOR CANCER THE CANCER
TREATMENT ACCELERATES AGING BUT
I WANT TO JUST GO BACK TO THAT
FIGURE AND SAY WELL, YOU KNOW,
AGING LEADS TO CANCER AND SO I
ALWAYS THINK ABOUT WHEN I SEE
THE PATIENT IN CLINIC, AND I
GIVE HER CHEMOTHERAPY AND
RADIATION AND SURGERY AND SHE
HAS A DECLINE IN HER PHYSICAL
AND COGNITIVE FUNCTION RELATIVE
TO HER PEERS, I DON'T REALLY
KNOW IF IT WAS JUST THE DECLINE
OCCURRED BECAUSE OF THE
TREATMENTS TA I HAVE GIVEN HER.
THERE'S THE POSSIBILITY THAT THE
FACT SHE DEVELOPED CANCER WAS
THAT SHE WAS ALREADY ON AN
ACCELERATED AGING TRAJECTORY SO
I THINK THAT THE WHOLE PREMISE
FOR ME AS AN ONCOLOGIST OR THE
PROMISE I GUESS OF GEROSCIENCE
IS THAT IT'S NOT JUST ABOUT
IMPROVING LIFE AFTER CANCER AND
THE CONTEXT OF THE DAMAGE THAT I
HAVE DONE AS AN ONCOLOGIST BUT
REALLY AS AN ONCOLOGIST WE
BELIEVE THAT YOU CAN ONLY CURE
CANCER BY PREVENT PARTICULAR IN
THE FIRST PLACE AND SO I THINK
IF GEROSCIENCE CAN HELP US LEAD
TO PREVENTION LIKE IN THE FAMILY
MEDICINE PRACTICE, IN THE FIRST
PLACE, THEN I THINK THAT'S
REALLY WHERE THE WIND WOULD BE
AND IT'S WAY BIGGER THAN
PREVENTING THE ACCELERATING
AGING IN THE CON TECH OF THE
TREATMENTS THAT WE GIVE OUR
PATIENT.
>>QUEER ALMOST AT THE END OF
THE SESSION, I WANT TO GIVE NATE
AND CHRISTINE A MOMENT TO SHARE
IT IT WILL BEFORE WE CLOSE THIS
SESSION SO MAYBE NATE YOU CAN GO
FIRST AND CHRISTINE YOU CAN TAKE
US HOME.
>>WE WERE TALKI TALKING ABOUT S
EARLIER.
THERE'S TWO HOSPITALS, WE HAVE
ONE ACADEMIC MEDICAL CENTER WITH
CANCER HOSPITAL AND HEART
HOSPITAL AND BRAIN AND SPINE
HOSPITAL AND THEN THERE'S SIX
MILES AWAY, NEAR WHERE YOUR
PRACTICE IS A COMMUNITY ACADEMIC
PARTNERSHIP HOSPITAL AND I WORK
IN BOTH AND IT'S REALLY
INTERESTING AND THE DIFFERENCE
IF CRON LOGIC AGE, THE ACADEMIC
CENTER YOU ARE SEES AND THE 75
AND 80-YEAR-OLDS WITH CANCER AND
COMPLICATIONS FROM CHEMO AND
WHAT HAVE YOU, UT GO TO THE
COMMUNITY ACADEMIC CENTER AND IT
IS EARLY 60s WITH SEVERE COPD,
UNCONTROLLED HEART FAILURE AND
THE DIFFERENCE IN SIX MILES IN
THE POPULATION THAT YOU TREAT
AND THE 20 YEARS DIFFERENCE
BETWEEN THE PATIENTS THAT GET
AND AND IT'S A PRIMARY CARE
PERSPECTIVE AND THAT KIND OF IN
DRAMATIC AND MEDICINE THAT WE
SEE.
SO IT'S VERY INTERESTING TO
THINK ABOUT THAT IN A LARGER
CONTEXT AND IT'S ONE OF OUR
TRAINING CLINICALLY.
>>Carolyn: .AND SO WE SEE THISF
PATIENTS THAT HAVE EXCELLENT
INSURANCE AND ALL OF THEIR
BENEFITS COVERED AND WE HAVE A
MIX OF PATIENTS THAT WOULD BE
DRASTICALLY UNINSURED AND HAVE
THE BENEFIT OF HAVING DECREASED
COST MEDICATION THIS IS MY STATE
AND CERTAINLY VERY STATE BUT
SOME OF THAT ASPECT OF THE TWO
DIFFERENT AGES OR AGES THAT YOU
SEE AT DIFFERENT POPULATIONS WE
SEE ALL THOSE AGES WITHIN ONE
CLINIC WITH DIFFERENT SOCIAL
STRESSORS THAT THE SAME ACCESS
TO MEDICATION WHICH CHANGES OUR
PERSPECTIVES A BIT AND I WANT
ODD COME IN OBVIOUSLY HIV IS
DIFFERENT THAN CANCER OR ICU
STAYS WHERE AGE IS GOING TO
PREDICT THE CURE OWE OCCURRENCEE
LEARNED O MUCH FROM THE HIV
EPIDEMIC CAN AGING IMPACTING HOW
WE INTERPRET LONG COVID AND THE
IMPACT OF OTHER CHRONIC
INFECTIONS OR DISEASE AND SO I
THINK THAT THE ENDEMIC NOW AND
AND WE CAN'T REVERSE AND PEOPLE
WITH HIV POPULATION AND AMAZING
IN TERMS OF PROVIDING OVER THE
LAST 40 YEARS.
>>THANK YOU SO MUCH.
REALLY WELL SAID AND THANK YOU
ALL FOR BEING SO PATIENT.
I KNOW THAT WE WERE OVER BUT
WE'LL HAVE YOUR BREAK FOR THE
NEXT 15 MINUTES.
WE'LL SEE YOU BACK AGAIN IN 15
MINUTE.
[APPLAUSE]
IT'S MY PLEASURE AND HONOR, MY
NAME IS ALLEY SANDRO
BARTOLOMUCCI AND IT'S MY GREAT
HONOR TO INTRODUCE AND CHAIR
THIS SESSION.
THEY ASKED ME TO DO A VERY SHORT
INTRODUCTION WILL I'LL KEEP
EXTREMELY SHORT DUE TO THE TIME
AND JUST TO INTRODUCE WHAT WE'LL
LISTEN TO IN THIS SESSION, AS WE
AGE AND WE ALL KNOW AND WE'VE
BEEN LISTENING IN THE MORNING
AND THIS EARLY AFTERNOON,
THERE'S GERIATRIC AND
MULTIMORBITITIES THAT CAN
ACCUMULATE AND DEVELOP IN PEOPLE
AND IN THIS SESSION, WE WILL
KEEP AND SPEAK NOT ME BECAUSE
I'M NOT PRESENTING MY OWN DATA
BUT THE SPEAKER WILL KEEP THE
GEROSCIENCE PERSPECTIVE AND THE
MEASURES OF BIOLOGICAL AGING AS
A BACKGROUND REALLY AND IT WILL
REALLY FOCUS ON HUMAN STUDIES,
TRANSLATIONAL STUDIES IN ANIMAL
MODELS LIKE PRIMATES, DOGS AND
ALSO RODENTS AND OTHER SPECIES.
I WOULD SAY THAT THINKING ABOUT
THIS SESSION, MY FEELINGS IS
THAT IT HAS THREE MAIN GOALS.
THE FIRST IS TO REALLY INTRODUCE
AND SUGGEST EXPERIMENTAL
APPROACHES TO THE FIELD.
EXTENDS TO MULTIMORBITITIES
WHICH ARE REALLY CRUCIAL IN THE
GERIATRIC SYNDROMES.
IT WILL ALSO PROVIDE TOOLBOX
USING ANIMAL MODELS WHICH OFFER,
IN MY OPINION, I WORK WITH MICE,
WORKING WITH ANIMAL MODELS OF
UNPRECEDENTED TO PROVIDE
CONTROLLED EX PER MEMBER DESIGN
AND APART VARIABLE LIKE SOCIAL
DETERMINANTS WHICH ARE VERY
DIFFICULT TO BEST IN RANDOMIZED
TRIALS IN HUMAN APPS, THE FIRST
SPEAKER DOES NOT NEED A
INTRODUCTION AND HE WILL SET THE
AIMING ON MULTIMORBITITIES AND
GERIATRIC SYNDROMES ON HUMANS
AND WE'LL SWITCH TO ANIMAL
MODEL.
ELLEN QUILLEN AND NATASHA OLBY
PROFESSOR OF NEUROLOGY AND WILL
PRESENT THE SAME CONCEPT BUT
SPEAKING OF CON PAN YUN DOGS AND
WE WILL END WITH CAROLINE ZEISS
WHO WILL PROVIDE AN OVERVIEW OF
MULTIMORBITITIES IN OUR PEE
SEIZE AND WE WILL END THE DAY
WITH A PANEL DISCUSSION PRODUCED
AND LED BY NOAH SCHNEIDER-MAKLER
AT THE CENTER OF EVOLUTION AND
MEDICINE AT ARIZONA STATE
UNIVERSITY AND WITH THIS,
WITHOUT FURTHER ADIEU, PLA PLEA.
>>THANK YOU, VERY MUCH.
IT'S MY PLEASURE TO BE TALKING
IN FRONT OF THIS AUDIENCE AND
CONTINUING THE VERY IMPORTANT
DISCUSSION THAT WE HAD THIS
MORNING.
I THINK THAT THE PEOPLE THAT
HAVE STARTED AGING ALMOSTEN
COUNTER AND REGULATE AGING AT
THE LIFE AND IN FACT, THAT A LOT
OF ALLOW US TO MAINT TO MAINTAIM
AND AT THE LEVEL AND MORE
IMPORTANT FOR ME IS THE FACT
THAT THE PRINCIPLE OF
GEROSCIENCE HAS INCREDIBLY
POWERFUL POSSIBLE APPLICATION TO
INCLUDE THE HEALTH OF THE
POPULATION AND THE REASON WHY I
THINK THIS IS TRUE, I HOPE WE'LL
BE CLEAR IN MY PRESENTATION.
AND IN EACH YEAR WE SELECTED
THOSE WITH THE LONGEST LIFE
EXPECTANCY AND FROM 1914 AND ON
THEY INCREASED IN LIFE
EXPECTANCY TO FOLLOW ALMOST A
PERFECT LINEAR POPULATION AND IT
SHOWS ME AT THAT TIME AROUND
2,000 IT WAS A NUMBER OF
MEETINGS THAT STARTED AND WHAT
WAS HAPPENING IN THE FUTURE AND
THEY CAME UP WITH SOME
PREDICTIONS THAT ILLUSTRATES BY
THIS DASHED LINE.
OF COURSE THEY WERE ALL WRONG
BECAUSE THE AGING OF THE
POPULATION, START INCREASING
OVER TIME.
NOT ONLY THE GOOD LIFE IS
BECOMING LONGER, BUT THE LIFE
THAT IS CHARACTERIZED BY ILLNESS
AND DISABILITY IS ALSO
INCREASING AND WHAT THIS MEANS
LOOKING AT THESE PROJECTIONS
FROM THE UNITED NATION AND
SHOWING THAT MORE YOU SPEND IN
HEALTH CARE, THE MORE THE
DIFFERENT NATIONED SPEND IN
HEALTHCARE THE LONGER YOU HAVE
THIS DISABILITY SO THERE'S
SOMETHING WRONG THE MORE WE
SPEND, THE MORE THERE IS IN OUR
LIVES AND THAT SHOULD MAKE US
PAUSE AND UNDERSTAND WHY AND
UNDERSTAND WHAT WE CAN DO TO
THESE TRENDS.
ANOTHER WAY OF LOOKING AT THAT
IS LOOKING THE MULTIMORBITITIES.
IN THIS PAPER WE HAVE RECEN RESU
CAN LOOK AT THE CHANGE IN
MULTIMORBITITIES WITH AGING.
WE'VE SEEN THIS MORNING THAT KEY
MULTIMORBITITIES INCREASES WITH
AGING.
IF YOU SELECT THE
MULTIMORBITITIES AND IN HIGH
INCOME COUNTRY AND IN LOW INCOME
COUNTRY YOU HAVE A LOT OF
MULTIMORBITITIES IN HIGH INCOME
COUNTRIES THAN IN LOW INCOME
COUNTRY.
WHAT'S GOING ON HERE?
YOU KNOW, WHY IS THAT AND WHAT'S
THE PROBLEM THAT WE ARE
ENCOUNTERING?
SO WHAT IS REALLY HAPPENING WILL
BE CLEAR BY LOOK AT THE
MORTALITY DATA.
OVER THE LAST FEW DECADES, AND
HERE ON ONLY SURE WITH NEW DATA
FROM THE YEAR 2000 TO 2019
THERE'S BEEN A DRAMATIC DECLINE
IN THE MORBIDITY OF MORTALITY OF
HEART DISEASE AND THERE'S BEEN
ALSO A DISTR DECLINE IN CANCER
ACCELERATING DUE TO THE NEW
AVAILABLE.
IT ISN'T CLEAR DECLINE IN THE
AND HOWEVER, THE DIFFICULTY
DISEASE THAT EFFECT THE
INDIVIDUALS THAT ARE EITHER
STABLE AND AND THE CAUSE THAT AS
MULTIPLE CAUSE OF DEATH AND MORE
AND MORE INDIVIDUALS ACROSS THE
TIME TEND TO HAVE MULTI CAUSES
OF DEATH IN THEIR DEATH
CERTIFICATE SO MORE PEOPLE
SURVIVE DEVELOP MULTIPLE DISEASE
AND WHEN THEY THINK THEY HAVE
MULTIPLE AND COMPARE THAT AND IN
THE DEATH CERTIFICATE AND IN
THOSE WHO DIE ABOVE THE AGE OF
90, WE REALLY DON'T KNOW 90% OF
THE TIME WHAT THESE PEOPLE HAVE
BEEN DYING FOR.
UP WITH OF THE ISSUES THAT WE
ALWAYS TALK ABOUT, IN THE
FIRSTEN COUNT I REMEMBER WITH
EPIDEMIOLOGY THE IDEA OF WHAT
HAPPENED IF WE ELIMINATE CARDIAC
RESISTANCE AND WE ARE REALIZING
THAT WAS THE WRONG QUESTION
BECAUSE DISEASE OCCURS BECAUSE
PAGE CONSTITUTES THE GREATEST
POSITION TO DISEASE.
AND IN FACT, IN ORDER TO KIND OF
DEMONSTRATE THIS IDEA AND YOU
CAN SEE CLEARLY HERE THAT IF YOU
HAVE INFORM DISEASE, THIS IS A
FORMER MODEL ASSUME AIMING 70
AND CLEAR FOLLOW-UP AND IF YOU
HAVE ZERO DISEASE, YOUR
PROBABILITY TO DEVELOP ONE
DISEASE IS 50%.
IF YOU HAVE ONE DISEASE YOUR
PROBABILITY IS 20% AND IF YOU
HAVE TWO DISEASE YOU ARE
PROBABILITY IS 23%.
AND SO ON AND IF OF FOUR DISEASE
IS 51% WILL DEVELOP ANOTHER
DISEASE, THIS MEANS THAT DISEASE
DEVELOPS IF CLUSTERS AND THAT IS
REALLY THE UNDERSTANDING OF THE
PAOPAO TEN SHALL AND IT'S
SUMMARIZED IN THIS SLIDE.
YOU HAVE A NUMBER OF DISEASE
THAT ARE OCCURRING OVER TIME AND
IT WILL EMERGE AND AFTER THE
DEVELOP OF THE FIRST DISEASE,
YOU WILL HAVE MANY MORE DISEASE
THAT DEVELOP IN CLUSTERS IN
ACCUMULATE IN FACT THE PEOPLE
THAT HAVE LONGER DISEASES FEEL
LIKE EXTRACTING IT WILL HAVE A
DELAY IN THE BEGINNING OF THE
FIRST DISEASE BUT THEN THERE
WILL EXPERIENCE MULTIMORBITITIES
LATER ON AND THOSE WHO HAVE
SHORT DISEASE LIFE EXPECTANCY
WILL HAVE THE SAME PROBLEM, YOU
KNOW, WHERE THEY WILL DEVELOP A
FIRST DISEASE EARLY AND THEN THE
CUMULATIVE EFFECT OF THIS
CLUSTER WILL EFFECT THE
INDIVIDUALS.
YOU CAN IMPROVE OUR ABILITY TO
TREAT DISEASE BUT ONLY THINK WE
CAN ACCOMPLISH IS INCLUDE THE
HEALTH DURING THE PERIOD OF TIME
AFTER THESE.
WE ARE DOING VERY, VERY LITTLE
TO IMPROVE HEALTH IN THE
PROGRESSION OF PATHOLOGY IN
VICTIM DURING THE PRIOR TO THE
CLINICAL EMERGENCE OF DISEASE.
THAT IS IMPORTANT, BECAUSE
UNLESS WE DO SOMETHING BEFORE,
IMPROVING OUR HEALTHCARE WOULD
ONLY EXPAND MULTIMORBITITIES AND
AT IS SOME POINT, WE WILL NOT BE
ABLE TO ADDRESS THAT THE PROBLEM
IS IN MY MIND, AN ITALIAN
EXPRESSION, THAT WE SEE THE EGG
IS KIND OF FALLING DOWN AND WE
KNOW THAT AT SOME POINT, IT WILL
SLASH WE WANT TO DO IN FACT IS
TO KIND OF GET THE EGG, WHILE
IT'S STILL IN THE CHICKEN AND
THAT'S THE STRATEGY TO WORK.
HOW THIS MAY WORK?
I'LL GO BACK TO THE MODEL I
SHOWED YOU BEFORE.
SO, THE ISSUE IS THAT IF YOU
LOOK UNDER THE IN THE
ACCUMULATION OF PATHOLOGY, THE
PEOPLE WILL LIVER EXPECTANCY
HAVE DIFFERENT RATE AVENUE
ACCUMULATION OF PATHOLOGY BEFORE
THEY BECOME EVIDENCE AND I THINK
IT IS CORRECT FOR MANY
PROSPECTIVE AND IT'S EFFECTED
VEMMENT ON MANY DISEASE AND WHEN
THIS DISEASE OCCUR, WE ARE
DEVELOPED AND POWERFUL AND DRUGS
AND INTERVENTIONS THAT PROLONG
THE LIFE AND TO SOME EXTENT,
REDUCE THE SYMPTOMS OF THESE
INDIVIDUALS.
BUT ONE POTENTIAL ALTERNATIVE
APPROACH WILL BE TO REDUCE THE
PACE OF AGING BY REDUCING THE
PACE OF AGING, WE CAN DELAY THE
BEGINNING OF DISEASE AND ALSO
DELAY THE BEGINNING OF MULTI
MORBIDITY.
IS THAT DOABLE?
THE POWER OF THIS IDEA IS THAT
IT'S IMMEDIATELY EVIDENCE IT'S
CLINICAL CONNECTIONS.
AIMING IS LIKELY IS A PROCESS
AND WE HAVE THOSE THAT DEAL WITH
THAT CULMINATION OF DAMAGE
BECOMES LESS EFFECTIVE.
AND WHEN THIS AND ASSUMING THAT
THIS IS A COMPLETE LIST WHICH I
DON'T THINK IT IS, WHAT THEY DO
IS THEY CREATE IN THE PHENOTYPE
AND THE WAY AND NIA IS STUDIED
AND THE PHENOTYPE IS CHANGING
BODY COMPOSITION, IMBALANCE IN
ENERGY PRODUCTION AND DEMAND AND
HOMEOSTATIC AND A AND THEN,
THESE CHANGES IN THE PHENOTYPE,
DETERMINING WHAT WE CALL THE
AGING SYNDROME OF THE GERIATRIC
SYNDROME.
WHEN YOU THINK ABOUT
INCONTINENCE YOU THINK ABOUT
CHANGING BODY COMPOSITION
BECAUSE THE MUSCLE THAT IS
AROUND THE SYSTEM AND AT THE
SAME TIME, IT'S LOSS PLASTIC
TYPE OF THIS SYSTEM AND WHEN YOU
HAVE TWO TYPES EFFECTED BY AGING
YOU GET THE GENETIC SYNDROME.
I WANT TO START GIVE YOU A HINT
OF WHAT WE ALREADY KNOW BECAUSE
I DON'T THINK THERE'S A FAMILIAR
SEE, IS THINK WE'RE ALREADY
EVIDENT AND SOME OF THESE
MECHANISMS ARE REALLY IMPORTANT
AND MY SHORT, YOU KNOW,
DIVERSION IS TO TALK ABOUT
MITOCHONDRIA.
WHY I THINK THAT MITOCHONDRIA, I
AM A HIGH DEGREE CON MYCO CON DS
CENTRAL TO ENERGY AND THE
DIFFERENT BIOLOGICAL MECHANISM
THAT PREVENT OR REPAIR DAMAGE,
ALL NEED MASSIVE AMOUNTS OF
ENERGY TO WORK.
IF YOU DON'T PROVIDE ENERGY TO
THIS MECHANISM, YOU WILL NOT BE
ABLE TO SEE THE SAME FINANCING
AND THE EVIDENCE IS CLEAR.
FOR EXAMPLE, THESE ARE DATA
FUNDED ON THE STUDY OF AGING IN
WHICH WE USE, WE MEASURE
MITOCHONDRIA FUNCTION IN A
MAGNET BY HAVING SOMEONE
EXERCISING IN THE MAGNET AND WE
MEASURE HOW FAST IT CAN BE
RECHARGED AND IT WILL GIVE YOU
AN IDEA AND THIS IS ASSOCIATED
WITH SOMETHING THAT IS IMPORTANT
WITH AGING IS WHAT WE SPEED IN
DIFFERENT TASK AND WHEN YOU DO A
MEDIATION IN OUR, YOU FIND IT'S
THROUGH MUSCLE STRENGTH SO IT'S
IMPORTANT FOR THE PHYSICAL
STRENGTH.
NEXT STEP, WE DEMONSTRATED
RECENTLY THAT MITOCHONDRIA
FUNCTION MEASURED IN MUSCLE ARE
PREDICTIVE OF THE AMYLOID IN THE
RAIN ARE AND AND I ALSO AND IT'S
VERY IMPORTANT ON THE MARKER OF
DISEASE AND SUCH AS THE GLIO
AGING PROCESS.
MITOCHONDRIA COURT LATE
PREDICTORS OF COGNITIVE FUNCTION
WHICH IS REALLY THE THEORY OF
AGING IF WE ACT ON THIS
RESILIENCE MECHANISMS, WE CAN
DELAY AND PREVENT MANY OF
DISEASE THAT CAN BE CLINICALLY
PHYSICAL FUNCTIONS DELINE WITH
AGING.
WITH THAT, I'M FINISHED AND
MANY, MANY PEOPLE THAT NOT
HELPED ME AND NOT JUST FUEL
EXAMPLES.
[APPLAUSE]
>>THANK YOU ALL FOR BEING HERE
AND THANK YOU FOR IN INVITING ME
TODAY.
I'M REALLY EXCITED TO BE HERE TO
TALK A LITTLE BIT ABOUT
MULTIMORBITITIES AND GERIATRIC
SYNDROME IN NON HUMAN PRIMATES.
SOL THANKFULLY, BECAUSE I'M
AFTER, I DON'T NEED TO EXPLAIN
WHY RESILIENCE IS IMPORTANT BUT
I WILL JUST BRIEFLY POINT OUT
THAT WHEN WE THINK ABOUT
RESILIENCE AND OUR ABILITY TO
RESIST OR RECOVER FROM AN ACUTE
STRESSOR, WE TEND TO THINK ABOUT
SORT OF A VERY SHORT TIMEFRAME
AND THIS IS PARTICULARLY TRUE
WHEN WE THINK ABOUT A LOT OF THE
MOST COMMON ACUTE STRESSORS
THINGS LIKE RADIATION EXPOSURE,
VACCINATIONS, SHORT PERIODS OF
BED REST SURGERY, ET CETERA, AND
THIS NOT RESPONSE OF SORT OF
THIS SHORT WEEKS OR MAYBE EVEN
MONTHS AND SUBPOENA WHETHER
WE'RE ABLE TO BOUNCE BACK OR OUR
NORMAL FUNCTION OR STAY IN THIS
FRAILTY AREA AND DEVELOP
MULTIMORBITITIES AND WHAT IS
INTERESTING ABOUT OUR A LOT TO
LOOK AT A LOT OF THIS THESE CAN
BE MODELED IN NON HUMAN PRIMATES
SO I'M GOING TO TALK ABOUT
RADIATION EXPOSURE AND I DO WANT
TO EMPHASIZE WHAT I'M SPEAKING
OF IS MUCH BROADER THAN THAT AND
THIS IS REALLY ABOUT RESPONSE TO
A STRESSOR AND NOT ONLY HOW THAT
MIGHT BE HETERO GENIUS IN THE
SHORT TERM, WHERE SOME ANIMALS
AND SOME INDIVIDUALS MAY DIE
SOON AFTER THAT ACUTE STRESS AND
SOME BOUNCE BACK BUT OVER A MUCH
LONGER TIME PERIOD, WHEN WE
THINK ABOUT YEARS LATER, THERE
IS A LOT OF VARIATIONS AND THAT
IS GOING TO BE INFLUENCED BY THE
MAGNITUDE OF THE STRESSOR BUT
ALSO, AND MULTI MORBIDITY INDEX
AND I WANT TO START BY
EMPHASIZING A LOT OF CHRONIC
CONDITIONS THAT WE THINK ABOUT
IN TERMS OF MULTIMORBITITIES ARE
WELL ESTABLISHED IN NON HUMAN
APP PRIMATE MODELS.
I'VE SELECTED FIVE OF THE MOST
COMMON NON HUMAN PRIMATE MODELS
HERE BUT THERE ARE MANY OTHERS.
IF YOU ARE INTERESTED IN THESE
QUESTIONS, THIS LINK AT THE
BOTTOM, IS A VERY HELPFUL
RESOURCE AND WHAT DISEASES ARE
BEST MODELED IN DIFFERENT NON
HUMAN PRIMATES.
THERE'S A LOT OF OVERLAP.
WE'RE INTERESTED ABOUT IN TERMS
OF UNDERSTANDING AIMING RELATED
DISEASE THINGS LIKE
CARDIOVASCULAR DISEASE, OBESE
TEES, ALZHEIMER'S, DIABETES, ALL
SORTS OF IMPAIRMENTS AND THINGS
LIKE CANCER, ARE ALL REALLY
NICELY STUDIED AND NON HUMAN
PRIMATES AND IT HAS A LOT TO DO
WITH THE FACT THAT THEY HAVE
LONG LIFE SPANS AND THAT GIVES
US THE ABILITY TO WATCH THEM
NATURALLY DEVELOPMENT SO IN A
LOT OF OTHER MODEL ORGANISMS AND
DISEASE AND OF COURSE NON HUMAN
PRIMATES ARE MUCH MORE SIMILAR
TO US, THAT IS GOING TO BE MAKE
IT ALL THE MORE READILY AND AND
I'M GOING TO PICK ONE STRESSOR
TO THINK ABOUT TODAY AND I'M
GOING TO DO RADIATION.
THAT'S WHAT I'VE BEEN STUDYING.
YOU GUYS ARE PROBABLY WELL AWARE
OF THE FACT THAT THERE ARE
LONG-TERM DIET STUDIES AND
THINGS LIKE THAT THAT ALSO
MODERATE AGING IN NON HUMAN
PRIMATES.
SO OUR PROGRAM IS CALLED RARRE
BECAUSE WE'RE WORKING WITH A
VERY RARE RESEARCH AND THIS IS
SOMETHING CALLED THE WAKE FOREST
RADIATION LATEST EFFECTS COHORT
RUN FOR 15 YEARS BY Dr. MARK
KLEIN WHO STARTED TAKING IN
ANIMALS WITH NIAID FUNDING AND
IT'S AN AGING COHORT NOW SO,
JUST TO SORT OF HIGHLIGHT FOR
YOU THE EFFECT OF THE RADIATION
EXPOSURE ON THE RIGHT YOU WILL
SEE, IN THE GOLD, THE RADIATED
ANIMALS AND IN THE GRAY THE
CONTROL NON ANIMALS AND THIS IS
LOOKING AT AGE OF ONSET SO YOU
WILL NOTICE THAT THE GOLD IS
SHIFTED TO THE LEFT AND WE HAVE
AN EASTERLY YEAR AGE OF ONSET OF
THE VARIETY OF DISEASES WE'RE
INTERESTED IN THINKING ABOUT
GERIATRIC SYNDROME.
HOWEVER, I ALSO WANT TO
EMPHASIZE WITH A FEW LIMITED
PERCEPTIONS THINGS LIKE
TESTICULAR ASTRO FEE AND BRAIN
LESIONS.
WE ARE SEEING DISEASE THAT'S
OCCUR NATURALLY JUST EARLIER.
AMONG THOSE, THESE ARE SAME
ANIMALS AT AGE FIVE AND AGE
EIGHT.
EVEN THOUGH AN 8-YEAR-OLD ANIMAL
IS EARLY MID LIFE, WE'RE STILL
SEEING 10% TO 20% PRESENCE OF
SOME OF THESE SKIN DISEASES AND
AT A RACKS HEART DISEASE SO
WE'RE SEEING HIGH LEVELS OF
DISEASE IN THESE ANIMALS AND IT
LET'S US UNDERSTAND MULTI
MORBIDITY IN A MUCH MORE RICHER
WAY THAN NON RADIATED ANIMALS.
WE CAN SEE IN THE TEMPORAL AND
IN THE ADDITION CEASES AND WE
CAN YEARS AND SO, YOU WILL
NOTICE THAT NOT AGE IS REALLY
THE STRONGEST PREDICT OR OF AGE
OF ONSET AND WE'RE SEEING AS
SORT OF RELATIVELY RAPID
ACCUMULATIONS OF VARIOUS
DISEASES STARTING AROUND AGE
SEVEN TO 10 AND 10 IS ABOUT 35
TO 40% OF MEDIUM LIFESPAN SO
WE'RE TALKING ABOUT A RELATIVELY
YOUNG AGE THEY'RE GETTING A LOT
OF THESE.
YOU WILL NOTICE SOME IN ARE VERY
COMMON.
THINGS LIKE PERRY OWE DON
ADVERTISE AND SKIN DISEASE,
HEART DISEASE, ARTHRITIS, AND
SOME ARE UNCOMMON.
SO THIS IS OVER ALL INCIDENTS.
IF WE THINK ABOUT, NORMALIZING,
THE OCCURRENCE OF THIS DISEASE,
TO THEIR OVER ALL INCIDENTS WE
CAN SEE WHEN THEIR EMERGING AND
IN WHAT COMBINATIONS THEY'RE
EMERGING.
WHAT WE CAN DO WHEN WE LOOK AT
EVERY ANIMAL AND EVERY ORGAN
SYSTEM, IT'S A POSITIVE CONTROL,
IF IT'S NOT A COMBINATION YOU
ARE SEEING YOU ARE NOT CAPTURING
NIPPING THAT RESEMBLES
OSTEOPOROSIS OWE.
WE ARE SEEING A BEING OVER
WEIGHT AND DIABETES BUT WE CAN
START TO SEE THINGS LIKE A
RELATIONSHIP BETWEEN DIABETES
AND LUNG FIBRO SIS AND BETWEEN
LUNG FIBRO SIS AND SKIN
DISORDERS AND SO WE CAN START TO
SORT OF PICK APART BECAUSE THESE
ARE RELATIVELY COMMON DISEASES
IN THIS COHORT AND WE CAN START
TO SEE WHAT DISEASES ARE
OCCURRING TOGETHER MORE THAN WE
WOULD EXPECT PURELY BY CHANCE.
OUT OF 17 DISEASES WE COLLECTS
DATA ON, HOW MANY OF THEM DOES
AN ANIMAL HAVE?
AS YOU CAN TELL, PRETTY CLEARLY
HERE, THEY ARE HEALTHY, MOST OF
THEM HAVE ZERO AND A FEW HAVE
ONE.
WHEN WE GET TO 12 AND 13 INJURY
OLD ANIMALS WE'RE SEEING
HETEROGENEITY IN THE AMOUNT OF
MULTIMORBITITIES AND IT'S
SOMETHING THAT COMES BACK OVER
AND OVER IN OUR CONVERSATION
TODAY THAT IT'S A TEE FEWER AND
NOT A BUG AND UNDERSTANDING THE
CORRECTIONION OF DISEASE SO YOU
MIGHT WANT TO KNOW DOES
MULTIMORBITITIES PRO DICTIONARY
MORTALITY SO THESE ARE IS
SURVIVAL CURVES BY I AM DEX EACH
SO AT AGE FIVE, MOST VICTIMS ARE
GOING TO LIVE ANOTHER THREE OR
FOUR YEARS AT LEAST REGARDLESS
OF HOW MANY MULTIPLE MORBIDITIES
THEY HAVE.
FOUR THE BLUE AND THE PURPLE
HERE, THEY'RE SURVIVING A LOT
LESSON AVERAGE.
THOSE ANIMALS THAT EARLY IN LIFE
HAVE HIGH MULTIMORBITITIES ARE
LESS LIKELY TO SURVIVE OVER THE
NEXT GIVEN SEVERAL YEARS AND BY
AGE 10, WE STILL SEE A LOT OF
DIFFERENCE.
THERE'S A LOT OF HETERO BEGIN A
HETEROGENEITYBETWEEN ZERO AND OK
SEVEN BUT WHAT IS INTERESTING TO
ME IS YOU SEE THERE'S A LOT MORE
OVER LAP MANY OF IT'S NOT A
COUNCILOR CURT DIFFERENCE.
OVER ALL IT PREDICTS THROUGH 75%
OF LIFESPAN AND HAVING A HIGHER
COUNT INDICATES A SHORTER
REMAINING LIFESPAN.
THIS IS OUR HAZARD RATIO SO FOR
EVERY ADDITIONAL CO MORBID
CONDITION WHEN YOU ARE YOUNGER
AND YOU ARE AT AGE FIVE, YOU CAN
SEE THAT EVERY INDIVIDUAL, EVERY
ADDITIONAL DISEASE MORE THAN
DOUBLES YOUR RISK OF DISEASE, OF
DYING OVER THE NEXT YEAR.
SO IT HAS A LARGE EFFECT.
WHAT IS INTERESTING IS IT
CHANGES OVER THE LIFESPAN AND WE
MIGHT ASSUME THAT AS WE GET
OLDER, MULTIPLE MORBIDITY MIGHT
IN FACT BE WORSE FOR YOU.
WE'RE SEEING THE OPPOSITE.
AS THE ANIMALS GET OLDER WE'RE
SEEING A REDUCT RETHAT OLDER ANS
MAY BE ABLE TO TOLERATE, BUFFER
THOSE UNTIL THE POLL CHRONIC
CONDITIONS AND THIS IS OUR NEXT
OBSERVATION THAT AS IN HUMANS,
MULTIMORBITITIES IS CORRELATED
WITH LIFESPAN.
THIS SEEMS OBVIOUS BECAUSE THE
LONGER YOU LIFT CHANCE YOU HAVE
TO DEVELOP THESE BUT THIS
SUGGESTS WHEN WE COMBINE IT WITH
OUR SURVIVAL ANALYSIS, WITH THE
OLDER ANIMALS THAT LIVED TO
DEVELOP 10 DOUGH MORBID
CONDITIONS, THEY'RE ABLE TO BEAT
THAT AND WITHIN ON TO BE ABLE TO
MAINTAIN THAT AND INCREASE THE
NUMBER OF CO MORBID CONDITIONS.
UNTIL THEY VOLKSWAGEN THESE
DISEASES AND THEY'RE ABLE TO
SURVIVE WITH THEM.
SO MULTIMORBITITIES CAN BE SEEN
AS AN ADVANCED BIOLOGICAL AGE OR
FRAILTY YOUNG THE AND WHEN WE
THINK OF THE CONTEXT OF THE
OLDER ANIMALS WE MAYBE NEED TO
SEE A GREATER MULTIMORBITITIES
AS A MEASURE OF RESILIENCE AND
NOT THE RESULTS OF POOR
RESILIENCE SO GIVEN THE
OVERLAPPING BUT DISTINCT TIVE
PATTERNS, HOW CAN WE REALLY
UNDERSTAND WHAT MULTI MORBIDITY
THAT BY LOOKING FOR ONE OR THE
OTHER AND MAYBE MISSING THE
POINTS.
WE CAN THINK ABOUT TISSUE
SPECIFIC AND AGING AND THAT
MIGHT LEAD TO DISEASE AND WE
SHOULD BE THINKING ABOUT THESE
BROADER GEROSCIENCE AND WHERE WE
DO HAVE SORT OF UNDERLYING
UNIVERSAL PATTERNS THAT SHIFT
WITH AGE AND CAN LEAD TO
WIDESPREAD MULTI MORBIDITY AND A
SINGLE INTERVENTION MAY IMPACT
ALL DISEASES SO I THINK THAT TO
DO COLLECTIONS WHICH ARE MUCH
MORE FEASIBLE IN A LARGE BODY
MODEL AND IN PARTICULAR, I THINK
WE NEED TO TAKE EXCELLENT
ADVANTAGE OF THE MANY AVAILABLE
BUYER REPOSITORIES SO THANK YOU
TO EVERYONE WHO HAS WORKED ON
OUR RARE PROJECT SO FAR AND AS
WELL AS THE NIANAID FOR FUNDING.
THANK YOU.
[APPLAUSE]
GOOD AFTERNOON, EVERYBODY, I'M
NATASHA OLBY AND I'M A VET AND A
NEUROLOGIST AND I AM VERY
INTERESTED IN UNDERSTANDING THE
AGING OF THE NERVOUS SYSTEM OF
COMPANION OR PET DOGS.
TODAY I'M GOING TO TALK ABOUT
PET DOGS AND IN PARTICULAR ABOUT
OUR IDEAS ON HOW WE CAN DEFINE A
GERIATRIC SYNDROME OF USED TO
VETS AND HOPEFULLY TO
GEROSCIENCE AS WELL.
I WANT TO START OUT FIRST OF ALL
BY JUST MAKING THE POINT THAT
DOGS ARE VERY, VERY IMPORTANT IN
OUR SOCIETY.
NOW HOW MANY PEOPLE HERE OWN
DOGS?
QUITE A FEW OF YOU.
OKAY, YES.
SO IN 2017 THEY DID A NICE
SURVEY AND CONCLUDE THERE WERE
78.6 MILLION PET DOGS IN 38% OF
OUTS HOLDS AND 500,000 SERVICE
DOGS IN THE U.S. AND POST COVID
WE KNOW EVERYBODY GOT DOGS SO
THE NUMBER IS CLOSER TO 90 AT
THIS POINT SO VERY, VERY
IMPORTANT IN OUR SOCIETY.
AS A VET, I HOPE THEY'RE ALL
GOING TO COME TO SEE US.
KAMALA HARRIS WE COLLECT USEFUL
DATA FOR OUR TRAMS RATIONALLY
SEARCH AND OUR VET RESEARCH THAT
ARE COMING INTO VETS.
THERE ARE PEOPLE LIKE ME IN
EVERY ACADEMIC INSTITUTION WHO
ARE DOING THEIR RESEARCH
PROJECTS AND COLLECTING DATA AND
COLLABORATING AND SHARING WE IN
ADDITION WE HAD GREAT
OPPORTUNITIES FOR LARGE DATASETS
NOW AND SO THEY HAVE NUMBER OF
ANIMALS AND WE START LOOKING AT
RESEARCH PROJECT DATABASES AND I
AM TENSIONAL PROSPECTIVE WELL
DESIGNED STUDIES USING A CITIZEN
SCIENCE APPROACH SO GOING OUT TO
THE CITIZENRY AND GETTING THEM
TO SUBMIT SAMPLES AND FILL OUT
ANOTHER OF QUESTIONNAIRES SO WE
HAVE A LIFETIME IN GOLDEN
RETRIEVERS TRETRIEVERS BEEN GOIE
LOOKING AT CANCER AND AGING AND
WE HAVE THE MONSTER DOG AGING
PROJECT THAT IS A REALLY
GENERATED A LOT OF DATA ON
AIMING AND PRIMARY VET CARE HAS
BEEN CORPORATE TIESED AND THERE
ARE VERY LARGE CORPORATE
PRACTICES ACROSS THE UNITED
STATES AND THEY ALL'S THE SAME
ELECTRONIC DATABASE AND THEY
HAVE LARGE STUDIES LOOKING AT
AGING, FOR EXAMPLE.
WE HAVE INSURANCE RECORDS.
THESE ARE MUCH MORE COMMONLY
USED IN EUROPE WHEN COMPARED TO
HERE BECAUSE IN EUROPE, MOST
PETS ARE INSURED AND WELL
CERTAIN COUNTRY AND AMERICA
THAT'S LESS COMMON AND AGAIN,
THEY HAVE VERY DETAILED DATAB
DATABASES.
THE INTENTION POINT IS WHETHER
OR NOT DOGS ARE RELEVANT TO
HUMAN NATURE.
I WOULD SAY YES.
THEY LIVE IN OUR ENVIRONMENT AND
WE'VE HEARD A LOT ABOUT HOW OUR
ENVIRONMENT PLAYS A ROLE SO THEY
SHARE THE AIR WE BREATH, THEY
SHARE ALL THE CHEMICALS, THEY
SHARE OUR FOOD.
MY DAUGHTER IS SHARING HER DOG'S
FOOD BUT USUALLY IT'S THE OTHER
WAY AROUND.
AND I THINK A COUPLE OF THINGS
WE DON'T TALK ABOUT SO MUCH,
THEY SHARE THE EXERCISE PATTERNS
AND THE SLEEP PATTERNS OF THE
HOUSEHOLD AND YOU MIGHT SAY
THEY'RE NOT EFFECTED BY THOSE
BUT I LOVE THE PAPER THAT SHOWS
THAT DOGS WITH HIGHER ANXIETY GO
GRAY SOONER.
THEY HAVE PREMATURE GRAYING.
IF YOU ARE STRESSED AS A DOG YOU
GO GRAY SOONER AND THEY ARE
STRESSORS AND THERE'S BEAUTIFUL
DATA AVAILABLE ON HOW SOMEONE'S
OWNERSHIP STYLE CAN EFFECT THEIR
ANXIETY LEVELS AND FOR EXAMPLE
AND FINALLY HAS BEEN MENTIONED A
LOT IN THIS PARTICULAR DAY OF
TALKS, UNFORTUNATELY WE SEE
SOCIOECONOMIC CONSEQUENCES WHEN
IT COMES TO LIFESPAN.
WE CAN LOOK AT OBSERVATIONAL AND
INTERSECTIONAL STUDIES SO THAT
IS A VERY HELPFUL THINGS BUT I
ALSO WANTED TO POINT SOMETHING
OUT HERE, AND THEY GO THROUGH
THE LIFE STAGES AND I WANT TO
POINT OUT VERY IMPORTANT THING,
THEY ACCELERATE THROUGH MUCH
QUICKER SO THEY LEAVE HOME MUCH
SOONER FOR OUR PARENTS OUT THERE
SO DOGS GO THERE THAT QUICKLY
BUT THEY EVEN OUT.
A DOG WITH BE A SMALL AND A
GREAT DANE.
I DO SURGEON BOTH AND IT'S GREAT
FUN.
THEY ARE COMPLETELY DIFF COMPLE.
THERE'S A OBVIOUS DIFFERENCE IN
SIZE IS THE LITTLE TINY DOGS
LIVE MUCH IMPORTANT ABOUT THE
GIANT DEGREED BOGS AND TOY AND
WHAT THAT DRAMATIC PHENOTYPIC
DIFFERENCE IN LIFESPAN ALLOWS US
TO DO WITH THE ASK QUESTIONS
ABOUT DIFFERENT ORGAN SYSTEMS
AND WHETHER THEY AGE RELATED TO
THE STAGE OF LIFE, OR THEY'RE
HERE AND THEY ASK YOU QUESTIONS
OF THIS COGNITION DECLINE AND
THEY WERE JUST RELATED TO THE
AMOUNT OF TIME THAT YOU ARE ON
EARTH OR A COMPRESSION THEORY
DOES IF ACCELERATE THROUGH WITH
YOUR LIFE STAGE AND THEY
COLLECTED A TON MUCH DATA FROM
OWNERS DOING COGNITIVE TESTS AT
HOME AND SUBMITTING THAT DATA
AND SHOWED VERY CLEARLY THAT IT
WAS RELATED TO THEY ARE
COGNITIVELY NOT FINE SO WHAT I
SEE COMPARES WITH THAT.
ALSO THEIR GENETIC MAKE UP LENDS
ITSELF TO DISCOVERY.
SO BREEDING FOR PHYSICAL AND
BEHAVIORAL TRAITS MEANS WE GET
LONG RUNS OF HOME SEW SIGH GOSSE
TEE AND WE HAVE DISEASES WITH A
SINGLE EFFECTED DOG AT THIS
POINT.
SO HAVING SAID ALL OF THAT, I
WANT TO GET ON TALK A LITTLE BIT
ABOUT OLD DOGS AND I HOPE THIS
WILL SHOW YOU MY VIDEO.
SO HERE IS AN OLD DOG TAKING
PART IN OUR TRIAL AND SHE'S
DOING A TEST OF ATTENTION.
SHE KNOWS THIS HANDLER WELL BUT
SHE CAN NO LONGER UNDERSTAND
WHAT HE WANTS HER TO DO.
SHE'S GATHERED SOME LUMPS AND
BUMPS AND SEE A VERY POOR BODY
CONDITION.
SO THAT IS AN OLD DOG AND EVERY
VET SEES LOTS OF OLD DOGS BUT WE
TEND TO SEE THEM AS A LIST
DIAGNOSIS AND RATHER THAN SEE
THEM HOLISTICALLY AND WHAT WE
WOULD REALLY LIKE TO DO IS TRY
TO CAPTURE ALL OF THE DIFFERENT
THINGS THAT ARE HAPPENING AND
PULL THEM TOGETHER AND DEFINE
THE GERIATRIC SYNDROME SO I WANT
TO TALK ABOUT THIS PAPER BY
MCKENZIE SO THIS IDEA WAS
BROUGHT BY FRANCIS AND THEY
COLLABORATED WITH US AND IT CALL
CAME TO ME AND THEY PROSE POD A
FRAMEWORK TO ESTABLISH A
CLINICAL DIAGNOSIS OF A
GERIATRIC SYNDROME AND IT WOULD
ALLOW VETS TO CAPTURE CHANGES
WHEN THEY WERE PRE CLIP CAL.
THAT IS THE HOPE AND AIM WE CAN
CAPTURE AND INTERVENE AND SEE
AGE AS A RISK FACTOR FOR THE
VARIOUS DIFFERENT THINGS GOING
ON AND INTERVENE AND ALSO IT
WOULD REALLY FACILITATE RESEARCH
INTO PRACTICE AND IMPACTING
HEALTH SPAN AND A LOUSE YOU TO
TRY TO UNDERSTAND WHAT MOLECULAR
MECHANISMS ARE LEADING TO
CLINICAL DISEASE.
AND ONE ISN'T REALLY WELL
DEFINED YET IN PHENOTYPE AND
LOOKING AT THE CLINICAL KILLS
CEASES AND QUALITY OF LIFE AND
CAREGIVER BURDEN.
I FEEL THIS IS CENTRAL TO VET
MEDICINE BECAUSE THE MOST COMMON
END POINT THAT WEN COUNTER FOR
ENDERLY DOGS IS HUMAN EUTHANASIA
AND IT HAPPENS WHEN A OWNER OR
VET, A SUPPORT SYSTEM AROUND
THEM DECIDE THE QUALITY OF LIFE
IS UNACCEPTABLE AND THERE'S NO
CHANCE OF ALTERING THAT IN A
POSITIVE DIRECTION.
IT'S A IMPORTANT END POINT FOR
US.
WE SEE LUMPS AND BUMPS AND LOTS
OF LIE POMA THAT PROBLEM IF THEY
GET BIG AND WE SEE LOSS OF
VISION AND HEARING AND THE
SCLEROSIS AND CAT A RACK
FORMATION AND WE SEE CHANGES IN
BODY CONDITION AND WE KNOW
OBESITY AND MIDDLE AGE FOR DOGS
IS NEGATIVE LEOSATED WITH
LIFESPAN.
WE KNOW FROM THE WORK WE'VE DONE
THAT SARK OWE PENA IS ASSOCIATED
WITH SIX MONTH MORTALITY AND
KEITH, OH TEETH.
DOGS DON'T BRUSH THEIR TEETH AND
PARTICULARLY THE SMALL BREEDS
HAVE JUST THE MOST TERRIBLE
MOUTHS AND WHEN YOU DON'T WANT
TO GET BIT BY AN OLD DOG, THAT'S
MU AADVICE TO YOU.
WE LOOKED AT THE ORAL MICROBIOME
IN DOGS AND WITH AGE THEY GET
THIS PER PONDERANCE PRODUCING
BACTERIA AND ALSO ONE STUDY, ONE
OF THE LARGER STUDIES THAT'S
BEEN DONE ON LIFESPAN, IT WAS
ASSOCIATED WITH A LONGER
LIFESPAN SO THOSE DENTAL CHANGES
ARE IMPORTANT.
AND WE HAVE FINANCINGAL CHANGES.
IN PEOPLFUNCTIONAL CHANGES.IT'SO
WHAT WE WANT THEM TO DO AND WE
DON'T HAVE THE HAND GRIP.
WE CAN DO JAW GRIP BUT I IF THEY
DON'T UNDERSTAND THERE'S
PROBLEMS.
WE HAVE A FEW VERY SIMPLE
MEASURES AND THOSE DOGS KNOW THE
HANDLERS VERY WELL AND THEY ARE
JUST PET DOGS.
THEY HAVE A SOTE DISTANCE TO
MOVE OVER AND THEY'RE RELEASED
AND CALLED FOR A TREAT.
ONE DOG MAKES IT REALLY FAST AND
THE OTHER DO MAKES IT BUT LOWER.
WE THINK THIS IS A ROBUST AND
USEFUL TEST THAT WE HAVE
DEVELOPED.
AND WE HAVE CHANGES AND THEY
REALLY MOVE INTO THAT SPHERE OF
OWNERS DECIDE TAG THEY'VE
REACHED THE POINT, OKAY.
THE POINT OF EUTHANASIA SO WE'VE
SHOWN AS DOGS LOSE THEIR
HEARINGS, THEY SCORE THEM LOWER.
CHANGES IN-HOUSE TRAINING AND
SLEEP PATTERNS AND THOSE ARE
TERRIBLE FOR THE DOGS AND WORSE
FOR THE OWNERS SO THOSE CAN
TRIGGER A TIME WHERE IT'S
EUTHANASIA TIME.
MANY DOGS GET MORE ANXIOUS AS
THEY AGE.
THESE THINGS COME SOLIDLY INTO
THE FUNCTIONAL HALLMARKS OF
CHANGES IN COGNITION AND
MOBILITY.
WE'RE LOOKING AT CLINICAL
DISEASE.
I HAVE A SUMMARY SLIDE FROM THE
DOG AGING PROJECT.
IN THIS PROJECT THEY LOOKED AT
THE DIFFERENT DISEASE PROCESSES
THAT HAPPENED WITH AGE.
AND THEN THE ACTUAL SYSTEMS.
THEY COMPARED AND CONTRASTED
THEM TO HUMANS.
YOU HAVE HUMANS AT THE TOP AND
DOGS AT THE BOTTOM.
IN MANY WAYS THEY'RE SIMILAR BUT
THERE'S ONE DRAMATIC DIFFERENCE,
DRAMATIC DIFFERENCE, AND THAT
DIFFERENCE IS VASCULAR DISEASE.
ZOO THERE IT IS IN HUMANS AND
THERE IT IS IN DOGS.
WE SEE DON'T HAVE DOGS DIE OF
VASCULAR DISEASE.
WHAT DO WE KNOW ABOUT DISEASE
CLUSTERS IN DOGS AND I THOUGHT
THESE WOULD SUMMARIZE TWO POINTS
AND IF YOU LOOK AT DISEASE
CLUSTERS, YOU CAN ACTUALLY GROUP
DOGS BY LIFE STAGE.
WE CAN DEFINE DEFINITE DISEASE
CLUSTERS FOR THE DIFFERENT
STAGES OF LIFE.
ANOTHER ONE AND THIS IS
INTERESTING TO ME IN THIS PAPER
THEY DIVIDED DOGS INTO SMALL,
MEDIUM AND LARGE BREED DOGS AND
THEY HAVE DIFFERENT LIFE SPANS
AND YET WHEN YOU LOOK AT THEIR
ACCRUAL OF MORBIDITIES AND THE
NUMBER OF MORBIDITIES THEY HAVE
IT AGES, IT HAPPENS AT THE SAME
RATE.
SO THAT IS INTERESTING TO THINK
ABOUT, ISN'T IT.
IT'S REALLY INTERESTING TO THINK
ABOUT AND IT GIVES ME A HEADACHE
TO THINK ABOUT IT.
WE HAVE METABOLIC CHANGES AND
WE'RE WAY BEHIND THE HUMAN
MEDICINE ON THAN THIS AND
SURVISUFFICE IT TO SAY WE SEE CS
IN FAT DISTRIBUTION AND
REDISTRIBUTES FROM UNDER THE
SKIN AND WE SEE INSULIN
RESISTANCE ASSOCIATED WITH THAT
AND WE SEE DIFFERENT LIPID
PROFILES WITH AGE AND WE KNOW IT
WILL PREDICT MORTALITY AND SOME
OF THE BEST STUDY WAS THIS STUDY
AND IT STARTED IN 1987 AND IT
WAS A DIETARY RESTRICTION AND
THE OLDEST DOG LIVED TO BE 15
AND A HALF AND THEY DID IT IN
LABRADOR RETRIEVERS, A BREED
THAT LOVES TO EAT AND THEY TOOK
DOG PAIRS AND THEY GAVE ONE THE
START FREE CHOICE FOOD AND THE
OTHER 75% CALORIE RESTRICTION, I
GUESS 25% CALORIE RESTRICTION
AND 75% OF WHAT THEY WANTED AND
AFTER A COUPLE YEARS THEY HAD TO
CHANGE THAT BECAUSE THE FREE
CHOICE LABS WERE GETTING SO
OBESE SO THE FREE CHOICE BECAME
SENSIBLE CHOICE BUT WHAT THEY
SHOWED VERY, VERY DEFINITELY
WITH 245 WAS A CHANGE IN
LIFESPAN, AND A STRONG
EVERYTHING ON HEALTH SPAN
INCLUDING AN EFFECT ON OSTEO
ARTHRITIS WHICH IS A REALLY
IMPORTANT MORBIDITY IN LABS AND
THEN ALL OF THESE METABOLIC
EFFECTS THEY DEFINE THEM
EXTREMELY WELL IN THIS
PARTICULAR STUDY.
DO WE HAVE ANYTHING WE USE IN
THE CLINIC YET?
NO WE DON'T.
AND FRAILTY, I MADE THE COMMENT
THAT WE DON'T HAVE A FRAILTY
PHENOTYPE.
WE CAN ASK DO DOGS GET FRAIL AND
HERE IS A LITTLE FRAIL DOG.
SHE'S 15.
SHE'S HAVING TROUBLE GETTING
AROUND.
SHE HAS REPEATED INFECTIONS AND
SHE'S LOST A LOT OF MUSCLE AND
SHE'S BECOME VERY, VERY WEAK AND
FRAIL.
WHAT YOU FIND IN VET MEDICINE
AND THEY'LL A OH MY DOG DIED OF
OLD AGE SO WE BELIEVE THEY'LL
THE FRAIL NI KNOWN FEN OWE TYPE.
THERE'S ONE PUBLISHED INDEX AND
THEY'RE BOTH DIFFICULT TO APPLY
SO WE DEVELOPED A VERY SIMPLE
FRAILTY PHONFRAIL PHENOTYPE BECE
OBSEOWNER DECIDEWHEN THEY'LL EUR
DOGS SO WE ADDED IN MUSCLE
CONDITIONS SCORING AND BODY
CONDITION SCORE AND OF YOU APPLY
THAT AND LOOK AT SIX MONTH
MORTALITY THE FRAILTY SCORES
DIVIDE OUT AND IF YOU DO FINE
THEM AS FRAIL, THIS IS NOT
FRAIL, FROM HAVING THREE OR
MOREEL SPHERES THAT ARE FRAIL
AGAIN THEY SEPARATE THAT
EXTREMELY WELL.
WE HAVE QUALITY OF LIFE AND
OWNER CAREGIVER BURDEN AND IF
YOU WANT TO ANIMATE ANY GROUP OF
VETS, JUST ASK THEM HOW THEY
TALK TO OWNERS ABOUT END-OF-LIFE
AND THEY ALL SPEND A LOT OF TIME
DOING IT, RESOLVING PROBLEMS
WITHIN A FAMILY ET CETERA, ET
CETERA.
THERE ARE MANY DIFFERENT TOOLS
AVAILABLE IN VET MEDICINE AND
MANY ARE SPECIFIC TO CERTAIN
DISEASES BUT THERE ARE SOME
GENERAL TOOLS AND HERE IS ONE
THAT WE LOVE CALLED QOLQ AND YOU
CAN SEE AGAIN IF YOU LOOK AT
SURVIVAL, AND THE SCORES HOW
WELL IT SEPARATES OUT SURVIVAL.
THAT BEING SAID, KNOWLEDGE GAPS,
WELL, AS YOU CAN SEE WE LACK A
LOT OF PREDICTIVE DATA ON
MORBIDITY AND MORTALITY AND MANY
OF THOSE AREAS I TALKED ABOUT
AND WE LACK PREDICTIVE
BIOMARKERS AND WE SEE LACK EASY
TO DEPLOY, RELAY ABLE SAFE,
FUNCTIONAL TOOLS ALTHOUGH WE'RE
GROWING THOSE RAPIDLY.
WE DEFINITELY NEED TO MOVE OUR
RESEARCH TO LOOK AT LINKS
BETWEEN MOLECULAR AGING AND
CLINICAL DISEASE AND THAT'S
REALLY STARTED AND SOME OF THE
CHALLENGES THAT WE HAVE DIDN'T
EPIDEMIOLOGY MENTION THE ISSUE
OF GONADECTOMY.
SO MOST EVER OUR PATIENTS ARE
NOT SEXUALLY INTACT.
IT HE IS LIFESPAN AND HEALTH
SPAN SO THERE'S ONE WAY YOU CAN
DO IT WE HAVE THE ISSUE OF
BREED.
IT'S ALWAYS BROUGHT UP TO ME
WHEN I TALK TO BASIC SCIENCE
RESEARCHERS OF HOW ARE YOU GOING
TO DEAL WITH THE FACT THERE ARE
DIFFERENT BREEDS AND MY ANSWER
IS, WELL WE CAN ACTUALLY USE IT
TO GREATER ARE EFFECT.
WE CAN ASK AND ANSWER VERY
DIFFERENT QUESTIONS, WE CAN
COMPARE AND CONTRAST.
WE JUST NEED TO CONTROL FOR IT.
WE HAVE THE EUTHANASIA END POINT
AND THE RELATIVE ASK AND I'M
GOING TO MOVE ON AND MANY 689
DOGS THAT TAKE PART IN OUR
STUDIES AND WE HAVE THE CLINICAL
TRIAL GOING RIGHT NOW AND THEN
MY MANY POSTDOCS AND
COLLABORATORS AND HAVE HELPED
WITH THIS AS WELL AS THIS.
THANK YOU, VERY MUCH.
[Please stand by]
>>I SEE THEM HERE BUT IT
DOESN'T HELP YOU BUT THEY'RE
HERE.
THANK YOU FOR WAITING UNTIL
4:00.
I'LL BE BRIEF.
I'M CAROLINE ZEISS AND I'M A
PRIME AT COMMISSION SO I SEE
PATIENTS THROUGHOUT THEIR
LIFESPAN AND THEY END UP ON THE
TABLE WHERE WE DO A NECROPSY ON
THEM.
WHAT EYE LIKE TO TALK ABOUT ARE
UNIFYING FACTORS REGARDLESS
SPECIES WE'RE USING TO STUDY
GEROSCIENCE.
ANIMAL MODEL PROVIDE A RICH
SOURCE OF MECHANISTIC IN SIGHT.
HOW DO WE HARNESS THAT AND
DEVELOP PREDICTIVE MODELS THAT
HELP HUMAN PATIENTS IN
GEROSCIENCE FIELD.
I THINK WE'RE ALL FAMILIAR WITH
THE TERM THE TRANSLATIONAL GAP
AND THAT REFERS TO THE FACT THAT
INTERVENTIONS THAT APPEAR
PROMISING IN THE PRECLINICAL
SPACE OFTEN FAIL WHEN WE APPLY
THEM TO HUMAN PATIENTS AND THE
PLACE WHERE THAT FAILURE CURSE
IS IN EFFICACY AND IT'S
DETERMINED TRANSLATIONAL GAP OR
VALUED DEATH.
AND SO IF YOU LOOK AT HOW THESE
ARE DEVELOPED A LOT OF WORK IS
DONE IN THE PRECLINICAL SPACE
AND A LOT OF IT IS DISCOVERY
WORK THAT'S DONE IN ACADEMIA AND
CARRIED FORWARD USUALLY BY A
DRUG COMPANY AND GETS THROUGH
PHASE 1 OR TWO -- AND TISSUE
AGING AND H CELLULAR AGING WE
HOPE TO USE THOSE AS ENDPOINTS
AND ASSOCIATE THEM WITH
FUNCTIONAL OUTCOME MEASURES.
I DON'T THINK WE'RE THERE YET
WITH PEOPLE AND WE'RE NOT THERE
YET WITH ANIMALS.
ONE REASON IS THE FUNCTIONAL
OUTCOMES WE PICK IN ANIMALS ARE
SELF-SELECTED AND THEY TEND TO
BE THINGS THAT ARE SIMILAR TO
THE FIELD OF INTEREST THAT IS
INTERESTING TO US AND THEY MAY
NOT RELATE DIRECTLY TO SOMETHING
IMPORTANT TO THE PATIENT.
I THINK ONE BIG GAP WE NEED TO
CLOSE AS WE DEVELOP MARKERS OF
BIOLOGICAL AGING HOW DO WE
ASSOCIATE THOSE WITH FUNCTIONAL,
CLINICAL MARKERS IN ANIMALS AND
THAT TRANSLATE ACCURATELY TO
THOSE SAME OUTCOMES IN PEOPLE.
SO ON THE LEFT, I'VE GIVEN A
ROUGH OVERVIEW OF AND YOU KNOW,
THIS IS VARIES OBVIOUSLY BY WHAT
YOU READ AND THE PURPOSE OF THIS
REALLY IS TO FORM A FRAMEWORK
FOR COMPARISON WITH THE OTHER
SPECIES I'M GOING TO TALK ABOUT
SO THERE ARE DIFFERENCES IN THE
NATURE OF THOSE MULTI
MORBIDITIES THAT ARE VERY
IMPORTANT.
SO WE CAN COMPARE THE MACAQUE
WITH HUMANS, THE MACAQUE IN
ORANGE.
THERE ARE SOME SIMILARITIES IN
DIFFERENCES.
THE BIGGEST DIFFERENCE IS THAT
IN NON HUMAN PRIMATES, VASCULAR
DISEASE INCIDENTS AND YOU WILL
SEE IT IN ANIMALS OF DIABETICS
AND SOME ANIMALS YOU CAN
OCCASIONALLY STROKE AND YOU
DON'T SEE THE HEART DISEASE AND
YOU DON'T SEE A HIGH PREVALENCE
OF HYPERTENSION.
MANY OF THESE ANIMALS DEVELOPED
DIABETES AND THIS IS COMMON AND
PARTICULARLY COMMON IN ANIMALS
THAT ARE HOUSED IN URBAN
SETTINGS WHERE THE CAGE LIMIT IS
VERY SMALL AND IT CAN SIT IN A
CAGE THEIR WHOLE LINE FOR 30
YEARS AND THEY BECOME OBESE AND
DEVELOP DIABETES AND SECOND TO
THAT THEY GET SECONDARY
INFECTIONS AND STREP ARTHRITIS
AND THEY DON'T TEND TO GET THE
VERY COMMON SEQUELAE THAT WE GET
WITH DIABETES, THEY DON'T GET
RENAL DISEASE, NATUROPATH I CANC
DISEASE AND IT'S A ORGAN
SPECIFIC AND SYSTEM SPECIFIC
DIFFERENCE IN BIOLOGICAL AGING
THAT IS ONE DUE TO ONE FORM OF
CANCER AND IT'S A CANCER THAT
CAUSES TYPICALLY AN CONSTRICTION
AND IT IS CAUSED BY COMBINATION
OF TWO THINGS, ONE IS,
ABNORMALITY AND MISMATCH REPAIR
JEANS AND THE OTHER IS A
TENDENCY FOR MACAQUES TO DEVELOP
THE SYNDROME CALLED CHRONIC
DIARRHEA OF RECESS MACAQUES AND
WE DO KN DON'T KNOW WHAT CAUSES.
IT RESPONDS TO STEROIDS AND IT
CREATES, SETS THEM UP FOR IN
FLAM TORI AND IT'S FOR THEIR
ENTIRE LIVES.
THEY TEND TO GET ARTHRITIS RUN
ABOUT MID AGE AND BY THE TIME
THEY DIE AROUND LATE 20s AND
30s, THAT IS RAMPANT AMONGST
ALL OF THEM AND IT'S IMPORTANT
CONTRIBUTE OR TO FRAILTY AND IN
TERMS OF COGNITIVE DECLINE, THEY
DO DECLINE WITH AGE AND THIS
WOULD BE WITHIN THE PARAMETERS
OF NORMAL DECLINE OF AGING, THEY
DO NOT BECOME DEMENTED.
SO HERE IS SOME OF THE PATHOLOGY
THAT YOU WOULD SEE.
CARDIAC DISEASE IS NOT HE IS
KEEP I CAN AND ANIMALS MAY
DEVELOP ARRHYTHMIA AND THEY
COULD DEVELOP HEART FAILURE AND
WHAT YOU SEE IS THIS KIND OF
FIBROSIS AND THIS IS AN EXAMPLE
FROM A 30-YEAR-OLD ANIMAL WITH
SEVERE DIABETES AND YOU COMPARE
THAT TO A VERY OLD HUMAN AND
IT'S NOT NEARLY AS BAD.
AND AT THE BOTTOM, WE HAVE THE
CARCINOMA THAT IS A COMMON CAUSE
FOR EUTHANASIA AND WHEN WE LOOK
AT REPRODUCTIVE CAPACITY, FEMALE
MACAQUES WILL CONTINUE TO CYCLE
WELL INTO THEIR LATE 20s EVEN
THOUGH THEY HAVE A VERY AND
OFTEN THEY DEVELOP ENDOMETRIOSES
AND AT THE TOP RIGHT WE HAVE
DISSEMINATED AND ENDOMETRIOSES
AND YOU CAN IMAGINE THE
COMPLICATIONS OF THAT AND AT THE
BOTTOM RIGHT, WE HAVE
DISSEMINATED ENDOMETRIOSES THAT
CONVERTED TO STROMAL SARCOMA AND
IT'S ENCASED IN THE TUMOR SO
BETWEEN THE TWO THEY'RE COMMON
CAUSES OF EUTHANASIA IN FEMALE
MACAQUES.
THIS IS VERY DIFFERENT TO WHAT
WE SEE IN PEOPLE.
ON THE RIGHT AND IT'S HUGE AND
LARGE RESTRICTIONS AND WE SEE
SOME PHYSICAL PARAMETERS THAT
ARE RELATIVELY EASY TO COLLECT
AND A LOT OF METABOLIC
PARAMETERS, DIABETES IS SO
COMMON, SOME MOTOR COORDINATION
AND IMMUNE MARKERS AND CAUSE OF
DEATH AND ORGAN PATHOLOGY.
THIS IS AN ENTITY COMPARED ABLE
TO PEOPLE AND IT'S COMPARABLE AT
THE CLINICAL LEVEL, BIOMARKER
LEVEL AND ? NICE TICK LEVEL EX
IN TERMS OF AN IDEAL MODEL FOR
HUMAN DISEASE THIS IS AN EXAMPLE
OF A VERY GOOD MODEL FOR HUMAN
CONDITION SO ANIMALS CAN BE
HYPER IN MID LIFE AND THEY
DEVELOPED DIABETES BECAUSE OF
AND THEY BECOME OBESE AND THEY
GET ABDOMINAL OBESITY AND AS
TIME PASSES THEY'RE RETAIN THIS
BIG BELLY AND EVENTUALLY THEY'RE
EUTHANIZED BECAUSE OF DECLINING
BODY CONDITIONS.
WE'VE SHOWN THAT BOTHEN DOUGH
ENEMY TRIOSIS DEKEYS LIFESPAN AB
VALUES ARE SIMILAR TO WHAT YOU
SEE IN PEOPLE AND THERE'S
INSULIN RESISTANCE AND THERE'S
FRANCO HYPO GLYCEMIA AND THEN
ALL KINDS OF LIPID ABNORMALITIES
TOO.
AND IN TERMS OF MESA NICK TICK
STUDIES THERE'S MANY IN
MACAQUES.
HERE IS ONE COMPARING
SPONTANEOUS DIABETES WITH
DIET-INDUCED DIABETES AND THE
TAKE HOME POINT THAT SPONTANEOUS
DIABETES AND INFLAMMATORY
BIOMARKERS ARE MUCH MORE
PREVALENT.
THE DOGS, SO Dr. OLBY DID A
GREAT JOB OF DESCRIBING THE DOG.
THERE ARE SOME DIFFERENCES IN
TERMS OF THESE METABOLIC
DISEASES.
IN DOGS YOU SEE IT WITH
HYPOTHYROIDISM.
DIABETES IS TYPE 2, DIABETES,
IT'S LESS COMMON IN DOGS AND YOU
MAY SEE IN ASSOCIATION OF
CURBINGS DISEASE WHICH IS
RELATIVELY MUCH MORE COMMON AND
IT IS IN PEOPLE AND COGNITIVE
DISORDER, THIS IS A REAL BIG
DIFFERENCE BETWEEN OTHER AGING
MAMMALS AND HUMANS AND DOGS,
DOGS DEVELOP THE MOST SEVERE
COGNITIVE DECLINE SO Dr. OLBY
SHOWED THE OLD LABRADOR THAT
KIND OF ABSENCE COGNITIVE
ABSENCE THAT YOU WOULD SEE IN A
DOG LIKE THAT AND YOU WOULD JUST
NOT SEE IN A MACAQUE AND DON'T
PROGRESS TO THAT DEGREE OF
COGNITIVE IMPAIRMENT.
AND IN TERMS OF CARDIAC DISEASE,
YOU DON'T SEE VASCULAR INITIATED
CARDIAC DISEASE BUT INSUFFICIENT
SEE THAT'S THE MOST COMMON THING
IN ALL DOGS AND OVER ALL, DOGS
HAVE A MUCH BROADER SPECTRUM OF
DESCRIBED DISEASES AND THAT'S A
FUNCTION OF THE FACT THAT THERE
ARE MILLIONS OF DOG AND A WHOLE
DISCIPLINE OF VET MEDICINE THAT
DESCRIBES ALL THESE DISEASES AND
I THINK THAT THERE MAY BE
SOMETHING BIOLOGICAL AS WELL IN
THAT.
MY OBSERVATIONS ARE THE SPECTRUM
OF RESENT MACAQUES DIE OF IS
THERE'S MUCH NARROW SPECTRUM OF
WHAT THEY DIE OF COMPARED TO
DOGS AND I THINK THAT MAY HAVE A
LOT TO DO WITH THE -- THIS IS
ALREADY BEEN SHOWN.
TO UNDERSCORE Dr. OLBY'S
COMMENT THEY SHARE OUR
ENVIRONMENT AND MACAQUES DON'T
SHARE OUR ENVIRONMENT.
THEY HAVE A CONTROLLED
ENVIRONMENT.
DOGS ARE EXPOSED TO THE SAME
DIET, STRESSES AND HAVE A
SHORTER LIFESPAN SO EVERYTHING
IS COMPRESSED AND ALL OF THOSE
STIMULI ARE COMPRESSED INTO A
SHORTER LIFESPAN WHICH IS
CONVENIENT FOR US TO STUDY.
THEIR BACKGROUND IS DESCRIBED
AND THE DIFFEREN DIFFERENCES INS
REAL STRENGTH.
WE HAVE THE APPEARANCE OF BREED
ASSOCIATED CONDITIONS.
ALSO DOGS ARE A LOT EASIER TO
WORK WITH.
YOU CAN TELL I HAVE A BUY AS
WORKING WITH DOGS.
WE ALL LOVE DOGS BUT THERE ARE
MANY PRACTICAL ADVANTAGES TO
WORKING WITH DOGS EVEN THOUGH
THEY ARE EVOLUTIONARILY DISTANT
FROM US COMPARED TO MACAQUES AND
THERE ARE MANY PRACTICAL
ADVANTAGES TO WORKING WITH THEM.
YOU CAN'T REALLY DO HOW LONG IT
TAKES TO CROSS A ROAD IN A
HUMAN, THAT'S A MEASURE OF
FUNCTIONAL ABILITY AND YOU CAN
DO THE SAME THING IF A DOG AND
IT'S VERY DIFFICULT TO DO THAT
IN A MACAQUE.
AND THE MOUSE, SO, AS YOU KNOW,
THEY'RE HOMOZYGOUS AND THAT
MEANS THAT THE SPECTRUM OF
CONDITIONS THAT THEY DEVELOP
WITH AGING VARIES GREATLY BY
INBRED STRAIN.
SOME STRAINS THAT COLLABORATIVE
ACROSS MICE THAT ATTEMPT TO
OVERCOME THAT AND HERE I'VE
SELECTED C57 BECAUSE THEY HAVE A
BACKGROUND FOR MOST EXPERIMENTS
THAT ARE DONE.
TYPICALLY WHAT YOU SEE IS THEY
DIE OF CANCER AND IT'S RELATED
TO THEIR UNDERLINE GENETICS AND
THEY MAY HAVE OBESITY AND THAT'S
VERY COMMON AND THEY DON DEVELOP
DIABETES IN ASSOCIATION WITH
THAT AND THEY DON'T GET VASCULAR
DISEASE THEY GET CHRONIC
NEPHROPATHY AND THIS WAS MORE
COMMON AND WE DECREASED THE
PROTEIN IN THEIR DIETS AND THEY
GET A RANGE OF HISS TA LOGIC
LESIONS THAT CONTRIBUTE TO A
MORBIDITY SCORE BUT CLINICALLY
WE DON'T REALLY KNOW WHAT THEY
CONTRIBUTE TO THE CLINICAL
STATUS OF THE ANIMAL.
SO HERE IS A TYPICAL OLD MOUSE
ON THE TOP LEFT AND IT'S LOSING
ITS FUR AND IT HAS AN ULCER AND
YOU GET INFLAMMATION.
IN THE TOP RIGHT YOU WILL SEE
THE STRAIN ASSOCIATED DISEASE
AND AT THE BOTTOM YOU WILL SEE
THE FIE PRO SIS THAT ACCOMPANIES
MANY ELDERLY MICE AS WELL AS THE
NEPHOPTHY.
THESE ARE COMMON ACROSS SPECIES.
MANY OF THEM CAN BE MEASURED IN
ADVANCED WEIGHS AND
SOPHISTICATED WAYS BECAUSE THEY
HAVE DEVELOPED, CAT SCANS, MICRO
CT, IF APPROXIMATE YOU CAPTURE
THESE PATHOLOGY PRE MORTEM AND
IT SHOULD BE NOTED THAT MANY
MEASURES OF -- MANY OF THESE
MEASURES THAT FOLKS HAVE
ATTEMPTED TO AGO AGREE GATE INTO
HEALTH SPAN MAY NOT CORRELATE
ACROSS STRINGS AND LIFESPAN AND
SO WE CAN COLLECT A LOT OF DATA
BUT THE PROBLEM ALWAYS REMAINS
HOW DO WE RELATE IT TO A SET OF
FUNCTIONAL OUTCOMES AND
TRANSLATABLE TO PEOPLE.
AND NO AGING TALK WILL BE
COMPLETE WITHOUT A REFERENCE TO
THE MOLE RAT.
THIS IS A VERY UNUSUAL SPECIES.
IT'S A ROTE APAR RODENT WITH A F
30 YEARS SO THIS IS EQUIVALENT
TO A MACAQUE.
THEY'RE SOCIAL.
SUBTERRANEAN AND STRIKINGLY
THEIR AGE SPECIFIC HAS MORTALITY
DOES NOT INCREASE WITH
INCREASING AGE.
THE PHYSIOLOGICAL DECLINE YOU
SEE WITH AGING DOESN'T OCCUR AND
THEY'RE PRE PRODUCTIVELY
FUNCTIONAL UNTIL THE END OF
THEIR LIVES.
AND THE QUESTION THEN IS WELL
WHY DO THEY DIE?
AND IF WE LOOK AT NECROPSY
FINDINGS, THIS IS ONE EXAMPLE.
WE SEE THAT IN THESE ANIMALS,
ONE OF THE MOST PREVALENT WAS
THE DEATH OF FIGHTS THAT OCCUR
WHEN A QUEEN DIES AND THE SOCIAL
UNREST THAT FOLLOWS THAT DEATH.
THE EVOLUTION OF A NEW QUEEN.
WE SEE CHRONIC NEPROTHAPY AND I
THINK THAT'S PROBABLY RELATED TO
THE AMOUNT OF PROTEIN IN THE
DIET, JUST LIKE OTHER RODENTS
AND WE HAVE OTHER FINDINGS THAT
LOOK RODENTISH IN THEIR
DISTRIBUTION BUT DON'T EFFECT
CLINICAL STATUS OF THE ANIMAL
VERY MUCH.
AND NEVERTHELESS, THEY DO
EXHIBIT AGE ASSOCIATED
EPIGENETIC CHANGE AND THE RATE
IS SLOWER THAN MICE BUT FASTER
THAN HUMANS.
AND I'VE BEEN TRUE TO THE
PICTURE AT THE BOTTOM THAT'S A
NORMAL LUNG AND IT LOOKS UNDER
DEVELOPED BECAUSE THEY RETAIN
THESE FEATURES OF LUNG MOR
FOLLOW GEE BECAUSE THEY MOSTLY
LIVE UNDERGROUND AND THEY CAN
TOLERATE CARBON DIOXIDE AND
HYPOXIA SO EVOLUTIONARILY THEY
HAVE A LOT OF ADAPTATIONS THAT
ARE THOUGHT TO UNDERPIN THEIR
LONGEVITY.
ANIMALS DO NOT MODEL VASCULAR
DISEASE WELL.
I'VE PUT THE RAT THERE AS ONE
EXCEPTION, JUST TO REMIND MYSELF
TO TELL YOU THERE ARE SOME RATS
THAT HAVE HYPERTENSION AND
OBESITY AS A SPONTANEOUS DISEASE
BUT THEY'RE THE EXCEPTIONS AND
VASCULAR DISEASE IS AT THE ROOTS
OF OUR ILLS AS HUMAN BEINGS.
SO, I THINK THIS IS SOMETHING TO
BEAR IN MIND AS WE DEVELOP
BIOLOGICAL CLOCKS AND WE A IT
TEMPT TO TRANSLATE FINDINGS FROM
ANIMALS TO BE HUMANS WITHOUT THE
COMPONENT OF VASCULAR DISEASE
AND IT'S SOMETHING THAT WE
REALLY HAVE TO BEAR IN MIND WHEN
TRYING TO INTERPRET WHAT WE SEE
IN ANIMALS AND RELATE THOSE TO
HUMAN BIOLOGICAL AGING.
IN TERMS OF DEMENTIA THE IMAGE
ON THE RIGHT IS FAMILIAR TO ALL
OF YOU ABOUT 40% ARE MODIFIABLE
AND IN ANIMALS, THERE ARE MANY,
MANY MODELS OF ALZHEIMER'S, THE
TAKE HOME POINT FOR AWFUL THEM
IS PRETTY MUCH EVERYBODY GETS
COMPLEX AS THEY AGE EXCEPT
RODENTS.
RODENTS DON'T GET THEM BUT THE
OTHER LARGER ANIMALS DON'T GET
THEM.
AND THEY CAN BE QUITE PERVASIVE
AND THEY SPEND TO BE DIFFUSE IN
THE NEUROPATHOLOGICAL PHENOTYPE
AND BECAUSE OF THAT THEY DON'T
INVETO TRACKING USING PIB AND
IT'S NOT USED IN DOGS OR MONKEYS
AND THE OTHER BIG DIFFERENCE IS
YOU GET HYPER PHOSPHORYLATION
AND ACCUMULATION OF WHAT COULD
CALL TANGLES AND YOU DON'T GET
TANGLES AND IT'S RARE AND YOU
SEE PHOSPHORYLATION AND
HIPPOCAMPUS AND EVEN IN THE
SHEEP YOU SEE THIS SO IT IS NOT
AN OUTLIER TO SEE THIS IN NOM
HUMAN PRIMATES.
THEY DON'T DEVELOP THAT TO ANY
GREATER DEGREE AND MANY OF THESE
OTHER SPECIES.
INTERESTING TO NOTE THAT IN
DOGS, REDUCED HEARING IS
ASSOCIATED WI INCREASE CREASED T
SEE THE MULTI MORBID NEURO
PATHOLOGY OF THESE MIXED
PATHOLOGIES THAT ARE SO COMMON
IN OLD ARE PEOPLE.
THEY DO NOT SEE THAT IN ANIMALS
AND WE DON'T SEE A SPONTANEOUS
CONDITION.
THAT BRINGS ME TO THIS SLIDE THE
MOST IMPORTANT SLIDE IN THE TALK
WHICH IS THE NOTION OF ORGAN
SPECIFIC BIOLOGICAL AGE AND CRON
LOGIC AGE AND IF THERE'S SPECIES
DIFFERENCES IN THIS.
THIS BOX AT TOP DESCRIBES A TALK
WHICH DEFINES ORGAN SPECIFIC
BIOLOGIC CLOCKS AND SHOWS THAT
THESE CLOCKS VERY WITH
INDIVIDUALS AND THE BRAIN LOOKS
GOOD AND IF WE LOOK AT
BIOLOGICAL CLOCKS AND WE'RE
LOOKING AT THE BRAIN, WE MAY NOT
BE ABLE TO APPLY DIRECTLY WHAT
WE SEE IN PRIMATES TO HUMANS.
PRIMATES MAY REFLECT THE HUMAN
IN MID AGE RATHER THAN THE HUMAN
IN OLD AGE.
SO LAST SLIDE, HOW BEST CAN WE
TRANSLATE INTERVENTIONS TO THE
CLINIC USING ANIMALS AND I THINK
THESE SPECIES ON THE LEFT ARE
INCREDIBLY IMPORTANT AND
IDENTIFYING BASIC MECHANISMS AND
THEY ALLOW US TO DO REDUCTION OF
SCIENCE AND IT MEANS THAT WE
REMOVE ALL VARIABLES EXCEPT THE
ONES THAT WE'RE INTERESTED AND
WE CAN ISOLATE A MECHANISM AND
THE DOWNFALL IS IT CREATES A
SENSITIVE SYSTEM AND WHERE WE
CAN REACH STATISTICAL
SIGNIFICANCE RELATIVELY EASILY
AND AND IN HAVING THAT KIND OF
HIGH INTRINSIC VALIDITY WE USE
VALIDITY IN OTHER WORDS WHEN WE
TROY TO EXTRAPOLATE THAT TO MUCH
MORE HETERO GENIOUS IT FALLS
APART SO THE LARGER MODELING A
GOOD SEG WAY BETWEEN THESE
MODELS AND HUMANS BECAUSE
THEY'RE MORE HETERO GENIUS AND
THAT IMPLIES WE GO TO NEED
LARGER SAMPLE SIZES AND IT
ALLOWS US TO COMPARE CONDITIONS
THAT HAVE MORE IMMEDIATE A
PARENT SIMILARITIES TO HUMAN
CONDITIONS AND I HAVE INDICATED
THOSE THAT I THINK ARE THE MOST
SIMILAR AND THE MOST USEFUL IN
RED AND IN DOING SO, WE NEED TO
BEAR IN MIND SOME THINGS AND THE
FIRST IS TO DEFINE A MECHANISM
OF THE DISEASE BEARING IN MIND
THE DEVELOPMENT OF SOME OF THOSE
DISEASES SPECIFICITY OF
MECHANISM AND VALIDATED
BIOMARKERS AND THAT AND FIFTH
WINK FIFTH THOUGH BIOMARKERS
NEEDS TON RELEVANT TO THE HUMAN
DISEASE CONDITIONS.
AND WITH THAT, I WILL STOP.
THANK YOU.
[APPLAUSE]
>>CAN ALL THE SPEAKERS COME UP.
THAT WAS A WONDERFUL WAY TO END
THE DAY AND IT FIGHT NICELY AND
WITH SOME OF THE TALKS THAT WEPT
ON BEFORE.
SORRY I HAVE TO HOLD THIS DOWN.
AND I THINK IT IS A REALLY NICE
EXTENSION OF ANOTHER WORKSHOP
ACTUALLY THAT DIVISION OF AGING
BIOLOGY ORGANIZED TWO WEEKS AGO
AND ON STRESS IN MID LIFE WHERE
THEY COMBINED WORK RESEARCHERS
WHO WERE STUDYING HUMANS WITH
THOSE STUDYING MODEL ORGANISMS
AND NON MODEL ORGANISMS SOME
WHICH WERE TOUCHED ON HERE AND
BRINGING EVERYONE INTO THE ROOM
TOGETHER TO SORT OF TALK HOW WE
CAN LEVERAGE THE TWO DIFFERENT
SYSTEMS AND DIFFERENT
POPULATIONS THAT WE'RE STUDYING
TO DRAW REALLY INTERESTING
INSIGHTS INTO THE BIOLOGY OF
AGING.
HERE PARTICULARLY WE'RING ABOUT
MULTIMORBITITIES AND I THINK
WHAT WAS REALLY HIGHLIGHTED WAS
YOU NEED TO FIND WITH THE RIGHT
TOOL FOR THE RIGHT JOB HERE.
AND THAT WAS PARTICULARLY THE
CASE WITH THE LAST SPEAKER,
SAYING YOU KNOW, CERTAIN ANIMAL
SYSTEMS, CERTAIN ANIMAL MODELS
ARE BETTER FITS FOR CERTAIN
ASPECTS OF AGING AND CERTAIN
DISEASES OF AGING AND OTHERS ARE
NOT.
SO THAT'S JUST SORT OF A GENERAL
COMMENT TO BRING THESE THINGS
TOGETHER BUT I HAVE A FEW
QUESTION AND I'LL OPEN ONE HERE
AND HOPEFULLY WE CAN OPEN UP TO
THE ROOM.
SOMETHING THAT WAS A THREAT THIS
LAST SESSION AS WE GET OLDER, WE
GET MORE DISEASES, RIGHT.
AND IT'S JUST NATURAL, THE
LONGER YOU ARE AROUND THE HIGHER
YOU ARE, LIKE THE MORE LIKELY
YOU ARE TO BE DIAGNOSED WITH THE
DISEASE.
AND I THOUGHT ABOUT THIS IN THE
CONTEXT OF DIAGNOSIS DIG
DISEASES IN RESEARCH ON HUMAN
POPULATIONS AND THIS FITS WITH
THE EARLIER TALKS ON DISPARITIES
IN HEALTH AND AGING.
BECAUSE HEALTHCARE'S REALLY
NECESSARY FOR ACCESS TO
HEALTHCARE IS NECESSARY FOR YOU
TO STAY HEALTHY BUT IT'S ALSO
CRITICAL FOR DIAGNOSING
DISEASES, RIGHT.
IF YOU DON'T GO TO SEE A
HEALTHCARE PROFESSIONAL YOU WILL
NOT BE DIAGNOSED WITH DISEASE
AND SOME OF THE ANIMAL MODELS
STUDIED HERE, ARE UNDER INTENSE
VETERINARY WATCH AND CARE AND WE
DO NECROPSY AFTER THEY DIE TO
KNOW WHAT THEY HAD.
AUTOPSIES ARE NOT ALWAYS
PERFORMED FOR DISEASES THAT HAVE
OCCURRED IN HUMA HUMANS AND THEY
CANNOT SEE DOCTORS AND MAY NOT
BE DIAGNOSED WITH DISEASES.
THIS ALSO EXTENDS TO DOGS.
THERE'S A RESENT STUDY OUST OF
THE DOG AGING PROJECT MY LAB WAS
A PART OF SHOWING THAT THERE ARE
SOCIOECONOMIC GRADIENTS IN
HEALTH AND DISEASE AND THE
DISEASE DIAGNOSIS WAS COUNT ERIN
TO YOU ACTIVIER ITIN INTUITY.
THOSE FROM LOWER SES HOUSEHOLDS
AND IT'S LIKELY DO YOU TO JUST
HOW FREQUENTLY THESE OWNERS ARE
TAKING THEIR DOGS TO THE VET,
RIGHT.
I SORT OF WANT TO OPEN IT UP TO
HOW CAN WE THINK ABOUT MEASURING
THESE DISEASES AND HOW TO
IMPACTS ARE QUANTIFICATION OF
MULTI MORBIDITY WITH AGING?
>>I CAN START WITH THAT.
WELL, I THINK THAT
VETERINARIANS, WHATEVER PEE
SEIZE IS THEIR SPECIALTY I THINK
OVER TIME WE RECOGNIZE, WE LEARN
TO RECOGNIZE CLINICAL SIGNS AND
WE HAVE A GOOD IDEA OF WHAT THE
ANIMAL HAS.
THERE AREN'T TOO MANY SURPRISES
IN NECROPSY.
THE KEY REALLY IS WHAT DISEASES
DO WE INCLUDE IN A
MULTIMORBITITIES INDEX.
THINGS ARE NOT RELEVANT IN THE
SENSE OF THEY DON'T CAUSE GREAT
SUFFERING AND THEY DON'T
CONTRIBUTE TO FRAILTY AND THEY
DON'T SHORTEN THE ANIMAL'S LIFE
AND THEY DO END UP WITH A
MEDICAL RECORDS.
DO THEY ARE PART OF A FRAILTY
INDEX OR MULTIMORBITITIES INDEX?
THINGS LIKE RENAL DISEASE.
HOW DO WE DEFINE RENAL DISEASE?
IS IT AS A TEAM OF SOME DURATION
OR IS IT SOMETHING THAT WE FIND
IN DECK ROP SEE AND IF IT'S JUST
SOMETHING YOU FIND IN NECROPSY,
IT'S EFFECTING THE WHOLE SYSTEM
FOR SURE BUT CLINICALLY, IT'S
NOT GOTTEN TO THE POINT WHERE IT
IS EFFECTING THE CLINICAL STATUS
OF THE ANIMAL SO I THINK IF WE
DO NEED TO COMMUNICATE ACROSS
SPECIES WITH PEOPLE WHO WORK
WITH DIFFERENT SPECIES AND
HUMANS AND DOGS TO COME UP WITH
A SET OF DISEASES AND I THINK
ONE OF THE THINGS THAT WE'RE
CERTAINLY FINDING IN THE
MACAQUES IS YOU RAISE THE POINT
IF WE'RE LOOKING TO DEVELOP A
FRAILTY INDEX WHAT IS RELEVANT
TO THE END-OF-LIFE AND I THINK
THERE'S ALSO AN INTERESTING
THING THAT WE CAN BRING BY
LOOKING AT MODEL ORGANISMS IS TO
CAPTURE THAT PRECLINICAL PHASE.
AND IN FACT THAT MAY BE
IMPORTANT AS WELL BECAUSE IT'S
SOMETHING WE CAN'T DO IN HUMANS.
WE GET AROUND THIS ISSUE OF SORT
OF SOCIOECONOMIC COMPONENT BY
MONITORING THESE ANIMALS BUT WE
MAYBE MISS OUT ON THE
OPPORTUNITY TO IDENTIFY EARLY
BIOMARKERS SO IT'S SOMETHING
THAT IS ABOUT WHAT THE QUESTION
YOU ARE ASKING IS.
IS IT DO WE WANT A CLINICALLY
TRANSLATABLE INDEX OR ARE WE
TRYING TO DEVELOP SOMETHING THAT
MAYBE LET'S US STRATIFY WITH A
HIGHER RESOLUTION THAN WE WILL
EVER BE ABLE TO IN HUMANS AND
USE THAT AS A MECHANISM TO GET
AT THE UNDERLYING FACTORS
CONTRIBUTING TO MULTIPLE
MORBIDITY.
>>I WANT TO MAKE TWO COMMENTS.
ONE IS, REALLY IT DEPENDS ON
WHAT YOU WANT TO DO.
BECAUSE IF WE ARE TRYING TO
UNDERSTAND WHAT IS THE
MECHANISMS OF AGING AND HOW THE
MECHANISMS OF AGING EFFECT
HEALTH, ACROSS DIFFERENT
SPECIES, IT'S LIKELY THAT IT
WILL EFFECT IT IN A DIFFERENT
WAY SO WE CAN'T REALLY REDUCE
THE TYPE OF DISEASE WE ARE ONLY
MEASURING SOME THAT ARE
IMPORTANT BY HUMANS AND MAY NOT
BE CAPTURING THOSE THAT ARE
EFFECTED BY AGING IN THESE
SPECIFIC SPECIES.
IF WE'RE TRYING TO HAVE A
CLINICAL PAT A LEGAL COMPARISM
BETWEEN ANIMAL AND IT WAS A
DESIGN IN MIND FOR THE
PHENOTYPES THAT ARE COMPARABLE
BETWEEN HUMAN AND ANIMAL AND
MICE IN THIS CASE AND DISCARDING
FOR EXAMPLE THAT IN THE MICE,
HIGH GLUCOSE IS NOT A PREDICT OR
OF MORTALITY AND IT IS AND A
VERY STRONG, PROBABLY ONE OF THE
PREDICTORS OF MORTALITY IN
HUMANS SO I THINK THAT WE NEED
TO BE CAREFUL WHAT IS THE INTENT
OR WHAT WE WANT TO DO TO DECIDE
YOU KNOW, WHETHER WE CAN HAVE
THE COMMON INTEXT AND HOW WE
CREATE IT.
>>FROM PERSPECTIVE AS A VET, I
HAVE TWO COMMENTS, ONE IS THE
VET LEGISLATURE THAT'S COMING
OUT OF THE CORPORATIZED
PRACTICES, IS SIMPLY LISTING
NUMBERS OF MEDICAL DIAGNOSIS
THAT THEY COULD BE A SKIN WART
THAT HAS NO MEDICAL SIGNIFICANCE
WHATSOEVER.
SO WE HAVE TO BE A LITTLE
CAUTIOUS ABOUT THOSE NUMBERS
BECAUSE THAT IS TRULY WHAT THEY
ARE CAPTURING.
BUT, WHAT WE ARE REALLY
INTENTIONALLY TRYING TO DO IN
OUR DOG WORK, IS UNDERSTAND THE
AGING PROCESS IN THE DOG TO TRY
TO ADVANCE THEIR HEALTH AND WE
ANTICIPATE THERE'S OVERLAP IN
CERTAIN PARTS OF THAT WHICH CAN
THEN BE TAKEN TO HUMANS AND SO
WE'RE SITTING AND UNDERSTANDING
THE AGING OF EACH ORGAN IN MUCH
MORE DETAIL SO WE CAN TRANSLATE
THEM BUT SOME OF IT WON'T BE
TRANSLATABLE BUT IT WILL HELP
DOG OWNERS AND DOGS.
>>A SHORT COMMENT ON WORKING
WITH MICE.
ONE OF THE REASONS WHY YOU DON'T
SEE A LOT OF DOSE DISEASES
APPEARING IN MICE IS THAT MOST
OF THE MOUSE WORK IS SCIENTIFIC
WORK IS REALLY DOMINATED BY THE
GENETIC APPROACH AND FOCUS ON A
SINGLE DISEASE IN A SINGLE MOUSE
AND PEOPLE ARE NOT LOOKING AT
THE DISEASES AND WORKING IN
AGING AND THAT FORCES YOU TO
OPEN YOUR TO MOVE TO MORBIDITY
AND LOOKING AT THE FACTOR FOR
THAT AND MAJOR FACTOR IN THAT
CONTEXT SO, THAT'S ONE OF THE
RELATION WHY YOU DON'T SEE THAT
POTENTIAL BUT WE SEE A POTENTIAL
VERY STRONGLY AND VERY SEVERE
ACTUALLY AND MONTHS MODELS.
SOCIAL STRESS SO ANYWAY, IF YOU
SEE YOU CAN DEVELOP AND VOTE.
>>WE HAVE A FEW QUESTIONS.
>>WHERE THEY'VE EXPLICITLY FED
MODELED AFTER HUMAN DIETS.
THE MEDITERRANEAN AND WESTERN
DIET IN A CONTROLLED SETTING TO
MACAQUES OVER A THREE-YEAR
PERIOD AND SAW MANY
PHYSIOLOGICAL AND BEHAVIORAL
EFFECTS OF THESE MANY OF WHICH
ARE RELATED TO THE AGING PROCESS
INCLUDING INCREASED
INFLAMMATION, PERIPHERAL
INFLAMMATION AFTER BEING ON THIS
WESTERN DIET RELATIVE TO THE
MEDITERRANEAN DIET FOR 15 MONTHS
AT THAT POINT AND IMPACTS ON THE
STRESS RESPONSE PATHWAY.
I CAN POINT YOU TO MORE OF THAT
LITERATURE.
>>WE'LL SAVE TIME FOR OTHER
QUESTIONS.
I DON'T KNOW WHO CAME FIRST BUT
OKAY, PLEASE.
>>I JUST WOULD LIKE TO OPEN YOU
ALL UP TO ANOTHER OPPORTUNITY
THAT IS KIND OF TIES IN WITH OUR
THEME OF THE GEROSCIENCE, RIGHT.
EARLIER IN THE DAY, WE HEARD
ABOUT THE SOCIAL DISPARITIES AND
WE'RE NOW HEARING ABOUT ANIMALS
AND FOR THE DOGS AND PROBABLY
CATS AND BIRDS AND WHATEVER
COMPANION ANIMALS THEY'RE LIVING
WITH THE HUMANS, RIGHT AND ALL
SOCIOECONOMIC CLASSES AND WE'RE
TRYING TO RECRUIT PEOPLE FROM
ALL DIFFERENT BACKGROUNDS AND WE
KNOW SOCIAL ISOLATIONS AND
LONELINESS IS A CONTRIBUTE OR TO
POOR OUTCOMES IN OLDER ADULTS,
HOW OFTEN THEY'RE WALKING AND
EXERCISING MAY BE RELATED IF
THEY HAVE AN ANIMAL THAT THEY
WALK AND SO, I THINK YOU KNOW,
EARLIER TODAY, WE'RE HEARING
ABOUT DIFFERENT DISCIPLINES
TRYING TO INTERACT WITH EACH
OTHER WHILE HERE WE'RE TALKING
ABOUT THIS ANIMAL GETS THIS AND
THAT HUMAN GETS THAT BUT MAYBE,
THERE'S REALLY THIS OPPORTUNITY
TO WORK TOGETHER TO UNDERSTAND
BOTH THE INTERACTIONS OF THE
HUMAN AND THE ANIMALS ON
OUTCOMES FOR THEM BOTH, IT'S
KIND OF A DYAD BUT IT'S A
DIFFERENT KIND OF DYAD.
AS WELL AS A WAY TO KIND OF
ENCOURAGE PEOPLE FROM MANY
DIFFERENT BACKGROUNDS THAT
THERE'S A LOT OF NUDGE
INTERVENTIONS AND THERE'S A LOT
OF WAYS THEY COULD BE IN
OBSERVATIONAL STUDIES AND SO I
JUST WANTED THROW OUT THAT MAYBE
INSTEAD OF HAVING THESE SEPARATE
DISCIPLINES OF VET AND HUMAN
MEDICINE WE COULD ACTUALLY WORK
TOGETHER.
WE KNOW EXERCISE IS GOOD AND
DIET EFFECTS OUR HEALTH AND I
MEAN I THINK VERY OFTEN DO WE DO
ANIMAL STUDIES TO CONFIRM TO SAY
LOOK WE HAVE AN ANIMAL MODEL FOR
THIS THING WE ALREADY KNOW
OCCURS IN PEOPLE AND HOW MUCH OF
THAT ARE WE REALLY DOING IN
ANIMALS THAT IS YOU NEW AND
ABOUT WHAT CAN WE REALLY LEARN
FROM ANIMALS THAT BREAKS
BOUNDARIES THAT WE CANNOT BREAK
IN PEOPLE.
>>I WANT TO MAKE A COMMENT.
I THINK THAT IT'S TRANSLATION
AND WE USE ANIMAL MODEL BECAUSE
ONE SIDE WE WANT TO LEARN
SOMETHING WE SEE WHETHER IT'S
APPLIED TO HUMANS AND THEN WE
MAY DISCOVER IN HUMANS WE WANT
TO SEE IN A MODEL WHERE WE MAY
DO INTERVENTIONS AND WHETHER
WHAT WE ARE DISCOVER IN HUMANS
AND IT'S FUNDAMENTAL AND WE
WON'T KNEE WHETHER WE'RE DOING
REAL TRANSITION OWN.
>>ONE VALUE OF THE ANIMAL MODEL
IS THAT YOU CAN DO RANDOMIZED
TRIAL OF THE IT WOULD BRING YOU
CLOSER TO THE CAUSATION THAT FOR
A LOT OF THESE HUMAN STUDIES, OF
PARTICULARLY ON SOCIAL
DETERMINANTS, SIMPLY CANNOT BE
PERFORMED FOR ETHICAL REASONS OR
OTHER REASONS.
ONE IS FUNDAMENTAL AND I WANTED
TO KNOW ALSO ABOUT DIET BUT HOW
MUCH OF THESE DISEASE
PROGRESSION OF FUNCTION OF HUMAN
DOG CO EVOLUTION AND WHETHER WE
KNOW ANYTHING ABOUT DISEASE THIS
IS OTHER AND MY OTHER QUESTION
AND MAYBE IT WAS --
>>SORRY, CAN YOU SPEAK?
>>MY APOLOGIES.
>>FROM HERE WE CAN'T HEAR YOU.
>>SO, I WANTED TO UNDERSTAND
DISEASE HE'DOLOGY AND I WAS
WONDERING WHETHER OTHER CANINE
HAVE THE SAME TYPE OF DISEASES
THAT WE'RE SEEING IN DOGS AND
HOW MUCH OF THAT IS A FUNCTION
OF DOG HUMAN CO EVOLUTION,
QUESTION ONE AND TWO, I MAY HAVE
MISUNDERSTOOD BUT IT SOUNDED
LIKE I WAS HEARING THAT THESE
INCIDENTAL FINDINGS WERE
INCIDENTAL AND THEY WERE NOT THE
SYMPTOMATIC TYPES OF THINGS THAT
BROUGHT THE ANIMAL TO THE
NECROPSY AND WOULDN'T IT BE
INFORMATIVE TO UNDERSTAND THOSE
INCIDENTAL FINDINGS GIVEN THAT
THAT COULD BE A CONTRIBUTING
FACTOR TO THE OTHER DISEASES AND
IT SEEMS TO ME THAT THAT WOULD
BE PRESUMING AN UNDERSTANDING OF
THESE ORGAN INTER RELATIONSHIPS
THAT WE DON'T HAVE YET.
AND SO, YES -- SO ADDRESS,
PLEASE.
SOLVE IT.
[LAUGHTER]
>>I CAN COMMENT ON THE SECOND
QUESTION.
I HAVE LEAVE THE CO EVOLUTION
QUESTION TO OTHERS.
ALTHOUGH THERE'S A FANTASTIC
BOOK ON DOG HUMAN CO EVOLUTION
THAT I DON'T KNOW ANSWERS TO
THAT QUESTION BUT IT'S
FASCINATING.
TERMS OF THE INCIDENTAL
FINDINGS, THIS IS SOMETHING
WE'VE BEEN WRESTLING WITH SO
IT'S FRONT OF MY MIND.
SO WE DO HAVE A NUMBER OF
DISEASES THAT ARE MUCH MORE
COMMONLY, I MEAN, I DON'T KNOW
THAT YOU CAN SAY YOU DIAGNOSE A
DISEASE AT NECROPSY BECAUSE YOU
KNOW, WHAT WAS THE MANIFESTATION
IN THE ANIMAL.
BUT TUMORS, FOR EXAMPLE, ARE
VERY COMMON TO FIND AT NECROPSY
AND IN FACT ABOUT HALF ARE THERE
AT THAT POINT AND SO I THINK, I
MEAN I THINK IT'S AN INTERESTING
QUESTION AND IT SUGGESTS THAT
THERE WAS SOME DISRUPTION OF THE
UNDERLYING PHYSIOLOGY AND I
THINK THAT THAT HAS BEEN VERY
INTERESTING FOR US TO TRY TO
FIGURE OUT HOW TO DEAL WITH IT
PARTICULARLY BECAUSE YOU DON'T
KNOW WHEN THEY EMERGED AND WE'VE
BEEN FOCUSED ON THESE
LONGITUDINAL QUESTIONS BUT AS A
OVER ALL SORT OF IN THIS CONTEXT
OF THE GEROSCIENCE HYPOTHESIS I
THINK YOU ARE RIGHT AND I THINK
YOU NEED TO, IF WHAT WE'RE
EXPECTING THERE'S SOME
UNDERLYING DISREGULATION, THEN
YES, WE DO NEED TO TAKE THOSE
INCIDENTAL FINDINGS INTO
CONSIDERATION AND HOW WE WEIGHT
THEM, HOW WE THINK ABOUT THEM IN
TERMS OF THEIR EMERGENCE IS THE
IMPLICATION PART IS THE TRICKY
PART BUT I THINK THAT YOU KNOW,
IN TERMS, YES, I WOULD
ABSOLUTELY AGREE WE SHOULD BE
THINKING ABOUT THEM.
>>OKAY, I CAN TACKLE THE DINGO
ABOUT WOLVES WHICH I KNOW
NOTHING.
SPEAKING AS A VETERINARIAN, MOST
OF THE DISEASE WE SEE IN DOGS IS
GENETIC IN ORIGIN.
IT'S GENERATED BY VERY SPECIFIC
BREEDING FOR VERY SPECIFIC
TRAITS.
AND SO WOLVES ARE DIFFERENT TO
THAT.
SO THE MAJOR THREE DISEASES THAT
WE SEE KILL OFF OUR DOGS AND OUR
LONGITUDINAL STUDY FOR EXAMPLE,
NUMBER ONE, MASSIVE CANCER.
THEY GET A CAR SIN OWN A OR
SARCOMA AROUND 10 AND 11 YEARS
OF AGE AND THEY'RE OUT OF THE
STUDY AND IF THEY GET BEYOND
THAT, IT'S RENAL DISEASE EX
DEMENTIA AND WE HAVE MOBILITY
ISSUES AND SOME DOGS GET
EUTHANIZED FOR THAT BUT MOVE THE
PORT ART IT'S OTHER THINGS AND I
REALLY COULD NOT TELL YOU WHAT
HAPPENS TO THESE OTHER WILD
DOGS, I'M AFRAID.
BUT I KNOW THAT THEY DON'T GET
THAT GENETIC DISEASE IN THE SAME
WAY.
>>I THINK IF WE CONSIDER ANY
LESION THAT ACCUMULATES WITH AGE
AS BEING A REFLECTION WITH
DISRUPTED HOMEY' STAY IS BUT AS
WE MOVE FORWARD WITH COLLECTING
EPIGENETIC DATA IN DIFFERENT
ORGAN SYSTEMS I ALSO THINK IT'S
IMPORTANT TO RECOGNIZE THAT
SPECIES DIFFERENCES IN DISEASE
MANIFESTATION BETWEEN THOSE
ORGAN SYSTEMS.