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New concepts for research in Elderly Care and Healthy Ageing.Game changers for prevention and treatment
P.Eline Slagboom
Leiden University Medical Centre (LUMC)
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Outline Integrated Approaches in Research
Why investigate ageing
What is healthy ageing by nature
By nurture, how to monitor and influence healthy ageing
Game changers: Integrating basic, biomedical and medical research
LUMC : Medical Research Profile on Ageing
National: Dutch Society for Research on Ageing (DuSRA)
More systematic observation of elderly in the clinic
Not treating
Teaching
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Age is the strongest risk factor for common diseases
20 % of life EU citizen spend in disability 65 + doubles before 2060 85 + triples before 2060
Co-morbidity, polypharmacy, heterogeneity/biological age ---personalized medicin
cancer
CVD
influenza
Alzheimer’s
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Healthy Ageing by nature. Leiden Longevity Study (3500 individuals)
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EU longevity research
APOE ; Chrome 5q3.33 ; EBF1
Worlwide longevity research (EU, US, China)
The genome of the oldest old in the EU
Joris DeelenHum Mol Genet 2014
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16-Jun-166
Nature : Intrinsic immune and metabolic health:Clinical Variables, Metabolites, Imaging (brain)
Morbidity, Mortality
Energy metabolism/nutrient sensing: Lipids, Insulin, Thyroid, mTORBonus
Can you influence it ?
Leiden Longevity Study Nature: drivers of healthy ageing
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Immune /Metabolic
Health
Biological aging Understanding pathways
-Biomechanics
-Cellular mechanisms
-Molecular pathways
Classifying individuals
-Developing biomarkers
-Insight in heterogeneity
Patient based interventions
-Improving therapies
-Improving preventions
-Insight in responses to stress
Neuro-cardiovascular Musculoskeletal
Albert Einstein SPLuiz Vicente RizzoEdson AmaroFabio Gazelato de Mello Franco
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Growing Old Together (GOTO) Study design
Baseline End
One week before end:• Accelerometer• 24 hr blood glucose• Blood, fat, muscle
Before baseline:• FFQ• IPAQ• Accelerometer• 24 hr blood glucose• At baseline : Blood, fat, muscle
13-weeks intervention
• 12.5% reduced dietary intake
• 12.5% increased physical activity
During intervention• 4 x 24h recalls• Diary • Hunger and satiety
questionnaires
Research questions:
• Is this “common sense” lifestyle intervention
feasible and healthy for all older adults (≈ 60 years
old)?
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Healthy Ageing Result of GOTO intervention
• 60-70 year old : Feasible : window of opportunity
• Buddy effect and coaching
• Well-being improved
• Sleep improved
• Metabolic health improved
• Longevity family members not different from spouse
• But: Heterogeneous responses
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GOTO: Weight change after 13 weeks
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GOTO: Change in systolic blood pressure after 13 weeks
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GOTO Change in insulin after 13 weeks
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Healthy Ageing
• Heterogeneous responses
• Research in Public/Private Collaboration
• How to understand: blood, fat and muscle studies
• How to monitor: Biomarkers (Brainshake, Pfizer, Philips)
• How to motivate : AGO study in 60 +
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Monitoring Behavioral patterns Sensors of heart rate variability, accelerometers etc.
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Wearables not tested in elderly ‘in the wild’. Investigation of 35 subjects 60-70 years
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Washing dishes (3 minutes)
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Organize bookshelf (3 minutes)
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Vacuuming (3 minutes)
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Cycling (15 minutes)
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Evaluation of Interventions
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Epigenome
Molecular Monitoring: BIOMARKERS Big data in the right context (BBMRI)
Gut microbiome
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Suhre et al. PLoS ONE | November 2010 | Volume 5 | Issue 11
BIOMARKERS : Metabolites in blood/urine monitoring tissue conditions
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Topic Study
Follow
Up (y) Cases Controls
Migrain LUMINA/CHARM/RVCL 439 125
NTR VU 4.4 897 1000
ERF EUMC 360 1000
Dementia VUMC Alzheimer 3 1100 400
EUMC dementia 1000 1000
Depression NESDA VU 6 1200 400
NTR VU 4.4 1000 1000
EUMC depression 900 1000
Mortality All cohorts
Ageing LLS LUMC 10 998 2313
EUMC 85+ 1-11 400 1200
Alpha/Omega MUMC 5.5 459 476
CardioVascular
Disease BIOMArCS EUMC 900
STEMI UMCG 400
UNCORBIO UMCU 3 1200
PROSPER LUMC 3.2 418 579
Type 2 Diabetes CODAM MUMC 7 145
Maastricht Study MUMC 854
DZS West-Friesland VUMC 10 1000
HELUIS AMC 500
Osteoarthritis GARP LUMC 2-6 412 2030
RAAK-PAPRIKA LUMC 476 2030
EUMC OA 6.6 793 1000
CHECK 8 981
Omics 500 FG 500
LifeLines 1500
22 cohorts in BBMRI
LUMCVUVUMCEUMCUMCGMUMCWURAMCRUMC
Disease-specificGeneric profiles
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Metabolites and Mortality (N=40.000)Personalised/stratified risk assessment
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GOTO: Beneficial Profile after intervention
Wurtz 2015 Circulation; Stancacova 2012 Diabetes; Mahendran 2013 Diabetes Care
* Independent of weight change
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Stay Fit, Stay Vertical
Aging is Inevitable
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Why investigate ageing
What is healthy ageing by nature
By nurture, how to monitor and influence healthy ageing
Game changers: Integrating basic, biomedical and medical research
LUMC : Medical Research Profile on Ageing
National: Dutch Society for Research on Ageing (DuSRA)
More systematic observation of elderly in the clinic (TENT)
Not treating
Teaching
National Biobanking : BBMRI.Nl
Outline Integrated Approaches in Research
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31 mei 201628 Grote visite poli
Triaging Elderly Needing Treatment (TENT)
Standardized vitality assessment and biobanking
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Not Treating or Nutritional Medicin
29 2016
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Discover the world at Leiden University
Master Vitality and Ageing
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Master Vitality and Ageing focus on
Content
• Biological mechanismes of ageing
• Older individuals
• Organisation of ageing society
• Skills
• Communication in science
• Evidence – research
• Academic Skills
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After graduation
Scientific careerFurther education in science (leading to a PhD degree)
Medical careerFurther medical education (geriatrics, internal medicine, general practice)
Management careerManagement position in care organisations or governmental organisations
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BBMRI-NL : Biobanking and BioMolecular resources Research Infrastructure in The Netherlands
Nation wide biobanking infrastructure
Founded in 2009: Dutch node of EU BBMRI-ERIC
> 200 Dutch biobanks
Sharing of Molecular, Clinical, Imaging Data. Accessible for scientific community.
Big data combined to stimulate personalized /stratified medicine
Dutch National Tissue Bank Portal
June 12, 2016
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Ambition BBMRI-NL
June 12, 2016
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36 http://www.bbmri.nlJune 12, 2016
Cataloguewith> 200
biobanks
Tools & Applications
ELSI center of expertise
Website BBMRI.nl
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37 http://www.bbmri.nl/wp-
content/uploads/2015/10/guidelineeng_def.pdf
June 12, 2016
BBMRI.nl Ethical, Legal, Social issues the site for the public, donors, politics and press
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Music, Science and HumorCollaborations with Brasil