1 5437 196 REMOTE HIND-LIMB ISCHEMIA MECHANISM OF PRESERVED EJECTION FRACTION DURING HEART FAILURE. DURING ACUTE HEART FAILURE (HF), REMOTE ISCHEMIC CONDITIONING (RIC) HAS PROVEN TO BE BENEFICIAL; HOWEVER, IT IS CURRENTLY UNCLEAR WHETHER IT ALSO EXTENDS BENEFITS FROM CHRONIC CONGESTIVE, CARDIOPULMONARY HEART FAILURE (CHF). PREVIOUS STUDIES FROM OUR LABORATORY HAVE SHOWN THREE PHASES DESCRIBING CHF VIZ. (1) HF WITH PRESERVED EJECTION FRACTION (HFPEF), (2) HF WITH REDUCED EF (HFREF), AND (3) HF WITH REVERSED EF. ALTHOUGH RECIPROCAL ORGAN INTERACTION, ABLATION OF SYMPATHETIC, AND CALCIUM SIGNALING GENES ARE ASSOCIATED WITH HFPEF TO HFREF, THE MECHANISM IS UNCLEAR. THE HFREF ENSUES, IN PART, DUE TO REDUCED ANGIOGENESIS, CORONARY RESERVE, AND LEAKAGE OF ENDOCARDIAL ENDOTHELIAL (EE) AND FINALLY BREAKDOWN OF THE BLOOD-HEART BARRIER (BHB) INTEGRITY. IN FACT, OUR HYPOTHESIS STATES THAT A CHANGE IN PHENOTYPE FROM COMPENSATORY HFPEF TO DECOMPENSATORY HFREF IS DETERMINED BY A POTENTIAL DECREASE IN REGENERATIVE, PROANGIOGENIC FACTORS ALONG WITH A CONCOMITANT INCREASE IN EPIGENETIC MEMORY, INFLAMMATION THAT COMBINEDLY CAUSES OXIDATIVE, AND PROTEOLYTIC STRESS RESPONSE. TO TEST THIS HYPOTHESIS, WE CREATED CHF BY AORTA-VENA-CAVA (AV) FISTULA IN A GROUP OF MICE THAT WERE SUBSEQUENTLY TREATED WITH THAT OF HIND-LIMB RIC. HFPEF VS. HFREF TRANSITION WAS DETERMINED BY SERIAL/LONGITUDINAL ECHO MEASUREMENTS. RESULTS REVEALED AN INCREASE IN SKELETAL MUSCLE MUSCLIN CONTENTS, BONE-MARROW (CD71), AND SYMPATHETIC ACTIVATION (BETA2-AR) BY RIC. WE ALSO OBSERVED A DECREASE IN VASCULAR DENSITY AND ATTENUATION OF EE-BHB FUNCTION DUE TO A CORRESPONDING INCREASE IN THE ACTIVITY OF MMP-2, VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF), CASPASE, AND CALPAIN. THIS DECREASE WAS SUCCESSFULLY MITIGATED BY RIC-RELEASED SKELETAL MUSCLE EXOSOMES THAT CONTAIN MUSCLIN, THE MYOKINE ALONG WITH BONE MARROW, AND SYMPATHETIC ACTIVATION. IN SHORT, BASED ON PROTEOME (OMICS) ANALYSIS, APPROXIMATELY 20 PROTEINS THAT APPEAR TO BE INVOLVED IN SIGNALING PATHWAYS RESPONSIBLE FOR THE SYNTHESIS, CONTRACTION, AND RELAXATION OF CARDIAC MUSCLE WERE FOUND TO BE THE DOMINANT FEATURES. THUS, OUR RESULTS SUPPORT THAT THE CHF PHENOTYPE CAUSES DYSFUNCTION OF CARDIAC METABOLISM, ITS CONTRACTION, AND RELAXATION. INTERESTINGLY, RIC WAS ABLE TO MITIGATE MANY OF THE DELETERIOUS CHANGES, AS REVEALED BY OUR MULTI-OMICS FINDINGS. 2021 2 2537 28 EPIGENETICS IN HEART FAILURE PHENOTYPES. CHRONIC HEART FAILURE (HF) IS A LEADING CLINICAL AND PUBLIC PROBLEM POSING A HIGHER RISK OF MORBIDITY AND MORTALITY IN DIFFERENT POPULATIONS. HF APPEARS TO BE IN BOTH PHENOTYPIC FORMS: HF WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION (HFREF) AND HF WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION (HFPEF). ALTHOUGH BOTH HF PHENOTYPES CAN BE DISTINGUISHED THROUGH CLINICAL FEATURES, CO-MORBIDITY STATUS, PREDICTION SCORE, AND TREATMENT, THE CLINICAL OUTCOMES IN PATIENTS WITH HFREF AND HFPEF ARE SIMILAR. IN THIS CONTEXT, INVESTIGATION OF VARIOUS MOLECULAR AND CELLULAR MECHANISMS LEADING TO THE DEVELOPMENT AND PROGRESSION OF BOTH HF PHENOTYPES IS VERY IMPORTANT. THERE IS EMERGING EVIDENCE THAT EPIGENETIC REGULATION MAY HAVE A CLUE IN THE PATHOGENESIS OF HF. THIS REVIEW REPRESENTS CURRENT AVAILABLE EVIDENCE REGARDING THE IMPLICATION OF EPIGENETIC MODIFICATIONS IN THE DEVELOPMENT OF DIFFERENT HF PHENOTYPES AND PERSPECTIVES OF EPIGENETIC-BASED THERAPIES OF HF. 2016 3 5891 38 SYSTEMS BIOLOGY IN CHRONIC HEART FAILURE-IDENTIFICATION OF POTENTIAL MIRNA REGULATORS. HEART FAILURE (HF) IS A COMPLEX DISEASE ENTITY WITH HIGH CLINICAL IMPACT, POORLY UNDERSTOOD PATHOPHYSIOLOGY AND SCANTLY KNOWN MIRNA-MEDIATED EPIGENETIC REGULATION. WE HAVE ANALYSED MIRNA PATTERNS IN PATIENTS WITH CHRONIC HF (CHF) AND A SEX- AND AGE-MATCHED REFERENCE GROUP AND PURSUED AN IN SILICO SYSTEM BIOLOGY ANALYSIS TO DISCERN PATHWAYS INVOLVED IN CHF PATHOPHYSIOLOGY. TWENTY-EIGHT MIRNAS WERE IDENTIFIED IN CHF THAT WERE UP-REGULATED IN THE REFERENCE GROUP, AND EIGHT OF THEM WERE VALIDATED BY RT-QPCR. IN SILICO ANALYSIS OF PREDICTED TARGETS BY STRING PROTEIN-PROTEIN INTERACTION NETWORKS REVEALED EIGHT CLUSTER NETWORKS (INVOLVING SEVEN OF THE IDENTIFIED MIRNAS) ENRICHED IN PATHWAYS RELATED TO CELL CYCLE, RAS, CHEMOKINE, PI3K-AKT AND TGF-BETA SIGNALING. BY ROC CURVE ANALYSIS, COMBINED PROBABILITIES OF THESE SEVEN MIRNAS (LET-7A-5P, MIR-107, MIR-125A-5P, MIR-139-5P, MIR-150-5P, MIR-30B-5P AND MIR-342-3P; CLUSTERS 1-4 [C:1-4]), DISCRIMINATED BETWEEN HF WITH PRESERVED EJECTION FRACTION (HFPEF) AND HF WITH REDUCED EJECTION FRACTION (HFREF), AND ISCHAEMIC AND NON-ISCHAEMIC AETIOLOGY. A COMBINATION OF MIR-107, MIR-139-5P AND MIR-150-5P, INVOLVED IN CLUSTERS 5 AND 7 (C:5+7), DISCRIMINATED HFPEF FROM HFREF. PATHWAY ENRICHMENT ANALYSIS OF MIRNAS PRESENT IN C:1-4 (LET-7A-5P, MIR-125A-5P, MIR-30B-5P AND MIR-342-3P) REVEALED PATHWAYS RELATED TO HF PATHOGENESIS. IN CONCLUSION, WE HAVE IDENTIFIED A DIFFERENTIAL SIGNATURE OF DOWN-REGULATED MIRNAS IN THE PLASMA OF HF PATIENTS AND PROPOSE NOVEL CELLULAR MECHANISMS INVOLVED IN CHF PATHOGENESIS. 2022 4 50 40 A DEEP LEARNING MODEL FOR EARLY RISK PREDICTION OF HEART FAILURE WITH PRESERVED EJECTION FRACTION BY DNA METHYLATION PROFILES COMBINED WITH CLINICAL FEATURES. BACKGROUND: HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF), AFFECTED COLLECTIVELY BY GENETIC AND ENVIRONMENTAL FACTORS, IS THE COMMON SUBTYPE OF CHRONIC HEART FAILURE. ALTHOUGH THE AVAILABLE RISK ASSESSMENT METHODS FOR HFPEF HAVE ACHIEVED SOME PROGRESS, THEY WERE BASED ON CLINICAL OR GENETIC FEATURES ALONE. HERE, WE HAVE DEVELOPED A DEEP LEARNING FRAMEWORK, HFMERISK, USING BOTH 5 CLINICAL FEATURES AND 25 DNA METHYLATION LOCI TO PREDICT THE EARLY RISK OF HFPEF IN THE FRAMINGHAM HEART STUDY COHORT. RESULTS: THE FRAMEWORK INCORPORATES LEAST ABSOLUTE SHRINKAGE AND SELECTION OPERATOR AND EXTREME GRADIENT BOOSTING-BASED FEATURE SELECTION, AS WELL AS A FACTORIZATION-MACHINE BASED NEURAL NETWORK-BASED RECOMMENDER SYSTEM. MODEL DISCRIMINATION AND CALIBRATION WERE ASSESSED USING THE AUC AND HOSMER-LEMESHOW TEST. HFMERISK, INCLUDING 25 CPGS AND 5 CLINICAL FEATURES, HAVE ACHIEVED THE AUC OF 0.90 (95% CONFIDENCE INTERVAL 0.88-0.92) AND HOSMER-LEMESHOW STATISTIC WAS 6.17 (P = 0.632), WHICH OUTPERFORMED MODELS WITH CLINICAL CHARACTERISTICS OR DNA METHYLATION LEVELS ALONE, PUBLISHED CHRONIC HEART FAILURE RISK PREDICTION MODELS AND OTHER BENCHMARK MACHINE LEARNING MODELS. OUT OF THEM, THE DNA METHYLATION LEVELS OF TWO CPGS WERE SIGNIFICANTLY CORRELATED WITH THE PAIRED TRANSCRIPTOME LEVELS (R < -0.3, P < 0.05). BESIDES, DNA METHYLATION LOCUS IN HFMERISK WERE ASSOCIATED WITH INTERCELLULAR SIGNALING AND INTERACTION, AMINO ACID METABOLISM, TRANSPORT AND ACTIVATION AND THE CLINICAL VARIABLES WERE ALL RELATED WITH THE MECHANISM OF OCCURRENCE OF HFPEF. TOGETHER, THESE FINDINGS GIVE NEW EVIDENCE INTO THE HFMERISK MODEL. CONCLUSION: OUR STUDY PROPOSES AN EARLY RISK ASSESSMENT FRAMEWORK FOR HFPEF INTEGRATING BOTH CLINICAL AND EPIGENETIC FEATURES, PROVIDING A PROMISING PATH FOR CLINICAL DECISION MAKING. 2022 5 6017 42 THE ASSOCIATION OF ACCELERATED EPIGENETIC AGE WITH ALL-CAUSE MORTALITY IN CARDIAC CATHETERIZATION PATIENTS AS MEDIATED BY VASCULAR AND CARDIOMETABOLIC OUTCOMES. BACKGROUND: EPIGENETIC AGE IS A DNA METHYLATION-BASED BIOMARKER OF AGING THAT IS ACCURATE ACROSS THE LIFESPAN AND A RANGE OF CELL TYPES. THE DIFFERENCE BETWEEN EPIGENETIC AGE AND CHRONOLOGICAL AGE, TERMED AGE ACCELERATION (AA), IS A STRONG PREDICTOR OF LIFESPAN AND HEALTHSPAN. THE PREDICTIVE CAPABILITIES OF AA FOR ALL-CAUSE MORTALITY HAVE BEEN EVALUATED IN THE GENERAL POPULATION; HOWEVER, ITS UTILITY IS LESS WELL EVALUATED IN THOSE WITH CHRONIC CONDITIONS. ADDITIONALLY, THE PATHOPHYSIOLOGIC PATHWAYS WHEREBY AA PREDICTS MORTALITY ARE UNCLEAR. WE HYPOTHESIZED THAT AA PREDICTS MORTALITY IN INDIVIDUALS WITH UNDERLYING CARDIOVASCULAR DISEASE; AND THE ASSOCIATION BETWEEN AA AND MORTALITY IS MEDIATED, IN PART, BY VASCULAR AND CARDIOMETABOLIC MEASURES. METHODS: WE EVALUATED 562 PARTICIPANTS IN AN URBAN, THREE-COUNTY AREA OF CENTRAL NORTH CAROLINA FROM THE CATHGEN COHORT, ALL OF WHOM RECEIVED A CARDIAC CATHETERIZATION PROCEDURE. WE ANALYZED THREE AA BIOMARKERS, HORVATH EPIGENETIC AGE ACCELERATION (HAA), PHENOTYPIC AGE ACCELERATION (PHENOAA), AND GRIM AGE ACCELERATION (GRIMAA), BY COX REGRESSION MODELS, TO ASSESS WHETHER AAS WERE ASSOCIATED WITH ALL-CAUSE MORTALITY. WE ALSO EVALUATED IF THESE ASSOCIATIONS WERE MEDIATED BY VASCULAR AND CARDIOMETABOLIC OUTCOMES, INCLUDING LEFT VENTRICULAR EJECTION FRACTION (LVEF), BLOOD CHOLESTEROL CONCENTRATIONS, ANGIOPOIETIN-2 (ANG2) PROTEIN CONCENTRATION, PERIPHERAL ARTERY DISEASE, CORONARY ARTERY DISEASE, DIABETES, AND HYPERTENSION. THE TOTAL EFFECT, DIRECT EFFECT, INDIRECT EFFECT, AND PERCENTAGE MEDIATED WERE ESTIMATED USING PATHWAY MEDIATION TESTS WITH A REGRESSION ADJUSTMENT APPROACH. RESULTS: PHENOAA (HR = 1.05, P < 0.0001), GRIMAA (HR = 1.10, P < 0.0001) AND HAA (HR = 1.03, P = 0.01) WERE ALL ASSOCIATED WITH ALL-CAUSE MORTALITY. THE ASSOCIATION OF MORTALITY AND PHENOAA WAS PARTIALLY MEDIATED BY ANG2, A MARKER OF VASCULAR FUNCTION (19.8%, P = 0.016), AND BY DIABETES (8.2%, P = 0.043). THE GRIMAA-MORTALITY ASSOCIATION WAS MEDIATED BY ANG2 (12.3%, P = 0.014), AND SHOWED WEAKER EVIDENCE FOR MEDIATION BY LVEF (5.3%, P = 0.065). CONCLUSIONS: EPIGENETIC AGE ACCELERATION REMAINS STRONGLY PREDICTIVE OF MORTALITY EVEN IN INDIVIDUALS ALREADY BURDENED WITH CARDIOVASCULAR DISEASE. MORTALITY ASSOCIATIONS WERE MEDIATED BY ANG2, WHICH REGULATES ENDOTHELIAL PERMEABILITY AND ANGIOGENIC FUNCTIONS, SUGGESTING THAT SPECIFIC VASCULAR PATHOPHYSIOLOGY MAY LINK ACCELERATED EPIGENETIC AGING WITH INCREASED MORTALITY RISKS. 2022 6 4249 32 METHYLATION-BASED BIOLOGICAL AGE AND BREAST CANCER RISK. BACKGROUND: AGE IS ONE OF THE STRONGEST PREDICTORS OF CANCER, CHRONIC DISEASE, AND MORTALITY, BUT BIOLOGICAL RESPONSES TO AGING DIFFER AMONG PEOPLE. EPIGENETIC DNA MODIFICATIONS HAVE BEEN USED TO ESTIMATE "BIOLOGICAL AGE," WHICH MAY BE A USEFUL PREDICTOR OF DISEASE RISK. WE TESTED THIS HYPOTHESIS FOR BREAST CANCER. METHODS: USING A CASE-COHORT APPROACH, WE MEASURED BASELINE BLOOD DNA METHYLATION OF 2764 WOMEN ENROLLED IN THE SISTER STUDY, 1566 OF WHOM SUBSEQUENTLY DEVELOPED BREAST CANCER AFTER AN AVERAGE OF 6 YEARS. USING THREE PREVIOUSLY ESTABLISHED METHYLATION-BASED "CLOCKS" (HANNUM, HORVATH, AND LEVINE), WE DEFINED BIOLOGICAL AGE ACCELERATION FOR EACH WOMAN BY COMPARING HER ESTIMATED BIOLOGICAL AGE WITH HER CHRONOLOGICAL AGE. HAZARD RATIOS AND 95% CONFIDENCE INTERVALS FOR BREAST CANCER RISK WERE ESTIMATED USING COX REGRESSION MODELS. ALL STATISTICAL TESTS WERE TWO-SIDED. RESULTS: EACH OF THE THREE CLOCKS SHOWED THAT BIOLOGICAL AGE ACCELERATION WAS STATISTICALLY SIGNIFICANTLY ASSOCIATED WITH INCREASED RISK OF DEVELOPING BREAST CANCER (5-YEAR AGE ACCELERATION, HANNUM'S CLOCK: HAZARD RATIO [HR] = 1.10, 95% CONFIDENCE INTERVAL [CI] = 1.00 TO 1.21, P = .04; HORVATH'S CLOCK: HR = 1.08, 95% CI = 1.00 TO 1.17, P = .04; LEVINE'S CLOCK: HR = 1.15, 95% CI = 1.07 TO 1.23, P < .001). FOR LEVINE'S CLOCK, EACH 5-YEAR ACCELERATION IN BIOLOGICAL AGE CORRESPONDED WITH A 15% INCREASE IN BREAST CANCER RISK. ALTHOUGH BIOLOGICAL AGE MAY ACCELERATE WITH MENOPAUSAL TRANSITION, AGE ACCELERATION IN PREMENOPAUSAL WOMEN INDEPENDENTLY PREDICTED BREAST CANCER. CASE-ONLY ANALYSIS SUGGESTED THAT, AMONG WOMEN WHO DEVELOP BREAST CANCER, INCREASED AGE ACCELERATION IS ASSOCIATED WITH INVASIVE CANCER (ODDS RATIO FOR INVASIVE = 1.09, 95% CI = 0.98 TO 1.22, P = .10). CONCLUSIONS: DNA METHYLATION-BASED MEASURES OF BIOLOGICAL AGE MAY BE IMPORTANT PREDICTORS OF BREAST CANCER RISK. 2019 7 1780 24 EDUCATION AND LIFESTYLE FACTORS ARE ASSOCIATED WITH DNA METHYLATION CLOCKS IN OLDER AFRICAN AMERICANS. DNA METHYLATION (DNAM) CLOCKS ARE IMPORTANT BIOMARKERS OF CELLULAR AGING AND ARE ASSOCIATED WITH A VARIETY OF AGE-RELATED CHRONIC DISEASES AND ALL-CAUSE MORTALITY. EXAMINING THE RELATIONSHIP BETWEEN EDUCATION AND LIFESTYLE RISK FACTORS FOR AGE-RELATED DISEASES AND MULTIPLE DNAM CLOCKS CAN INCREASE THE UNDERSTANDING OF HOW RISK FACTORS CONTRIBUTE TO AGING AT THE CELLULAR LEVEL. THIS STUDY EXPLORED THE ASSOCIATION BETWEEN EDUCATION OR LIFESTYLE RISK FACTORS FOR AGE-RELATED DISEASES AND THE ACCELERATION OF FOUR DNAM CLOCKS, INCLUDING INTRINSIC (IEAA) AND EXTRINSIC EPIGENETIC AGE ACCELERATION (EEAA), PHENOAGE ACCELERATION (PHENOAA), AND GRIMAGE ACCELERATION (GRIMAA) IN THE AFRICAN AMERICAN PARTICIPANTS OF THE GENETIC EPIDEMIOLOGY NETWORK OF ARTERIOPATHY. WE PERFORMED BOTH CROSS-SECTIONAL AND LONGITUDINAL ANALYSES. IN CROSS-SECTIONAL ANALYSES, GENDER, EDUCATION, BMI, SMOKING, AND ALCOHOL CONSUMPTION WERE ALL INDEPENDENTLY ASSOCIATED WITH GRIMAA, WHEREAS ONLY SOME OF THEM WERE ASSOCIATED WITH OTHER CLOCKS. THE EFFECT OF SMOKING AND EDUCATION ON GRIMAA VARIED BY GENDER. LONGITUDINAL ANALYSES SUGGEST THAT AGE AND BMI CONTINUED TO INCREASE GRIMAA, AND THAT AGE AND CURRENT SMOKING CONTINUED TO INCREASE PHENOAA AFTER CONTROLLING DNAM CLOCKS AT BASELINE. IN CONCLUSION, EDUCATION AND COMMON LIFESTYLE RISK FACTORS WERE ASSOCIATED WITH MULTIPLE DNAM CLOCKS. HOWEVER, THE ASSOCIATION WITH EACH RISK FACTOR VARIED BY CLOCK, WHICH SUGGESTS THAT DIFFERENT CLOCKS MAY CAPTURE ADVERSE EFFECTS FROM DIFFERENT ENVIRONMENTAL STIMULI. 2019 8 1955 28 EPIGENETIC AGE ACCELERATION PREDICTS CANCER, CARDIOVASCULAR, AND ALL-CAUSE MORTALITY IN A GERMAN CASE COHORT. BACKGROUND: PREVIOUS STUDIES HAVE DEVELOPED MODELS PREDICTING METHYLATION AGE FROM DNA METHYLATION IN BLOOD AND OTHER TISSUES (EPIGENETIC CLOCK) AND SUGGESTED THE DIFFERENCE BETWEEN DNA METHYLATION AND CHRONOLOGICAL AGES AS A MARKER OF HEALTHY AGING. THE GOAL OF THIS STUDY WAS TO CONFIRM AND EXPAND SUCH OBSERVATIONS BY INVESTIGATING WHETHER DIFFERENT CONCEPTS OF THE EPIGENETIC CLOCKS IN A POPULATION-BASED COHORT ARE ASSOCIATED WITH CANCER, CARDIOVASCULAR, AND ALL-CAUSE MORTALITY. RESULTS: DNA METHYLATION AGE WAS ESTIMATED IN A COHORT OF 1863 OLDER PEOPLE, AND THE DIFFERENCE BETWEEN AGE PREDICTED BY DNA METHYLATION AND CHRONOLOGICAL AGE (DELTAAGE) WAS CALCULATED. A CASE-COHORT DESIGN AND WEIGHTED PROPORTIONAL COX HAZARD MODELS WERE USED TO ESTIMATE ASSOCIATIONS OF DELTAAGE WITH CANCER, CARDIOVASCULAR, AND ALL-CAUSE MORTALITY. HAZARD RATIOS FOR DELTAAGE (PER 5 YEARS) CALCULATED USING THE EPIGENETIC CLOCK DEVELOPED BY HORVATH WERE 1.23 (95 % CI 1.10-1.38) FOR ALL-CAUSE MORTALITY, 1.22 (95 % CI 1.03-1.45) FOR CANCER MORTALITY, AND 1.19 (95 % CI 0.98-1.43) FOR CARDIOVASCULAR MORTALITY AFTER ADJUSTMENT FOR BATCH EFFECTS, AGE, SEX, EDUCATIONAL LEVEL, HISTORY OF CHRONIC DISEASES, HYPERTENSION, SMOKING STATUS, BODY MASS INDEX, AND LEUCOCYTE DISTRIBUTION. ASSOCIATIONS WERE SIMILAR BUT WEAKER FOR DELTAAGE CALCULATED USING THE EPIGENETIC CLOCK DEVELOPED BY HANNUM. CONCLUSIONS: THESE RESULTS SHOW THAT AGE ACCELERATION IN TERMS OF THE DIFFERENCE BETWEEN AGE PREDICTED BY DNA METHYLATION AND CHRONOLOGICAL AGE IS AN INDEPENDENT PREDICTOR OF ALL-CAUSE AND CAUSE-SPECIFIC MORTALITY AND MAY BE USEFUL AS A GENERAL MARKER OF HEALTHY AGING. 2016 9 1074 32 CLONAL HAEMATOPOIESIS IN CHRONIC ISCHAEMIC HEART FAILURE: PROGNOSTIC ROLE OF CLONE SIZE FOR DNMT3A- AND TET2-DRIVER GENE MUTATIONS. AIMS: SOMATIC MUTATIONS OF THE EPIGENETIC REGULATORS DNMT3A AND TET2 CAUSING CLONAL EXPANSION OF HAEMATOPOIETIC CELLS (CLONAL HAEMATOPOIESIS; CH) WERE SHOWN TO BE ASSOCIATED WITH POOR PROGNOSIS IN CHRONIC ISCHAEMIC HEART FAILURE (CHF). THE AIM OF OUR ANALYSIS WAS TO DEFINE A THRESHOLD OF VARIANT ALLELE FREQUENCY (VAF) FOR THE PROGNOSTIC SIGNIFICANCE OF CH IN CHF. METHODS AND RESULTS: WE ANALYSED BONE MARROW AND PERIPHERAL BLOOD-DERIVED CELLS FROM 419 PATIENTS WITH CHF BY ERROR-CORRECTED AMPLICON SEQUENCING. CUT-OFF VAFS WERE OPTIMIZED BY MAXIMIZING SENSITIVITY PLUS SPECIFICITY FROM A TIME-DEPENDENT RECEIVER OPERATING CHARACTERISTIC (ROC) CURVE ANALYSIS FROM CENSORED DATA. 56.2% OF PATIENTS WERE CARRIERS OF A DNMT3A- (N = 173) OR A TET2- (N = 113) MUTATION WITH A VAF >0.5%, WITH 59 PATIENTS HARBOURING MUTATIONS IN BOTH GENES. SURVIVAL ROC ANALYSES REVEALED AN OPTIMIZED CUT-OFF VALUE OF 0.73% FOR TET2- AND 1.15% FOR DNMT3A-CH-DRIVER MUTATIONS. FIVE-YEAR-MORTALITY WAS 18% IN PATIENTS WITHOUT ANY DETECTED DNMT3A- OR TET2 MUTATION (VAF < 0.5%), 29% WITH ONLY ONE DNMT3A- OR TET2-CH-DRIVER MUTATIONS ABOVE THE RESPECTIVE CUT-OFF LEVEL AND 42% IN PATIENTS HARBOURING BOTH DNMT3A- AND TET2-CH-DRIVER MUTATIONS ABOVE THE RESPECTIVE CUT-OFF LEVELS. IN CARRIERS OF A DNMT3A MUTATION WITH VAF >/= 1.15%, 5-YEAR MORTALITY WAS 31%, COMPARED WITH 18% MORTALITY IN THOSE WITH VAF < 1.15% (P = 0.048). LIKEWISE, IN PATIENTS WITH TET2 MUTATIONS, 5-YEAR MORTALITY WAS 32% WITH VAF >/= 0.73%, COMPARED WITH 19% MORTALITY WITH VAF < 0.73% (P = 0.029). CONCLUSION: THE PRESENT STUDY DEFINES NOVEL THRESHOLD LEVELS FOR CLONE SIZE CAUSED BY ACQUIRED SOMATIC MUTATIONS IN THE CH-DRIVER GENES DNMT3A AND TET2 THAT ARE ASSOCIATED WITH WORSE OUTCOME IN PATIENTS WITH CHF. 2021 10 176 30 ACCELERATED DNA METHYLATION AGE AND MEDICATION USE AMONG AFRICAN AMERICANS. DNA METHYLATION AGE ACCELERATION, THE DISCREPANCY BETWEEN EPIGENETIC AGE AND CHRONOLOGICAL AGE, IS ASSOCIATED WITH MORTALITY AND CHRONIC DISEASES, INCLUDING DIABETES, HYPERTENSION, AND HYPERLIPIDEMIA. IN THIS STUDY, WE INVESTIGATE WHETHER MEDICATIONS COMMONLY USED TO TREAT THESE DISEASES IN 15 DRUG CATEGORIES ARE ASSOCIATED WITH FOUR EPIGENETIC AGE ACCELERATION MEASURES: HORVATHAGE ACCELERATION (HORVATHAA), HANNUMAGE ACCELERATION (HANNUMAA), PHENOAGE ACCELERATION, AND GRIMAGE ACCELERATION (GRIMAA) USING CROSS-SECTIONAL (PHASE 1, N=1,100) AND LONGITUDINAL (PHASES 1 AND 2, N=266) DATA FROM AFRICAN AMERICANS IN THE GENETIC EPIDEMIOLOGY NETWORK OF ARTERIOPATHY (GENOA) STUDY. IN CROSS-SECTIONAL ANALYSES, THE USE OF CALCIUM CHANNEL BLOCKERS WAS ASSOCIATED WITH 1.27 YEARS LOWER HANNUMAA AFTER ADJUSTING FOR COVARIATES INCLUDING HYPERTENSION (P=0.001). LONGITUDINAL ANALYSES SHOWED THAT, COMPARED TO THOSE WHO NEVER USED ANTIHYPERTENSIVES, THOSE WHO STARTED TO TAKE ANTIHYPERTENSIVES AFTER PHASE 1 HAD A 0.97-YEAR DECREASE IN GRIMAA (P=0.007). IN ADDITION, COMPARED TO THOSE WHO NEVER USED NSAID ANALGESICS, THOSE WHO STARTED TO TAKE THEM AFTER PHASE 1 HAD A 2.61-YEAR INCREASE IN HORVATHAA (P=0.0005). OUR STUDY DEMONSTRATES THAT THREE COMMONLY USED MEDICATIONS ARE ASSOCIATED WITH DNAM AGE ACCELERATION IN AFRICAN AMERICANS AND SHEDS LIGHT ON THE POTENTIAL EPIGENETIC EFFECTS OF PHARMACEUTICALS ON AGING AT THE CELLULAR LEVEL. 2021 11 1785 35 EFFECT OF APABETALONE ON CARDIOVASCULAR EVENTS IN DIABETES, CKD, AND RECENT ACUTE CORONARY SYNDROME: RESULTS FROM THE BETONMACE RANDOMIZED CONTROLLED TRIAL. BACKGROUND AND OBJECTIVES: CKD AND TYPE 2 DIABETES MELLITUS INTERACT TO INCREASE THE RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS (I.E., CARDIOVASCULAR DEATH, NONFATAL MYOCARDIAL INFARCTION, OR STROKE) AND CONGESTIVE HEART FAILURE. A MALADAPTIVE EPIGENETIC RESPONSE MAY BE A CARDIOVASCULAR RISK DRIVER AND AMENABLE TO MODIFICATION WITH APABETALONE, A SELECTIVE MODULATOR OF THE BROMODOMAIN AND EXTRATERMINAL DOMAIN TRANSCRIPTION SYSTEM. WE EXAMINED THIS QUESTION IN A PRESPECIFIED ANALYSIS OF BETONMACE, A PHASE 3 TRIAL. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: BETONMACE WAS AN EVENT-DRIVEN, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL COMPARING EFFECTS OF APABETALONE VERSUS PLACEBO ON MAJOR ADVERSE CARDIOVASCULAR EVENTS AND HEART FAILURE HOSPITALIZATIONS IN 2425 PARTICIPANTS WITH TYPE 2 DIABETES AND A RECENT ACUTE CORONARY SYNDROME, INCLUDING 288 PARTICIPANTS WITH CKD WITH EGFR <60 ML/MIN PER 1.73 M(2) AT BASELINE. THE PRIMARY END POINT IN BETONMACE WAS THE TIME TO THE FIRST MAJOR ADVERSE CARDIOVASCULAR EVENT, WITH A SECONDARY END POINT OF TIME TO HOSPITALIZATION FOR HEART FAILURE. RESULTS: MEDIAN FOLLOW-UP WAS 27 MONTHS (INTERQUARTILE RANGE, 20-32 MONTHS). IN PARTICIPANTS WITH CKD, APABETALONE COMPARED WITH PLACEBO WAS ASSOCIATED WITH FEWER MAJOR ADVERSE CARDIOVASCULAR EVENTS (13 EVENTS IN 124 PATIENTS [11%] VERSUS 35 EVENTS IN 164 PATIENTS [21%]; HAZARD RATIO, 0.50; 95% CONFIDENCE INTERVAL, 0.26 TO 0.96) AND FEWER HEART FAILURE-RELATED HOSPITALIZATIONS (THREE HOSPITALIZATIONS IN 124 PATIENTS [3%] VERSUS 14 HOSPITALIZATIONS IN 164 PATIENTS [9%]; HAZARD RATIO, 0.48; 95% CONFIDENCE INTERVAL, 0.26 TO 0.86). IN THE NON-CKD GROUP, THE CORRESPONDING HAZARD RATIO VALUES WERE 0.96 (95% CONFIDENCE INTERVAL, 0.74 TO 1.24) FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND 0.76 (95% CONFIDENCE INTERVAL, 0.46 TO 1.27) FOR HEART FAILURE-RELATED HOSPITALIZATION. INTERACTION OF CKD ON TREATMENT EFFECT WAS P=0.03 FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS, AND P=0.12 FOR HEART FAILURE-RELATED HOSPITALIZATION. PARTICIPANTS WITH CKD SHOWED SIMILAR NUMBERS OF ADVERSE EVENTS, REGARDLESS OF RANDOMIZATION TO APABETALONE OR PLACEBO (119 [73%] VERSUS 88 [71%] PATIENTS), AND THERE WERE FEWER SERIOUS ADVERSE EVENTS (29% VERSUS 43%; P=0.02) IN THE APABETALONE GROUP. CONCLUSIONS: APABETALONE MAY REDUCE THE INCIDENCE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH CKD AND TYPE 2 DIABETES WHO HAVE A HIGH BURDEN OF CARDIOVASCULAR DISEASE. 2021 12 2150 31 EPIGENETIC MEASURES OF AGEING PREDICT THE PREVALENCE AND INCIDENCE OF LEADING CAUSES OF DEATH AND DISEASE BURDEN. BACKGROUND: INDIVIDUALS OF THE SAME CHRONOLOGICAL AGE DISPLAY DIFFERENT RATES OF BIOLOGICAL AGEING. A NUMBER OF MEASURES OF BIOLOGICAL AGE HAVE BEEN PROPOSED WHICH HARNESS AGE-RELATED CHANGES IN DNA METHYLATION PROFILES. THESE MEASURES INCLUDE FIVE 'EPIGENETIC CLOCKS' WHICH PROVIDE AN INDEX OF HOW MUCH AN INDIVIDUAL'S BIOLOGICAL AGE DIFFERS FROM THEIR CHRONOLOGICAL AGE AT THE TIME OF MEASUREMENT. THE FIVE CLOCKS ENCOMPASS METHYLATION-BASED PREDICTORS OF CHRONOLOGICAL AGE (HORVATHAGE, HANNUMAGE), ALL-CAUSE MORTALITY (DNAM PHENOAGE, DNAM GRIMAGE) AND TELOMERE LENGTH (DNAM TELOMERE LENGTH). A SIXTH EPIGENETIC MEASURE OF AGEING DIFFERS FROM THESE CLOCKS IN THAT IT ACTS AS A SPEEDOMETER PROVIDING A SINGLE TIME-POINT MEASUREMENT OF THE PACE OF AN INDIVIDUAL'S BIOLOGICAL AGEING. THIS MEASURE OF AGEING IS TERMED DUNEDINPOAM. IN THIS STUDY, WE TEST THE ASSOCIATION BETWEEN THESE SIX EPIGENETIC MEASURES OF AGEING AND THE PREVALENCE AND INCIDENCE OF THE LEADING CAUSES OF DISEASE BURDEN AND MORTALITY IN HIGH-INCOME COUNTRIES (N /=35.0 VS. 18.5-24.9, BETA = 3.15 YEARS, 95% CONFIDENCE INTERVAL (CI): 2.41, 3.90; P FOR TREND < 0.001). IN A MUTUAL-ADJUSTMENT MODEL, BOTH WERE ASSOCIATED WITH PHENOAGE AGE ACCELERATION (BMI OF >/=35.0 VS. 18.5-24.9, BETA = 2.69 YEARS, 95% CI: 1.90, 3.48; P FOR TREND < 0.001; QUARTILE 4 VS.1 WTH, BETA = 1.00 YEARS, 95% CI: 0.34, 1.65; P FOR TREND < 0.008). AFTER ADJUSTMENT, PHYSICAL ACTIVITY WAS ASSOCIATED ONLY WITH GRIMAGE (QUARTILE 4 VS. 1, BETA = -0.42 YEARS, 95% CI: -0.70, -0.14; P FOR TREND = 0.001). PHYSICAL ACTIVITY ATTENUATED THE WAIST CIRCUMFERENCE ASSOCIATIONS WITH PHENOAGE AND GRIMAGE. EXCESS ADIPOSITY WAS ASSOCIATED WITH EPIGENETIC AGE ACCELERATION; PHYSICAL ACTIVITY MIGHT ATTENUATE ASSOCIATIONS WITH WAIST CIRCUMFERENCE. 2021