A Federated Database for Obesity Research: An IMI-SOPHIA Study.

Obesity is considered by many as a lifestyle choice rather than a chronic progressive disease. The Innovative Medicines Initiative (IMI) SOPHIA (Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy) project is part of a momentum shift aiming to provide better tools for the stratification of people with obesity according to disease risk and treatment response. One of the challenges to achieving these goals is that many clinical cohorts are siloed, limiting the potential of combined data for biomarker discovery. In SOPHIA, we have addressed this challenge by setting up a federated database building on open-source DataSHIELD technology. The database currently federates 16 cohorts that are accessible via a central gateway. The database is multi-modal, including research studies, clinical trials, and routine health data, and is accessed using the R statistical programming environment where statistical and machine learning analyses can be performed at a distance without any disclosure of patient-level data. We demonstrate the use of the database by providing a proof-of-concept analysis, performing a federated linear model of BMI and systolic blood pressure, pooling all data from 16 studies virtually without any analyst seeing individual patient-level data. This analysis provided similar point estimates compared to a meta-analysis of the 16 individual studies. Our approach provides a benchmark for reproducible, safe federated analyses across multiple study types provided by multiple stakeholders.

Intracellular signaling pathways of muscarinic acetylcholine receptor-mediated detrusor muscle contractions.

Acetylcholine plays an essential role in the regulation of detrusor muscle contractions, and antimuscarinics are widely used in the management of overactive bladder syndrome. However, several adverse effects limit their application and patients' compliance. Thus, this study aimed to further analyze the signal transduction of M2 and M3 receptors in the murine urinary bladder to eventually find more specific therapeutic targets. Experiments were performed on adult male wild-type, M2, M3, M2/M3, or Gαq/11 knockout (KO), and pertussis toxin (PTX)-treated mice. Contraction force and RhoA activity were measured in the urinary bladder smooth muscle (UBSM). Our results indicate that carbamoylcholine (CCh)-induced contractions were associated with increased activity of RhoA and were reduced in the presence of the Rho-associated kinase (ROCK) inhibitor Y-27632 in UBSM. CCh-evoked contractile responses and RhoA activation were markedly reduced in detrusor strips lacking either M2 or M3 receptors and abolished in M2/M3 KO mice. Inhibition of Gαi-coupled signaling by PTX treatment shifted the concentration-response curve of CCh to the right and diminished RhoA activation. CCh-induced contractile responses were markedly decreased in Gαq/11 KO mice; however, RhoA activation was unaffected. In conclusion, cholinergic detrusor contraction and RhoA activation are mediated by both M2 and M3 receptors. Furthermore, whereas both Gαi and Gαq/11 proteins mediate UBSM contraction, the activation at the RhoA-ROCK pathway appears to be linked specifically to Gαi. These findings may aid the identification of more specific therapeutic targets for bladder dysfunctions.NEW & NOTEWORTHY Muscarinic acetylcholine receptors are of utmost importance in physiological regulation of micturition and also in the development of voiding disorders. We demonstrate that the RhoA-Rho-associated kinase (ROCK) pathway plays a crucial role in contractions induced by cholinergic stimulation in detrusor muscle. Activation of RhoA is mediated by both M2 and M3 receptors as well as by Gi but not Gq/11 proteins. The Gi-RhoA-ROCK pathway may provide a novel therapeutic target for overactive voiding disorders.

Health care system efficiency and life expectancy: A 140-country study.

Despite the evidence of links between health expenditure and health care efficiency, it is still unclear why countries with similar levels of health expenditures experience different outputs in terms of life expectancy at birth. Health care system efficiency might shed some light on the question. Using output-oriented data envelopment analysis, we compared the health systems of 140 countries in terms of attained life expectancy. Efficiency is determined by the distance from the closest country on the best practice frontier, which identifies the highest attainable life expectancy observed for any given level of health care spending. By using national data form the Human Development Data, we built the efficiency frontier and computed the potential life expectancy increase for each country. The potential improvement was, on average, 5.47 years [95%CI: 4.71-6.27 years]. The least efficient countries (10th percentile of the efficiency score) could improve by 11.78 years, while the most efficient countries (90th percentile of the efficiency score) could only improve by 0.83 years. We then analyzed, with regression analysis stratified by average education level, and by the role of health-related variables in differentiating efficient and inefficient countries from each other. The results suggest that, among countries with lower levels of education, decreasing unemployment and income inequality increases average life expectancy, without increasing health expenditure levels.

Signaling Pathways Mediating Bradykinin-Induced Contraction in Murine and Human Detrusor Muscle.

Bradykinin (BK) has been proposed to modulate urinary bladder functions and implicated in the pathophysiology of detrusor overactivity. The present study aims to elucidate the signaling pathways of BK-induced detrusor muscle contraction, with the goal of better understanding the molecular regulation of micturition and identifying potential novel therapeutic targets of its disorders. Experiments have been carried out on bladders isolated from wild-type or genetically modified [smooth muscle-specific knockout (KO): Gαq/11-KO, Gα12/13-KO and constitutive KO: thromboxane prostanoid (TP) receptor-KO, cyclooxygenase-1 (COX-1)-KO] mice and on human bladder samples. Contractions of detrusor strips were measured by myography. Bradykinin induced concentration-dependent contractions in both murine and human bladders, which were independent of secondary release of acetylcholine, ATP, or prostanoid mediators. B2 receptor antagonist HOE-140 markedly diminished contractile responses in both species, whereas B1 receptor antagonist R-715 did not alter BK's effect. Consistently with these findings, pharmacological stimulation of B2 but not B1 receptors resembled the effect of BK. Interestingly, both Gαq/11- and Gα12/13-KO murine bladders showed reduced response to BK, indicating that simultaneous activation of both pathways is required for the contraction. Furthermore, the Rho-kinase (ROCK) inhibitor Y-27632 markedly decreased contractions in both murine and human bladders. Our results indicate that BK evokes contractions in murine and human bladders, acting primarily on B2 receptors. Gαq/11-coupled and Gα12/13-RhoA-ROCK signaling appear to mediate these contractions simultaneously. Inhibition of ROCK enzyme reduces the contractions in both species, identifying this enzyme, together with B2 receptor, as potential targets for treating voiding disorders.

Location-Scale Models in Demography: A Useful Re-parameterization of Mortality Models.

Several parametric mortality models have been proposed to describe the age pattern of mortality since Gompertz introduced his "law of mortality" almost two centuries ago. However, very few attempts have been made to reconcile most of these models within a single framework. In this article, we show that many mortality models used in the demographic and actuarial literature can be re-parameterized in terms of a general and flexible family of models, the family of location-scale (LS) models. These models are characterized by two parameters that have a direct demographic interpretation: the location and scale parameters, which capture the shifting and compression dynamics of mortality changes, respectively. Re-parameterizing a model in terms of the LS family has several advantages over its classic formulation. In addition to aiding parameter interpretability and comparability, the statistical estimation of the LS parameters is facilitated due to their significantly lower correlation. The latter, in turn, further improves parameter interpretability and reduces estimation bias. We show the advantages of the LS family over the typical parameterization of mortality models with two illustrations using the Human Mortality Database.

Two stochastic processes shape diverse senescence patterns in a single-cell organism.

Despite advances in aging research, a multitude of aging models, and empirical evidence for diverse senescence patterns, understanding of the biological processes that shape senescence is lacking. We show that senescence of an isogenic Escherichia coli bacterial population results from two stochastic processes. The first process is a random deterioration process within the cell, such as generated by random accumulation of damage. This primary process leads to an exponential increase in mortality early in life followed by a late age mortality plateau. The second process relates to the stochastic asymmetric transmission at cell fission of an unknown factor that influences mortality. This secondary process explains the difference between the classical mortality plateaus detected for young mothers' offspring and the near nonsenescence of old mothers' offspring as well as the lack of a mother-offspring correlation in age at death. We observed that lifespan is predominantly determined by underlying stochastic stage dynamics. Surprisingly, our findings support models developed for metazoans that base their arguments on stage-specific actions of alleles to understand the evolution of senescence. We call for exploration of similar stochastic influences that shape aging patterns beyond simple organisms.

Complexity of the relationship between life expectancy and overlap of lifespans.

Longevity has long been recognised as a key facilitator of reciprocal altruism because repeated cooperation of partners hinges on mutual survival. Although demographic tools can be used to quantify mutual survival and expected overlapping lifespans, studies on the evolutionary theory of cooperation take only limited advantage of demography. Overlap of lifespans depends on variation in survival across ages and can be high or low independently of high or low life expectancies. Here we develop formal demographic measures to study the complex relationships between shared life expectancy of two birth cohort peers, the proportion of their lives that they can expect to overlap, and longevity. We simulate age-specific mortality schedules using a Siler model to reveal how infant and senescent mortality, along with age-independent mortality, affect the relationship between the proportion of life shared and life expectancy. We find that while the proportion of life shared can vary vastly for similar life expectancies, almost all changes to mortality schedules that result in higher life expectancies also result in higher proportions of life shared. A distinct exception occurs if life expectancy increases due to lowering the rate of senescence. In this case the proportion of life shared decreases. Our work shows that almost all selective pressures that result in higher life expectancies also result in a larger proportion of life shared. Therefore, selective forces that extend life also improve the chances that a cooperative system would be stable in terms of reciprocal interactions. Since reciprocal interactions may also reduce mortality and result in a feedback loop with the evolution of longevity, our measures and findings can be used for future cross-species comparisons that aim to disentangle predecessor and successor in the evolution of longevity and cooperation.

The emergence of longevous populations.

The human lifespan has traversed a long evolutionary and historical path, from short-lived primate ancestors to contemporary Japan, Sweden, and other longevity frontrunners. Analyzing this trajectory is crucial for understanding biological and sociocultural processes that determine the span of life. Here we reveal a fundamental regularity. Two straight lines describe the joint rise of life expectancy and lifespan equality: one for primates and the second one over the full range of human experience from average lifespans as low as 2 y during mortality crises to more than 87 y for Japanese women today. Across the primate order and across human populations, the lives of females tend to be longer and less variable than the lives of males, suggesting deep evolutionary roots to the male disadvantage. Our findings cast fresh light on primate evolution and human history, opening directions for research on inequality, sociality, and aging.

Rise, stagnation, and rise of Danish women's life expectancy.

Health conditions change from year to year, with a general tendency in many countries for improvement. These conditions also change from one birth cohort to another: some generations suffer more adverse events in childhood, smoke more heavily, eat poorer diets, etc., than generations born earlier or later. Because it is difficult to disentangle period effects from cohort effects, demographers, epidemiologists, actuaries, and other population scientists often disagree about cohort effects' relative importance. In particular, some advocate forecasts of life expectancy based on period trends; others favor forecasts that hinge on cohort differences. We use a combination of age decomposition and exchange of survival probabilities between countries to study the remarkable recent history of female life expectancy in Denmark, a saga of rising, stagnating, and now again rising lifespans. The gap between female life expectancy in Denmark vs. Sweden grew to 3.5 y in the period 1975-2000. When we assumed that Danish women born 1915-1945 had the same survival probabilities as Swedish women, the gap remained small and roughly constant. Hence, the lower Danish life expectancy is caused by these cohorts and is not attributable to period effects.

DNA methylation age is associated with mortality in a longitudinal Danish twin study.

An epigenetic profile defining the DNA methylation age (DNAm age) of an individual has been suggested to be a biomarker of aging, and thus possibly providing a tool for assessment of health and mortality. In this study, we estimated the DNAm age of 378 Danish twins, age 30-82 years, and furthermore included a 10-year longitudinal study of the 86 oldest-old twins (mean age of 86.1 at follow-up), which subsequently were followed for mortality for 8 years. We found that the DNAm age is highly correlated with chronological age across all age groups (r = 0.97), but that the rate of change of DNAm age decreases with age. The results may in part be explained by selective mortality of those with a high DNAm age. This hypothesis was supported by a classical survival analysis showing a 35% (4-77%) increased mortality risk for each 5-year increase in the DNAm age vs. chronological age. Furthermore, the intrapair twin analysis revealed a more-than-double mortality risk for the DNAm oldest twin compared to the co-twin and a 'dose-response pattern' with the odds of dying first increasing 3.2 (1.05-10.1) times per 5-year DNAm age difference within twin pairs, thus showing a stronger association of DNAm age with mortality in the oldest-old when controlling for familial factors. In conclusion, our results support that DNAm age qualifies as a biomarker of aging.

Gompertz-Makeham life expectancies: expressions and applications.

In a population of individuals, whose mortality is governed by a Gompertz-Makeham hazard, we derive closed-form solutions to the life-expectancy integral, corresponding to the cases of homogeneous and gamma-heterogeneous populations, as well as in the presence/absence of the Makeham term. Derived expressions contain special functions that aid constructing high-accuracy approximations, which can be used to study the elasticity of life expectancy with respect to model parameters. Knowledge of Gompertz-Makeham life expectancies aids constructing life-table exposures.