Lung-Targeted Delivery of Dimethyl Fumarate Promotes the Reversal of Age-Dependent Established Lung Fibrosis

Idiopathic pulmonary fibrosis (IPF), a severe and deadly form of lung fibrosis, is widely regarded as a disease of aging. We previously demonstrated that aged mice with persistent lung fibrosis and IPF lung myofibroblasts exhibit deficient Nrf2-mediated antioxidant responses. Tecfidera is an orally administered FDA-approved drug for the treatment of multiple sclerosis, where the active pharmaceutical ingredient is dimethyl fumarate (DMF), an active Nrf2 activator. However, no studies have evaluated the efficacy of DMF for age-associated persistent lung fibrosis. Here, we demonstrate that in IPF lung fibroblasts, DMF treatment inhibited both TGF-β-mediated pro-fibrotic phenotypes and led to a reversal of established pro-fibrotic phenotypes. We also evaluated the pre-clinical efficacy of lung-targeted (inhaled) vs. systemic (oral) delivery of DMF in an aging murine model of bleomycin-induced persistent lung fibrosis. DMF or vehicle was administered daily to aged mice by oral gavage or intranasal delivery from 3-6 weeks post-injury when mice exhibited non-resolving lung fibrosis. In contrast to systemic (oral) delivery, only lung-targeted (inhaled) delivery of DMF restored lung Nrf2 expression levels, reduced lung oxidative stress, and promoted the resolution of age-dependent established fibrosis. This is the first study to demonstrate the efficacy of lung-targeted DMF delivery to promote the resolution of age-dependent established lung fibrosis.

Leveraging ageing models of pulmonary fibrosis: the efficacy of nintedanib in ageing

Nintedanib is one of two US Food and Drug Administration (FDA)-approved treatments for idiopathic pulmonary fibrosis (IPF). The clinical efficacy of nintedanib for inhibiting the progression of lung fibrosis is well-established [1]. However, although nintedanib is overwhelmingly prescribed to elderly patients, the impact of ageing on its efficacy is difficult to discern from clinical data due to the magnitude of confounding variables that exist among human subjects (genetics, gender, comorbidities, disease stage at the onset of treatment, etc.). A recent post hoc meta-analysis of five IPF clinical trials suggested that the effect of nintedanib in reducing the rate of forced vital capacity decline is consistent across patients with age (patients >75 versus patients <75 years of age) [2]. However, it is important to note that the average age of IPF diagnosis is 66 years and the average patient ages in these cohorts were 78 (>75) versus 64 (<75) years. Further, one could argue that patients in both cohorts represent the elderly population. This study highlights the complexity of evaluating the impact of ageing on efficacy in a clinical setting. To date, all pre-clinical efficacy studies with nintedanib have been performed in young animals. We therefore sought to determine whether ageing impacts the efficacy of nintedanib for inhibiting the development of lung fibrosis. Bleomycin-induced lung injury in young (2 month) and aged (18 month) mice was followed by treatment with nintedanib or vehicle from day 10–21 (figure 1a), using a previously described protocol [3]. We previously demonstrated in this injury model that the severity of lung fibrosis is identical in young and aged mice, in terms of the net increase in total lung collagen following injury [4]. Although some prior studies have reported seemingly contradictory results, indicating increased severity of fibrosis in aged mice [5, 6], this discrepancy could be attributed to increased baseline levels of collagen in aged mice and the methodology/analyses used for fibrosis assessment, as the net increase in collagen appear to be similar in both young and aged mice [5, 6]. In line with our previous findings, both young and aged vehicle-treated mice demonstrated similar levels of fibrosis severity and a similar decline in lung function at 3 weeks post-injury (figure 1b–d, g–h). Also consistent with numerous prior reports [7, 8], we found that in young mice, nintedanib demonstrated efficacy for inhibiting the development of fibrosis (figure 1b–g) and led to improved lung function (figure 1h). Interestingly, nintedanib also significantly inhibited the development of lung fibrosis in aged mice, to a similar extent as young cohorts (figure 1b–g). Although nintedanib treatment resulted in lung functional improvement to a similar extent in both young (49%) and aged (57%) mice (figure 1h), results did not reach statistical significance in aged mice. Of note, there is less than 47% power to detect mean differences between the aged-vehicle and aged-nintedanib groups given the observed effect and sample sizes of aged mice; the trending p-value of 0.06 is displayed to provide a better understanding of the results. No significant differences in survival rate were observed between nintedanib- versus vehicle-treated groups for both young (68% versus 72%, respectively) and aged mice (83% versus 76%, respectively) during this treatment period (day 10–21). Overall, these data indicate that ageing does not impact the efficacy of nintedanib in terms of its ability to inhibit the development of de novo lung fibrosis.

Although nintedanib is overwhelmingly prescribed to elderly patients, this is the first study to demonstrate that ageing does not impact the efficacy of nintedanib. This study sheds light on the utility of aged animal models in pulmonary fibrosis.https://bit.ly/3zA9RC5

Impaired Myofibroblast Dedifferentiation Contributes to Nonresolving Fibrosis in Aging

Idiopathic pulmonary fibrosis (IPF) is a fatal age-associated disease with no cure. Although IPF is widely regarded as a disease of aging, the cellular mechanisms that contribute to this age-associated predilection remain elusive. In this study, we sought to evaluate the consequences of senescence on myofibroblast cell fate and fibrotic responses to lung injury in the context of aging. We demonstrated that nonsenescent lung myofibroblasts maintained the capacity for dedifferentiation, whereas senescent/IPF myofibroblasts exhibited an impaired capacity for dedifferentiation. We previously demonstrated that the transcription factor MyoD acts as a critical switch in the differentiation and dedifferentiation of myofibroblasts. Here, we demonstrate that decreased levels of MyoD preceded myofibroblast dedifferentiation and apoptosis susceptibility in nonsenescent cells, whereas MyoD expression remained elevated in senescent/IPF myofibroblasts, which failed to undergo dedifferentiation and demonstrated resistance to apoptosis. Genetic strategies to silence MyoD restored the susceptibility of IPF myofibroblasts to undergo apoptosis and led to a partial reversal of age-associated persistent fibrosis in vivo. The capacity for myofibroblast dedifferentiation and subsequent apoptosis may be critical for normal physiologic responses to tissue injury, whereas restricted dedifferentiation and apoptosis resistance in senescent cells may underlie the progressive nature of age-associated human fibrotic disorders. These studies support the concept that senescence may promote profibrotic effects via impaired myofibroblast dedifferentiation and apoptosis resistance, which contributes to myofibroblast accumulation and ultimately persistent fibrosis in aging.

Long-term seafloor monitoring at an open ocean aquaculture site in the western Gulf of Maine, USA: development of an adaptive protocol

The seafloor at an open ocean finfish aquaculture facility in the western Gulf of Maine, USA was monitored from 1999 to 2008 by sampling sites inside a predicted impact area modeled by oceanographic conditions and fecal and food settling characteristics, and nearby reference sites. Univariate and multivariate analyses of benthic community measures from box core samples indicated minimal or no significant differences between impact and reference areas. These findings resulted in development of an adaptive monitoring protocol involving initial low-cost methods that required more intensive and costly efforts only when negative impacts were initially indicated. The continued growth of marine aquaculture is dependent on further development of farming methods that minimize negative environmental impacts, as well as effective monitoring protocols. Adaptive monitoring protocols, such as the one described herein, coupled with mathematical modeling approaches, have the potential to provide effective protection of the environment while minimize monitoring effort and costs.

Quantifying calculus: A suggested new approach for recording an important indicator of diet and dental health

This paper describes a quantitative approach to the assessment of dental calculus in human archaeological skeletal samples. The approach combines the ranked calculus scoring method described by Buikstra and Ubelaker [1994. Arkansas Archeological Survey Research Series, Arkansas Archeological Survey, Fayetteville, Arkansas] and a modified Simplified Calculus Index, utilized by dental clinicians. We recorded amounts of calculus on the buccal, lingual, and interproximal surface of all extant teeth, and generated an index for the maxillary posterior dentition, maxillary anterior dentition, mandibular posterior dentition, and mandibular anterior dentition for three skeletal samples. They include 145 Egyptian Predynastic individuals from the site of Hierakonpolis, 104 Predynastic individuals from Naqada, Egypt, and 101 Meroitic Nubians from Semna South, present-day Sudan. Mann-Whitney U tests were used to analyze differences between the sexes and among age groups at each site. The results demonstrate that the calculus indices more effectively reveal trends and differences in calculus severity than frequency data can alone. For example, at Hierakonpolis, males (18-35 years) had significantly more calculus in the maxillary posterior dentition than females, while females (50+ years) had significantly more calculus in the maxillary posterior teeth. Frequency data merely showed that 94% of both males and females had calculus. The use of calculus indices can reveal how quickly calculus accumulates with age within the dental arcade and within a sample. Moreover, better understanding of the severity and location of calculus can improve a researcher's knowledge regarding the effect of calculus on dental pathologies, such as carious lesions and periodontal disease.

Palatine torus in the pre-conquest inhabitants of the Canary Islands

An unusually high frequency of palatine torus in prehistoric Canary Islands skeletal remains is investigated in terms of population origins, evolutionary forces (gene flow and genetic drift) and environmental effects. Palatine torus frequencies (percent presence) are compared between the Canary Islands sample and skeletal samples from proposed ancestral regions, including northwest Africa, northeast Africa, sub-Saharan Africa, southern Europe, northern Europe and western Asia. The frequency of palatine torus is much higher in the Canary Islands sample (23.8%) than in samples from Northern and sub-Saharan Africa (1.8-6.1%), southern Europe (7.5%) and western Asia (2.1%), but is much lower than in the sample from northern Europe (57.4%). Because biological and archaeological evidence provide strong support for a northwest African origin for indigenous Canary Islands populations, the relatively high occurrence of palatine torus in the Canary Islands populace cannot be explained by an alternative ancestry; rather, it may be best explained by either evolutionary forces such as genetic drift or gene flow, or by environmental forces, such as hard chewing or a heavy dependence on marine foods. Genetic drift and gene flow seem less likely, since frequencies of other dental traits known to be under strong genetic control do not differ greatly between the prehistoric Canary Islands and northwest African samples. Environmental factors such as diet seem the most likely explanation and may include heavy consumption of marine foods, which has been implicated in torus formation.

Canary islands-north African population affinities: measures of divergence based on dental morphology

This investigation addresses two related questions about the origins and biological affinities of the Canary Islands' aboriginal inhabitants. First: With which North African populations do the pre-conquest inhabitants of the Canary Islands have their greatest affinities? Second: Does inter-island biological variability among the Canary Islanders, as has been suggested by other researchers (Hooton 1925, Schwidetzky 1963), imply that potentially different founding populations remained distinct during the pre-conquest period? This study employs dental morphology data derived from pre-conquest skeletons to answer these questions. Non-metric dental traits appear to be controlled by polygenic systems with a low to moderate environmental contribution to the resulting phenotype (Berry 1978, Harris & Bailit 1980, Nichol 1990) and can thus be assumed to reflect genetic relationships. The dental morphology of a sample of Canary Islanders (n = 397) is compared to that of Northwest African samples of Algerian Shawia Berbers (n = 26), Kabyle Berbers (n = 32), Bedouin Arabs (n = 49) and Punic Carthaginians (n = 28) as well as to six samples from Northeast Africa (n = 307) included for the purpose of understanding Canary Islanders' affinities within a wider context. The analysis employs 28 dental traits, quantifying differences in their expression among the various samples through a summary statistic, CAB Smith's Mean Measure of Divergence (MMD). The MMD analysis indicates that the Canary Island sample is most similar to the four samples from Northwest Africa: the Shawia Berbers, Kabyle Berbers, Bedouin Arabs and Carthaginians, less similar to the three Egyptian samples and least like the three Nubian samples. An intra-island comparison among samples from La Gomera, Gran Canaria and Tenerife reveals low, insignificant MMD values in all cases, implying that inter-island dental morphology differences are not so great as to require hypotheses of separate founding populations.

The Iberomaurusian enigma: north African progenitor or dead end?

Data obtained during an ongoing dental investigation of African populations address two long-standing, hotly debated questions. First, was there genetic continuity between Late Pleistocene Iberomaurusians and later northwest Africans (e.g., Capsians, Berbers, Guanche)? Second, were skeletally-robust Iberomaurusians and northeast African Nubians variants of the same population? Iberomaurusians from Taforalt in Morocco and Afalou-Bou-Rhummel in Algeria, Nubians from Jebel Sahaba in Sudan, post-Pleistocene Capsians from Algeria and Tunisia, and a series of other samples were statistically compared using 29 discrete dental traits to help estimate diachronic local and regional affinities. Results revealed: (1) a relationship between the Iberomaurusians, particularly those from Taforalt, and later Maghreb and other North African samples, and (2) a divergence among contemporaneous Iberomaurusians and Nubian samples. Thus, some measure of long-term population continuity in the Maghreb and surrounding region is supported, whereas greater North African population heterogenity during the Late Pleistocene is implied.

Ancestral dental traits in recent Sub-Saharan Africans and the origins of modern humans

Assuming that phenetic expression approximates genetic variation, previous dental morphological analyses of Sub-Saharan Africans by the author show they are unique among the world's modern populations. Numerically-derived affinities, using the multivariate Mean Measure of Divergence statistic, revealed significant differences between the Sub-Saharan folk and samples from North Africa, Europe, Southeast Asia, Northeast Asia and the New World, Australia/Tasmania, and Melanesia. Sub-Saharan Africans are characterized by a collection of unique, mass-additive crown and root traits relative to these other world groups. Recent work found that the most ubiquitous of these traits are also present in dentitions of earlier hominids, as well as extinct and extant non-human primates; other ancestral dental features are also common in these forms. The present investigation is primarily concerned with this latter finding. Qualitative and quantitative comparative analyses of Plio-Pleistocene through recent samples suggest that, of all modern populations, Sub-Saharan Africans are the least derived dentally from an ancestral hominid state; this conclusion, together with data on intra- and inter-population variability and divergence, may help provide new evidence in the search for modern human origins.

Characteristic high- and low-frequency dental traits in sub-Saharan African populations

In an earlier investigation (Irish [1993] Biological Affinities of Late Pleistocene Through Modern African Aboriginal Populations: The Dental Evidence [Ann Arbor: University Microfilms]), biological affinities of 32 sub-Saharan and North African dental samples were estimated using comparative analyses of 36 dental morphological traits. Marked dental homogeneity was revealed among samples within each of the two geographic regions, but significant interregional differences were noted. Assuming dental phenetic expression approximates or is an estimate of genetic variation, the present study of 976 sub-Saharan-affiliated Africans indicates they are not closely related to other world groups; they are characterized by numerous morphologically complex crown and root traits. Turner ([1984] Acta Anthropogenetica 8:23-78; [1985] in R Kirk and E Szathmary (eds.): Out of Asia: Peopling the Americas and the Pacific [Canberra: The Journal of Pacific History], pp. 31-78; [1990] Am. J. Phys. Anthropol. 82:295-318; [1992] Persp. Hum. Biol. 2/Archaeol. Oceania 27:120-127; [1992] in T Akaszawa, K Aoki, and T Kimura (eds.): The Evolution and Dispersal of Modern Humans in Asia [Tokyo: Hokusen-Sha Publishing Co-], pp. 415-438) reports that Northeast Asian/New World sinodonts also have complex teeth relative to Europeans, Southeast Asian sundadonts, Australian/Tasmanians, and Melanesians. However, sinodonty is characterized by UI1 winging, UI1 shoveling, UI1 double shoveling, one-rooted UP1, UM1 enamel extension, M3 agenesis, and three-rooted LM1. Sub-Saharan peoples exhibit very low frequencies of these features. It is proposed that the collection of dental traits which best differentiate sub-Saharan Africans from other worldwide samples includes high frequencies of the Bushman Canine, two-rooted UP1, UM1 Carabelli's trait, three-rooted UM2, LM2 Y-groove pattern, LM1 cusp 7, LP1 Tome's root, two-rooted LM2, UM3 presence, and very low incidences of UI1 double shoveling and UM1 enamel extension. This suite of diagnostic traits is termed the sub-Saharan African dental complex.

Brief communication: first evidence of LSAMAT in non-native Americans: historic Senegalese from west Africa

To date, the distinctive dental wear pattern known as LSAMAT, or "lingual surface attrition of the maxillary anterior teeth," has been documented in prehistoric samples from Brazil, Panama, and Puerto Rico only. However, new data from a historic Senegalese sample reveals the first example of this wear pattern outside the Americas. The Senegal LSAMAT is present in 45% of 22 adult crania, and is associated with a caries rate of 40% in 38 adults (6.7% of 534 permanent teeth). A correlation between LSAMAT and caries was also observed in the Latin American samples. In these cases, it was hypothesized that LSAMAT was caused by the specialized consumption of an abrasive, high carbohydrate food, such as manioc. Manioc is a common cultigen in Senegal; thus, it may have also caused the African LSAMAT. The chewing of sugar cane could have been an additional, contributing factor.

Hypoplastic area method for analyzing dental enamel hypoplasia

Most analyses of dental enamel hypoplasia compare frequencies of disturbed tooth types, which do not account for variability in the area of affected enamel. An alternate methodology, hypoplastic area, is presented here that accounts for this variability by combining acute and continuous enamel hypoplasia into an interval-level variable. The method compares samples based on individuals, by multiple tooth type variables, or by a single value rather than by tooth types. Use of the hypoplastic area method is illustrated by analyzing human skeletal dentitions in three archaeological samples: Meroitic Nubians from Semna South, Sudan; Anasazi from Navajo Reservoir, New Mexico; and Mogollon from Grasshopper Pueblo, Arizona. Both univariate and multivariate statistical tests are employed to assess variation in defects between individuals and samples. By incorporating measurements of continuous defects, the hypoplastic area method provides information beyond that of frequency data in comparing levels of stress. Flexibility of the method is also discussed.

Morphological and metrical comparison of San and Central Sotho dentitions from southern Africa

Comparative morphological and metrical study of San and Central Sotho dentitions indicates that the teeth of the two samples are significantly different from one another. The San dental complex contains traits that add mass to the occlusal surface of microdontic dentitions: moderate low-grade UI1 (13.5%) and UI2 shoveling (24.7%), high Bushman canine (43.1%), fairly low UM2 hypocone reduction (23.3%), high UM2 cusp 5 (55.6%), high LM1 cusp 7 (35.2%), LM1 distal trigonid crest (7.1%), and LM2 deflecting wrinkle (5.3%), lack of reduction of LM1 and LM2 cusp number, in the presence of very low UM1 Carabelli's trait (6.7%) and high LM2 Y-groove (86.3%). Culturally, males occasionally exhibit filed UI1 and females are missing LI1. Conversely, mesodontic Central Sotho dentitions display a more simplified morphology, with the exception of moderately high incidence of UM1 Carabelli's trait (41.0%) and very high LM1 cusp 7 (71.3%). Discriminant analysis of mesiodistal and buccolingual diameters and tooth crown surface area data for the left maxillary teeth supports classification of San dentitions as microdont and Central Sotho dentitions as mesodont. Additionally, metrical analysis indicates that San teeth are more sexually dimorphic than are those of Central Sotho.

More lingual surface attrition of the maxillary anterior teeth in American Indians: prehistoric Panamanians

Lingual surface attrition of the maxillary anterior teeth (LSA-MAT) has been found in additional prehistoric Latin American Indian skeletons. LSAMAT was first observed in crania from an Archaic Brazilian site. This second finding occurs in teeth from Venado Beach, a late prehistoric site in Panama. LSAMAT is also present in some fragmentary specimens from the Archaic Cerro Mangote site in Panama. LSAMAT at Venado Beach is present in 57% of 28 adult crania. As in the Brazilian study, LSAMAT is associated with a high caries rate (82% of 50 adults; 11.7% of 852 permanent teeth). As first suggested, eating and processing of some type of abrasive carbohydrate food, such as manioc, is the possible cause of LSAMAT. However, other possible causes relating to habitation on or near marine coasts cannot be totally ruled out.