Nutrition and Age-Associated Inflammation :Role of Nutritional Intervention Simin Nikbin Meydani, DVM, PhD.

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1 Nutrition and Age-Associated Inflammation :Role of Nutritional Intervention Simin Nikbin Meydani, DVM, PhD

2 Outline 1) Role of immune and inflammatory responses in age-related diseases 2) Brief description of mechanism of age-related increase in macrophage inflammatory products and its contribution to ageassociated decline in T cell function and increase susceptibility to infectious diseases. 3) Age-associated adipose tissue inflammation and its implication for type 2 diabetes 4) Use of nutritional strategies to reverse macrophage inflammation and its impact for reducing the risk of infectious diseases.

3 Auto immune diseases Antibody response Infection Cancer B Cell Function T Cell Function Immune, Inflammatory Dysregulation and Age-Related Disease Macrophage Inflammatory products CVD Alzeheimer s disease Osteoprosis Type II Diabetes Cancer Adipose Tissue Inflammatory products Type II Diabetes

4 Cytokine and PGE2 Production by LPS-stimulated M of Young and Old Mice (pg/ g protein) Young Old IL-1 4 ± 1 20 ± 4 IL-6 60 ± ± 22 TNF- 5 ± 1 5 ± 1 IL ± ± 7 PGE 2 85 ± ± 50 Mean ± SE, n=11-13/group Significant age effect a Ren et al., Unpublished data

5 PGE 2 and Immune Function in the Aged T cell function declines with aging in both animals and humans Increased PGE 2 production contributes to the age- associated suppression in T cell function (Beharka et al., Mech. Aging Devel. 93:59-77, 1997) PGE 2 is also implicated in pathogenesis of inflammatory, cardiovascular, and neoplastic diseases, incidence of which increases with age

6 Membrane Phospholipid Phospholipase A 2 Arachidonic Acid 12-LO 15-LO 5-LO COX PGH 2 12-HETE 15-HETE LTs PGI 2 TXA 2 PGE 2

Age-associated Increase in COX-2 mrna Expression Relative COX-2 mrna/actin 12 10

7 Age-associated Increase in COX-2 mrna Expression Relative COX-2 mrna/actin Hayek et al. J. Immunol. 1997; 159: Time (h) old young

8 What Is the Mechanism of Ageassociated Increase in COX-2 Expression?

9 Regulators of COX-2 Gene Expression COX-2 expression IL-1 TNF- IL ceramide IL-10 glucocorticoid GSH

10 Mediators of Age-associated COX-2 Expression young old X IL-1 IL-6 X TNF- X IL-10 X glucocorticoid X GSH ceramide X IL-1 IL-6 X TNF- X IL-10 X glucocorticoid X GSH ceramide

11 LPS GSH + - Sphingomyelin SMase Ceramide Erk, Jnk, p38 NFkB NF-IL6 CRE TATA COX-2 gene

12 Age-associated Increase in COX-2 Expression is Due to Ceramide-induced Upregulating of NF B Activation Old M have higher ceramide levels and NF B activity than young M. Addition of Ceramide increases NF B and COX-2 expression in young M. NF B inhibitors decrease COX-2 expression in old M Claycombe et al., JBC 277:30784, 2002 Wu et al., JBC; 278: 10983, 2003

13 Mechanism for age-associated increase in COX-2 transcription LPS PKC Ceramide NIK Bcl3? Aging Claycombe et al., JBC 277:30784, 2002 Wu et al., JBC; 278: 10983, 2003 I B P IKK IKK I B p65 p50 p65 p50 (C/EBP) NFkB NF-IL6 CRE TATA -223/ / /-53-31/-25 COX-2 gene

14 Auto immune diseases Antibody response Infection Cancer B Cell Function T Cell Function Immune, Inflammatory Dysregulation and Age-Related Disease Macrophage Inflammatory products CVD Alzeheimer s disease Osteoprosis Type II Diabetes Cancer Adipose Tissue Inflammatory products Type II Diabetes

15 Aging, Insulin Resistance, T2D incidence It has been known for a long time that glucose intolerance, insulin resistance, and T2D incidence are increased with advancing age.

16 Obesity Results in Insulin Resistance Through Inducing Macrophage Infiltration and Their Production of Inflammatory Cytokines Wellen and Hotamisligil, JCI, 112:1785, 2003

17 Sharp increase with age in diabetes incidence can t be entirely explained by the change in body weight and body composition Rate (per 100) Prevalence of obesity in US (2001) and over Age group (years) Prevalence of diagnosed diabetes in US (2004) 20 Rates of obesity in US adults with diabetes (2003) Rate (per 100) Rate (per 100) Age group (years) Age groups (years) CDC data (

18 Age-related Increase in Adipose Tissue Inflammation and its Underlying Mechanisms Ceramide Aging PKC-? PPAR- NF- B IL-6 TNF- Insulin resistance and other metabolic complications

19 Methods Dayong Wu, MD, PhD Animals: C57BL mice Young (5-6 mo) Old (23-24 mo) Adipocyte and SVC isolation: collagenase digestion mrna analysis: Real time RT-PCR M in AT: FACS and immunohistochemistry IL-6 and TNF- assay: ELISA PGE 2 assay: RIA Cell viability: MTS and LDH assays

20 Epididymal Adipose Tissue From Old Mice Have Higher Expression of Inflammatory Genes Relative quantification (Log) Young Old 0 COX-2 IL-1 IL-6 TNF PPAR-g Significantly different from Young mice Wu et al., JI, 179:4829, 2007

21 M (F4/80+ cells) in epididymal adipose tissues of young and old mice 100 x 400 x 1000 x Young Old Wu et al., JI, 179:4829, 2007

22 IL-6 and PGE 2 Production Is Not Significantly Different Between Stromal Vascular Cells of Young and Old Mice IL-6 (pg/ g protein) Young Old PGE2 (pg/ g protein) Young Old 0 Medium LPS 0 Medium LPS Mean+ SE, n=6 Wu et al., JI, 179:4829, 2007

23 Adipocytes From Old Mice Have Higher IL-6 and PGE 2 Production Than Those of Young Mice IL-6 (pg/ g DNA) Young Old PGE 2 (pg/ g DNA) Young Old 0 0 Medium LPS Medium LPS Significantly different from young mice. Mean+SE, n=7-10 Wu et al., JI, 179:4829, 2007

24 Old Adipocytes Have Higher Levels of Ceramide and Sphingomyelin Compared to Those From Young pmol/ g DNA Young Old pmol/ g DNA Young Old SM Cer GlcCer SO 0 S1P C1P Sphingolipids Phosphated sphingolipids SM: sphingomyelin; Cer: ceramide; ClcCer: glucosylated ceramide; SO: sphingosine; S1P: sphingosin-1-phosphate; C1P: ceramide-1-phosphate. Wu et al., JI, 179:4829, 2007

25 Ceramide Increases IL-6 Production by Adipocytes of Young and Old Mice control C2-ceramide C6-ceramide C IL-6 (pg/ g DNA) SMase c A B B 100 a b b 0 Young Old Significan age difference within each treatment. Mean+SE, n=6 Wu et al., JI, 179:4829, 2007

26 Ceramide Synthesis, Related Enzymes and Enzyme Inhibitors Sphingosine 1-phosphate Sphingosine Palmitoyl CoA Sphingosine kinase Ceramidase Ceramide synthase Sphingomyelin synthase + L-serine 3-keto sphinganine Sphinganine Dihydroceramdie Ceramide Sphingomyelin Serine palmitoyltransferase (SPT) Ketosphinganine reductase Dihydroceramide synthase Dihydroceramide desaturase Ceramide kinase Sphingomyelinase (SMase) GW4869 Myriocin FB1 Ceramide 1-phosphate Me-SM

27 Effect of inhibiting de novo ceramide synthesis and nsmase on LPS-stimulated IL-6 and TNF- production by adipocytes IL-6 TNF- IL-6 (pg/ g DNA) a A b B c C Young Old d C TNF- (pg/ g DNA) a A b B b C Young Old c D 0 LPS Myriocin Me-SM Myriocin+ Me-SM Treatment 0 LPS Myriocin Me-SM Myriocin+ Me-SM Treatment Mean ± SE, n=10 Different letters within each age denote significant difference at p<0.05. There is a significant difference between age group in every treatment.

28 Inhibiting NF- B Activation Reduces IL-6 Production by Adipocytes of Young and Old Mice Young Old IL-6 (pg/ g DNA) Medium Medium+Bay LPS LPS+Bay Treatment Wu et al., JI, 179:4829, 2007

29 Inhibiting NF- B Activation Reduces Sphingomyelinase-induced IL-6 Production by Mouse Adipocytes Young Old IL-6 (pg/ g DNA) Medium Medium+Bay SMase Smase+Bay Treatment Wu et al., JI, 179:4829, 2007

30 Summary 1. Adipose tissue expression of pro-inflammatory mediators is upregulated while anti-inflammatory and insulin-sensitizing factor PPAR- is downregulated with aging. 2. Unlike the changes observed in obesity, there is no apparent age-related difference in either M infiltration into adipose tissue or MCP-1 production by adipocytes. 3. Adipocytes and not non-adipocytes (stromal vascular cells) in adipose tissue may be the major player responsible for age-related upregulation of inflammatory products, suggesting a different mechanism from that in obesity.

31 Age-related Increase in Adipose Tissue Inflammation and its Underlying Mechanisms Ceramide Aging PKC-? PPAR- NF- B IL-6 TNF- Insulin resistance and other metabolic complications

32 Nutritional Intervention and Age- associated Inflammation Vitamin E n-3 PUFA Calorie restriction

33 Vitamin E and PGE 2 Production PGE2 (pg/ g protein) ppm E 500 ppm E young old Wu, et al., AJP 1998;275:C661

34 Vitamin E and Immune Response in the Older Adults Vitamin E supplementation of healthy elderly significantly improves in vivo and in vitro indices of T cellmediated function. Meydani et al. AJCN 1990; 52: Meydani et al. JAMA 1997; 277: Pallast et al. AJCN 69: ,1999.

35 Effect of Vitamin E Supplementation on Respiratory Infections Placebo Vitamin E OR (CI) All respiratory Infections Upper respiratory infections Lower respiratory infections 74% 65% 0.65 ( ) 62% 50% 0.62 ( ) 32% 33% 1.03 ( ) Significantly difeent from Placebo at p<0.05 Meydani et al. JAMA, 292: , 2004.

36 Vitamin E treatment did not have an overall effect on TNF production

37 Genetics influence cytokine production There is a high degree of variability in cytokine production between healthy individuals Genetic factors may explain variability in cytokine production SNPs may account for individual variability Single nucleotide polymorphisms (SNPs) are single base pair changes in the DNA. Identified at genes that encode cytokine proteins. SNP influence cytokine response impact infection

38 The Effect E on TNF- Production Depends on TNF- -308G>A Interaction: vitamin E and TNF-a -308G>A p=0.039 TNF-a Production (pg/ml) G/G TNF-a -308G>A Genotype A/G and A/A Adjusted for baseline TNF- production Placebo n=56 (G/G =46; A/G and A/A =10); Vitamin E group n=39 (G/G=22; A/G and A/A =17) Placebo Vitamin E Belisle et al., JN, 2009

39 Concolusions These observations suggest that individual immune responses to vitamin E supplementation are in part mediated by genetic factors. Because A allele at TNF is associated with higher TNF levels, our observation suggest that the antiinflammatory effect of vitamin E is specific to those genetically predispose to higher inflammation.

40 Fish Oil Was Shown to Improve Clinical Symptoms In: Cardiovascular diseases Rheumatoid arthritis Psoriasis Multiple sclerosis Systemic lupus erythematosus Atopic dermatitis Ulcerative colitis

41 Modulatory Effect of EPA on Eicosanoid Synthesis Diet AA membrane phospholipids PLA 2 EPA AA LOX COX LOX COX LTB 5 PGE 3 LTB 4 PGE 2 Less inflammatory Inflammatory

42 Effect of Low-fat Diets High and Low in Fish on Ex-vivo Cytokine and PGE 2 Production Low fat, high fish low fat, low fish % change # IL TNF IL PGE # Compared to their own baseline Meydani et al., JCI; 92:105-1, 1993

43 Comprehensive Assessment of Longterm Effects of Reducing Intake of Energy CALERIE Jean Mayer USDA HNRCA at TUFTS UNIVERSITY BOSTON, MA

44 Experimental Design Design: Randomized, controlled, single-blind Subjects: Men and women, years old, with BMI of Kg/m 2 Intervention: 10 or 30% calorie restriction. DTH: Baseline and after 6 mo. In vitro immune measures: Baseline and after 6 mo.

45 Effect of Calorie Restriction on LPS-Stimulated PGE 2 Production 2500 PGE2 (pg/ml) M0 M6 0 10% 30% Significantly different from baseline Ahmed et al. J. Gerontology, 2009

46 Effect of Calorie Restriction on Delayed Type Hypersensitivity Skin Response Total diameter of Maximum induration (mm) % restricted 30% restricted Baseline 6-month Significantly different from baseline Ahmed et al. J. Gerontology, 2009

47 Effects of Calorie Restriction on Lymphocyte Proliferation cpm Anti CD3 Baseline 6-month 0 10% restricted 30% resricted ConA PHA cpm cpm % restricted 30% resricted 10% restricted 30% resricted Significantly different from baseline Ahmed et al. J. Gerontology, 2009

48 Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University Advancing Healthy Aging Through Nutrition Research

Age and Nutrition-induced changes in Immune and Inflammatory Response: Implications for Disease Prevention Simin Nikbin Meydani, DVM, PhD

Age and Nutrition-induced changes in Immune and Inflammatory Response: Implications for Disease Prevention Simin Nikbin Meydani, DVM, PhD Tufts University, Jean Mayer United States Department of Agriculture