title: The immune risk phenotype is associated with IL-6 in the terminal decline stage: findings from the Swedish NONA immune longitudinal study of very late life functioning.
abstract: In the present NONA immune longitudinal study, we further examine the previously identified T cell immune risk phenotype (IRP), relative inflammatory activity, morbidity and 2-year mortality in very old individuals >90 years. T-cell subsets as well as the inflammatory markers IL-6, IL-10, C-reactive protein, transthyretin and albumin were evaluated. IRP and low-grade inflammation predicted 57% of observed deaths and 97% of survival over 2 years, and was not significantly affected by individuals' health status, suggesting that the physiological ageing processes of T-cell immunosenescence and low-grade inflammation are of primary importance in late life survival. IRP non-survivors showed only a minor inflammatory activity at baseline, but had in contrast to survivors developed increased activity at follow-up. The results suggest a sequence of stages for IRP individuals that begin with acquisition of CMV infection in earlier life, followed by generation of CD8+CD28- cells to control persistent CMV infection and eventually the development of an IRP. Intriguingly, we also found that rare individuals moved out of the IRP category by a process of immune suppression, including increases in IL-6 and IL-10 and decreases in the number of CD3+CD8+CD28- cells. The further characterisation of these exceptional individuals may allow insight into remedial approaches for those who remain in the IRP category until death.
authors.affiliation: Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Box 1026, 551 11 Jönköping, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Wikby
authors.forename: Bengt-Olof
authors.initials: BO
authors.lastname: Nilsson
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Forsey
authors.forename: Julie
authors.initials: J
authors.lastname: Thompson
authors.forename: Jan
authors.initials: J
authors.lastname: Strindhall
authors.forename: Sture
authors.initials: S
authors.lastname: Löfgren
authors.forename: Jan
authors.initials: J
authors.lastname: Ernerudh
authors.forename: Graham
authors.initials: G
authors.lastname: Pawelec
authors.forename: Frederick
authors.initials: F
authors.lastname: Ferguson
authors.forename: Boo
authors.initials: B
authors.lastname: Johansson
mesh_terms: D000369:Aged, 80 and over; D000375:Aging / Q000276:immunology*; D000418:Albumins / Q000276:immunology; D001835:Body Weight; D002097:C-Reactive Protein / Q000032:analysis; D016516:CD4-CD8 Ratio; D005260:Female; D006801:Humans; D007239:Infections; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D011228:Prealbumin / Q000032:analysis; D013601:T-Lymphocytes / Q000166:cytology / Q000276:immunology*
chemical_list: D000418:Albumins; D015850:Interleukin-6; D011228:Prealbumin; D002097:C-Reactive Protein