Haagen D. Klaus

Frontiers in the bioarchaeology of stress and disease: Cross‐disciplinary perspectives from pathophysiology, human biology, and epidemiology

Over the last four decades, bioarchaeology has experienced significant technical growth and theoretical maturation. Early 21st century bioarchaeology may also be enhanced from a renewed engagement with the concept of biological stress. New insights on biological stress and disease can be gained from cross-disciplinary perspectives regarding human skeletal variation and disease. First, pathophysiologic and molecular signaling mechanisms can provide more precise understandings regarding formation of pathological phenotypes in bone. Using periosteal new bone formation as an example, various mechanisms and pathways are explored in which new bone can be formed under conditions of biological stress, particularly in bone microenvironments that involve inflammatory changes. Second, insights from human biology are examined regarding some epigenetic factors and disease etiology. While epigenetic effects on stress and disease outcomes appear profoundly influential, they are mostly invisible in skeletal tissue. However, some indirect and downstream effects, such as the developmental origins of adult health outcomes, may be partially observable in bioarchaeological data. Emerging perspectives from the human microbiome are also considered. Microbiomics involves a remarkable potential to understand ancient biology, disease, and stress. Third, tools from epidemiology are examined that may aid bioarchaeologists to better cope with some of the inherent limitations of skeletal samples to better measure and quantify the expressions of skeletal stress markers. Such cross-disciplinary synergisms hopefully will promote more complete understandings of health and stress in bioarchaeological science.

Subadult scurvy in Andean South America: Evidence of vitamin C deficiency in the late pre-Hispanic and Colonial Lambayeque Valley, Peru

Scurvy is a disease caused by vitamin C deficiency and is a key paleopathological indicator of subadult health and nutritional status in the past. Yet, little is known about scurvy in human remains from South America and the Peruvian Central Andes in particular. In the Lambayeque Valley Complex on the north coast of Peru, a sample of 641 archaeologically recovered subadults (A.D. 900-1750) were scored for the skeletal manifestations of vitamin C deficiency, testing the hypotheses that scurvy was common in this region and that prevalence increased following European contact. The findings reveal only five convincing cases of scurvy; overall prevalence appears extremely low, and scurvy did not become perceptibly more common following conquest. Of diagnostic interest, complex ectocranial vascular impressions were documented in two cases. Though rarely attributed to scurvy, examination suggests they formed during scorbutic episodes. Another Colonial Period subadult may demonstrate comorbidity between scurvy and rickets. This work also provides new questions for the investigation of scurvy in Andean South America.

Advancements, challenges, and prospects in the paleopathology of scurvy: Current perspectives on vitamin C deficiency in human skeletal remains

Every human being who has ever lived has shared an underying vulnerability to scurvy. This disease arose from a random utation that occurred in a basal anthropoid ancestor. Monkeys, pes, and hominins are unable to endogenously synthesize ascorbic cid, or vitamin C, which must be obtained from our diets. Among odern humans, deficiency of this vitamin is related to fundamenal intersections between underlying biology, diet, economy, social rganization, ecology, and behavior. Despite the fact that scurvy is metabolic disease that has such wide-ranging bioanthropological ignificance, it has been a neglected subject in paleopathology. This special issue of the International Journal of Paleopatholgy showcases recent advances in the study of scurvy in skeletal emains. It is also dedicated to the memory of Dr. Donald J. Ortner 1939–2012). His work represented singular contributions to the tudy of scurvy. Ortner helped to bring scurvy out of obscurity by eveloping modern diagnostic criteria to recognize the disease in keletal remains. He then applied those methods in the reconstrucion of the history and patterning of scurvy in the ancient Western emisphere. We seek to honor his career and memory in this colection of rigorous, anthropological studies that bring together the esearch of scholars from around the globe. Some of the papers escribe evidence of scurvy where it has not been documented reviously, and others focus on regional perspectives of scurvy in

Paleopathological rigor and differential diagnosis: Case studies involving terminology, description, and diagnostic frameworks for scurvy in skeletal remains

Diverse pathological processes can produce overlapping or even indistinguishable patterns of abnormal bone formation or destruction, representing a fundamental challenge in the understanding of ancient diseases. This paper discusses increasing rigor in differential diagnosis through the paleopathological study of scurvy. First, paleopathologys use of descriptive terminology can strive to more thoroughly incorporate international standards of anatomical terminology. Second, improved observation and description of abnormal skeletal features can help distinguish between anemia or vitamin C deficiency. Third, use of a structured rubric can assist in establishing a more systematic, replicable, and precise decision-making process in differential diagnosis. These issues are illustrated in the study of two new cases of suspected scurvy from northern Peru. From this, it appears possible that ectocranial vascular impressions may further examined as a morphological marker of scurvy in the skeleton. Also, increased paleopathological attention to pellagra is long overdue, especially as it may produce generally comparable lesions to scurvy. This paper reflexively speaks to the process of paleopathological problem solving and the epistemology of our discipline-particularly regarding the ways in which we can continuously improve description and the construction of diagnostic arguments.

Paleopathology of an ovarian teratoma: Description and diagnosis of an exotic abdominal bone and tooth mass in a historic Peruvian burial

Neoplasms are among the most rarely described categories of skeletal abnormalities in paleopathology, and of these, bone- and tooth-forming ovarian teratomas may represent the most extraordinary and exotic. In this case study, we examine a bone and tooth mass found in an Early Colonial period burial from Eten, Peru. We document a complex array of 83 bony and 37 dental elements in the abdominal cavity of an adolescent female individual. The bones possess unclassifiable and non-functional morphologies, while the teeth tended to resemble incisors, canines, premolars, and molars but were more bulbous, smaller in size, and irregularly mineralized. We examine various differential diagnoses, including ectopic pregnancy, fetus in fetu or parasitic twin, lithopedia, and ovarian teratoma. We can confidently rule out the former three options, and the evidence is highly concordant with expectations of a mature ovarian teratoma. We also discuss a range of paleopathological and archaeological considerations for the identification, recovery, analysis, and prevalence of these distinctive neoplasms that are virtually unknown in the paleopathological literature.

Cranial lesions and maxillofacial asymmetry in an archaeological skeleton from Peru: A paleopathological case of possible trauma-induced epidermal inclusion cysts

Background: In 2010, the Lambayeque Valley Biohistory Project recovered the skeletal remains of an elderly adult man who died probably during the late 19th century in Eten, on the north coast of Peru. This individual′s cranium exhibited a constellation of highly unusual lytic cranial lesions spanning the left aspect of the frontal bone, nasal region, and right aspect of the superior orbit. Simultaneously, the midfacial and orbital regions exhibited marked asymmetry. In this paper, we describe these dry bone lesions and evaluate various differential diagnosis. Lesion characteristics and patterning is inconsistent with more familiar pathological processes such as infections (i.e., tuberculosis, treponematosis, and leprosy). Lesion morphology most closely resembles cystic development, such as those produced by an epidermal or dermal cyst. Metastatic processes are also examined, but represent remote diagnostic options. The cyst-like lesion morphology, combined with facial asymmetry may be most consistent with a complex etiology involving development of epidermal inclusion cysts secondary to facial trauma. This case describes a very rarely reported kind of craniofacial lesion in archaeological skeletons, highlights the process of differential diagnosis in paleopathology, and contributes to a more complete accounting of craniomaxillary disorders in the Andean past. Context: An archaeologically recovered 19 th century human skeleton, designated Burial CNS U3-5B, documented from the Colonial-era site of Eten, Peru. Aim: Describe, identify, and provide plausible differential diagnosis of a set of highly anomalous craniofacial lesions. Settings and Design: Meticulous observation, description, and differential diagnosis of dry bone lesions in Burial CNS U3-5B. Materials and Methods: The entire skeleton was visually examined and recorded, using standardized data collection protocols involving detailed skeletal and dental inventories, age and sex estimation, development and growth, anthropometry, and pathological conditions of the skeleton and dentition. Pathological features of the lesions were described in terms of abnormal bone size, abnormal bone formation, and abnormal bone loss. Lesion distribution was then mapped throughout the skeleton. Statistical Analysis Used: None. Results: The individual′s cranium exhibited a constellation of highly unusual lytic cranial lesions spanning the left aspect of the frontal bone, nasal region, and right aspect of the superior orbit. The midfacial and orbital regions exhibited marked left-side asymmetry. Conclusions: Lesions appear to be most consistent with epidermal inclusion cysts, perhaps secondary to a well-healed traumatic midfacial injury. Infectious disease processes and cancer metastases are ruled out. Through a process of careful description and differential diagnosis, this study presents plausible diagnosis of a condition rarely encountered in archaeological remains.

Possible prostate cancer in northern Peru: Differential diagnosis, vascular anatomy, and molecular signaling in the paleopathology of metastatic bone disease

This paper describes four possible cases of metastasized prostate cancer in archaeological human skeletons from the north coast of Peru spanning the Middle Sicán to Colonial eras (roughly A.D. 900-1600). Varying combinations of exuberant abnormal new bone formation and some abnormal bone loss affecting lumbar vertebrae and the bony sacrum were observed in these individuals. Detailed lesion descriptions are followed by a differential diagnosis that systematically eliminates pseudopathology, infectious diseases, sclerosing bone disorders, and most metastatic processes. However, metastasized prostate cancer cannot be rejected and is highly consistent with the observed lesions. Metastasized pancreatic, bladder, or carcinoid tumors represent additional, though far less likely, diagnostic options. Anatomical and molecular signaling factors further validate this differential diagnosis. The paravertebral venous plexus of Baston plays an anatomical role in the metastatic seeding of lumbar vertebra from prostate cancer. Further, abundant molecular signaling mechanisms upregulate multiple bone-forming mechanisms in prostate metastases, though initially such lesions may originate as lytic phenomena. These multiple lines of evidence help demonstrate a multi-level framework for explanation in paleopathology and especially to help better elucidate the complexities of ancient neoplastic diseases.