Victoria Menzies

Telomere Length: A Review of Methods for Measurement

BackgroundThe exciting discovery that telomere shortening is associated with many health conditions and that telomere lengths can be altered in response to social and environmental exposures has underscored the need for methods to accurately and consistently quantify telomere length. ObjectivesThe purpose of this article is to provide a comprehensive summary that compares and contrasts the current technologies used to assess telomere length. DiscussionMultiple methods have been developed for the study of telomeres. These techniques include quantification of telomere length by terminal restriction fragmentation—which was one of the earliest tools used for length assessment—making it the gold standard in telomere biology. Quantitative polymerase chain reaction provides the advantage of being able to use smaller amounts of DNA, thereby making it amenable to epidemiology studies involving large numbers of people. An alternative method uses fluorescent probes to quantify not only mean telomere lengths but also chromosome-specific telomere lengths; however, the downside of this approach is that it can only be used on mitotically active cells. Additional methods that permit assessment of the length of a subset of chromosome-specific telomeres or the subset of telomeres that demonstrate shortening are also reviewed. ConclusionGiven the increased utility for telomere assessments as a biomarker in physiological, psychological, and biobehavioral research, it is important that investigators become familiar with the methodological nuances of the various procedures used for measuring telomere length. This will ensure that they are empowered to select an optimal assessment approach to meet the needs of their study designs. Gaining a better understanding of the benefits and drawbacks of various measurement techniques is important not only in individual studies, but also to further establish the science of telomere associations with biobehavioral phenomena.

Integrated Review of the Association of Cytokines With Fibromyalgia and Fibromyalgia Core Symptoms

Fibromyalgia (FMS) is a chronic widespread pain (CWP) and fatigue syndrome that affects three to six million adults in the United States. Core symptoms of FMS include pain, fatigue, and mood and sleep disturbances. To date, consensus has not been reached among researchers regarding the pathogenesis of FMS nor the specific role of cytokine activation on the neuroendocrine—immune response patterns in persons with FMS. The purpose of this article is to describe and synthesize the results of research studies focused on the relationship between cytokines and FMS and among cytokines and core symptoms of FMS. There is some support in the literature for relationships among FMS symptoms and cytokines; however, there are discrepant findings related to whether proinflammatory and anti-inflammatory cytokines are elevated or reduced in persons with FMS and whether their levels correlate with the core symptoms of this disorder. Although the use of cytokine biomarkers must be considered exploratory at this time due to the lack of consistent empirical findings, biobehavioral research focused on understanding the relationship of FMS with cytokines may lead to a better understanding of this complex syndrome. This knowledge may ultimately contribute to the development of interventions for symptom management that address not only the symptom manifestation but also a biological mediator of symptoms.

Epigenetic Alterations and an Increased Frequency of Micronuclei in Women with Fibromyalgia

Fibromyalgia (FM), characterized by chronic widespread pain, fatigue, and cognitive/mood disturbances, leads to reduced workplace productivity and increased healthcare expenses. To determine if acquired epigenetic/genetic changes are associated with FM, we compared the frequency of spontaneously occurring micronuclei (MN) and genome-wide methylation patterns in women with FM (n = 10) to those seen in comparably aged healthy controls (n = 42 (MN); n = 8 (methylation)). The mean (sd) MN frequency of women with FM (51.4 (21.9)) was significantly higher than that of controls (15.8 (8.5)) (χ 2 = 45.552; df = 1; P = 1.49 × 10−11). Significant differences (n = 69 sites) in methylation patterns were observed between cases and controls considering a 5% false discovery rate. The majority of differentially methylated (DM) sites (91%) were attributable to increased values in the women with FM. The DM sites included significant biological clusters involved in neuron differentiation/nervous system development, skeletal/organ system development, and chromatin compaction. Genes associated with DM sites whose function has particular relevance to FM included BDNF, NAT15, HDAC4, PRKCA, RTN1, and PRKG1. Results support the need for future research to further examine the potential role of epigenetic and acquired chromosomal alterations as a possible biological mechanism underlying FM.

Unique cytokine signature in the plasma of patients with fibromyalgia.

Fibromyalgia (FMS) is a chronic pain syndrome with a complex but poorly understood pathogenesis affecting approximately 10 million adults in the United States. The lack of a clear etiology of FMS has limited the effective diagnosis and treatment of this debilitating condition. The objective of this secondary data analysis was to examine plasma cytokine levels in women with FMS using the Bio-Plex Human Cytokine 17-plex Assay. Post hoc analysis of plasma cytokine levels was performed to evaluate patterns that were not specified a priori. Upon examination, patients with FMS exhibited a marked reduction in TH2 cytokines such as IL-4, IL-5, and IL-13. The finding of this pattern of altered cytokine milieu not only supports the role of inflammation in FMS but also may lead to more definitive diagnostic tools for clinicians treating FMS. The TH2 suppression provides strong evidence of immune dysregulation in patients with FMS.

Relaxation and guided imagery in Hispanic persons diagnosed with fibromyalgia: a pilot study.

Fibromyalgia (FM) is a chronic pain disorder affecting 2% of the population in the United States. Another 16 million Hispanics suffer from generically identified rheumatic diseases that likely include FM. Because there are few reported studies of Hispanics with FM, a pilot study using a repeated-measures pretest–posttest design investigated the effects of a 10-week mind–body intervention (visual imagery with relaxation) on symptom management. The change in means from baseline to week 10 demonstrated improvement in self-efficacy for managing pain and other symptoms and functional status. Visual imagery with relaxation is a mind–body intervention that may be used for symptom management in this population.

Preprocedural Distress in Children With Cancer: An Intervention Using Biofeedback and Relaxation

Children diagnosed with cancer experience many invasive procedures throughout diagnosis and treatment of their disease. These procedures, oftentimes a source of distress in children, can elicit a variety of anticipatory symptoms prior to the actual procedure. Although there have been efforts to develop approaches to alleviate this distress through use of distraction, relaxation, sedation, guided imagery, and hypnosis, there has not been a combination treatment that merged relaxation techniques and biofeedback within a pediatric framework. A group of 12 children diagnosed with cancer participated in a 4-session intervention combining relaxation and biofeedback. This feasibility study suggests that the combination intervention offered in a clinical setting may be beneficial to children experiencing procedural distress as a novel coping strategy.

Psychoneuroimmunological Relationships in Women With Fibromyalgia

Introduction: The purpose of this pilot study was to characterize the relationships among perceived stress, pain, fatigue, depression, anxiety, biomarkers, and functional status in women with fibromyalgia syndrome (FMS) using a psychoneuroimmunological (PNI) framework. Materials and Method: Using a cross-sectional, correlational design, the authors asked 50 women diagnosed with FMS to complete the Perceived Stress Scale (PSS), Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI), Center for Epidemiological Studies—Depression scale, State–Trait Anxiety Inventory (STAI), and Functional Impact Questionnaire. The authors analyzed plasma levels of 17 cytokines using a BioPlex® assay and levels of C-reactive protein (CRP) using a high-sensitivity enzyme-linked immunosorbent assay (ELISA). Results: Compared to published guidelines (>3 mg/L reflects high inflammation), CRP levels were elevated in participating women. Perceived stress demonstrated positive correlations with pain, fatigue, depression, anxiety, and functional status and negative correlations with monocyte chemotactic protein (MCP)-1(r = −.30) and interleukin-1 beta (IL-1β; r = −.29). Pain severity correlated with macrophage inflammatory protein (MIP)-1β (r = .29), and pain interference negatively correlated with IL-1β (r = −.30). Fatigue negatively correlated with IL-1β (r = −.32), interleukin-10 (IL-10; r = −.31), and granulocyte colony-stimulating factor (G-CSF; r = −.31). Depressive symptoms correlated with CRP (r = .31). Discussion: Relationships among perceived stress and symptoms supported the PNI framework. Study findings are similar to previous studies showing that cytokines in persons with FMS do not show a consistent pattern. The elevated CRP levels suggest higher levels of generalized inflammation in the sample and provide evidence for continued development of biobehavioral interventions to address both symptoms and their biological markers over time.

Absorption An Individual Difference to Consider in Mind–Body Interventions

Given that mind-body interventions constitute a major portion of complementary and alternative medicine used by the public, it seems important to explore those human characteristics that may contribute to the efficacy of mind-body interventions in those who are most likely to benefit. One such characteristic, absorption, reflects an individuals cognitive capacity for involvement in sensory and imaginative experiences in ways that alter an individuals perception, memory, and mood with behavioral and biological consequences. Thus, ones level of absorption may potentially create differential treatment effects in mind-body intervention outcomes. Conducting practical clinical trials helps address the challenge of determining whether a specific mind-body modality intervention may be effective. Such trials may be strengthened by including measures of personality dimensions such as absorption.

Guided Imagery as a Treatment Option for Fatigue A Literature Review

Purpose: Fatigue is one of the most common complaints experienced among the general population. Because fatigue is recognized as a biobehavioral occurrence, a biobehavioral intervention such as guided imagery may be effective in reducing self-reported fatigue. Therefore, the purpose of this study was to explore the research literature related to the use of guided imagery as a nonpharmacological mind-body intervention for the symptom of fatigue. Method: The electronic databases MEDLINE, CINAHL, PsychInfo, Psychology and Behavioral Sciences Collection and the Cochrane Library were searched from January 1980 to June 2010. Findings: Of 24 articles retrieved, eight met the inclusion criteria and were included in this systematic literature review. Findings were inconsistent regarding the effectiveness of guided imagery on fatigue. Studies varied in study length, duration of the applied guided imagery intervention, dosage, and whether the images were targeted to the purpose of the intervention. Implications: Guided imagery is a simple, economic intervention with the potential to effectively treat fatigue, thus further research is warranted using systematic, well-designed methodologies Standardizing guided imagery interventions according to total duration of exposure and targeted imagery in a variety of different populations adequately powered to detect changes will contribute to and strengthen nursing’s symptom-management armamentarium.

A Biobehavioral Perspective on Telomere Length and the Exposome

A major objective of biobehavioral research is defining the mechanisms that underlie linkages among behavior, biology, health, and disease. The genomic revolution has demonstrated the importance of studying the role of the environment in (epi)genetic mechanisms. The idea that interactions between environment and genetics influence health outcomes is a central concept of the exposome, a measure of environmental exposures throughout a lifetime. Research suggests that telomere length (TL) and biologic factors involved in telomere stability may provide an understanding of the effects of gene–environment interaction on disease risk. Telomeres, thus, have become important biomarkers for aging as well as for stress-related disease. However, incorporating telomeres into biobehavioral research requires consideration of several aspects of the exposome. Internal and external modifiable and nonmodifiable exposures have the potential to influence TL. Future research utilizing the concept of the exposome will provide meaningful findings related to exposure sources as well as dosage and duration across the life span that influence telomere biology and disease occurrence. Such findings can be translated into clinical practice and may provide a basis for personalized disease prevention and treatment approaches.