WO2023027951A1 - Treatment of disease using iage and mig - Google Patents

Abstract

Patients can be screened for their iAge, MIG levels, and EOTAXIN levels, and patients with lower iAge-chAge, and increased MIG levels can proceed to immunotherapy. Patients with higher iAge-chAge and lower MIG levels can be treated to lower their iAge-chAge and raise their MIG levels prior to immunotherapy. Compounds and described herein can reduce iAge-chAge, and raise MIG of the patients. For example, a patients iAge-chAge can be moved into a responders cohort from a non-responders cohort.

Description

TREATMENT OF DISEASE USING iAGE AND MIG

BACKGROUND

[001] Over the past five years cancer immunotherapy treatments have witnessed a great deal of clinical success in multiple cancer types often with extended disease-free survival periods of >10 years. Examples of successful immunotherapies are immune checkpoint inhibitors, which have demonstrated unprecedented rates of durable responses in many difficult-to-treat cancers. However, regardless of the organ affected and cancer type, only a limited percentage of patients benefit from these approaches. Thus, there is a growing need to identify biomarkers that will improve the selection of patients who will respond to therapy.

[002] Biomarkers are needed both before and during treatment to enable identification of patients likely to respond to immunotherapy treatment in order to reduce inappropriate drug use. Objective clinical responses are defined as a reduction in tumor size during the course of treatment. Multiple baseline factors associated with disease prognosis have been linked to response rates. For example, patients with small-sized tumors or low baseline levels of serum lactate dehydrogenase (LDH) are more likely to respond to anti-PD-1 treatment. Circulating tumor DNA (ctDNA) that can be released by dead tumor cells and detected in the serum of some patients correlate strongly with tumor progression.

[003] Response to anti-PD-1 treatment can partially be predicted by the expression of the ligand PD-L1 within the tumor microenvironment. Although PD-L1 expression is correlated with treatment efficacy in melanoma patients, it is not in patients with other cancers such as squamous cell carcinoma, non-small cell lung cancer and Merkel cell carcinoma.

[004] The presence of neoantigens on tumor cells promotes immunogenicity against tumors and improves treatment efficacy. Thus, high genetic variation between tumor cells and host cells is one indicator of checkpoint inhibitor treatment efficacy. This is particularly true for anti-CTLA-4 treatment in melanoma patients and anti-PD-1 treatment in patients with colorectal cancer or non-small cell lung cancer with high mutation rates.

[005] Other immunological factors associated with improved treatment responses prior to immunotherapy treatment include elevated eosinophil and lymphocyte counts; high numbers of CD8⁺ T cells infiltrating the tumor, and increased TGF-P levels in the serum from melanoma patients treated with anti-PD-1.

[006] A number of post-treatment immune biomarkers have also been suggested to be associated with improved responses to cancer immunotherapy. For instance, patients who were more likely to respond to anti-CTLA-4 treatment had increased counts of inducible co-stimulatory molecule (ICOS)(+) T cells and lower neutrophil/lymphocyte ratios.

SUMMARY

[007] The disclosure describes a method for treating patients with immunotherapy or antimicrobial treatments whereby subjects can be stratified based on their inflammatory age levels; and can receive individualized interventions to reduce inflammatory age and improve clinical and immune responses to treatment. Prior to disease, subjects with a low iAge score and/or low i Age-chronological Age (chAge) score respond well to immunotherapy, or treatments that work in combination with the subject’s immune system (e.g., antimicrobial treatments, vaccines). During disease and a subject’s acute immune response to a disease, subjects with low iAge, low iAge-chAge and/or high MIG levels respond well to immunotherapy, or treatments that work in combination with the subject’s immune system (e.g., antimicrobial treatments, vaccines).

[008] Subjects who have higher iAge and/or higher iAge-chAge scores prior to disease can be treated to lower their iAge and so improve the acute immune response of the subject’s immune system. Subjects who have higher iAge-chAge scores and/or lower MIG levels during disease can be treated to lower their iAge-chAge score and/or to raise the level of MIG prior to treatment with immunotherapy or treatments that work in combination with the subject’s immune system (e.g., antimicrobial treatments, vaccines).

[009] iAge-chAge and/or MIG levels can be used to classify cancer patients into those who will mount an objective clinical response to immunotherapy versus those who will not. This scoring system can be used to guide initial therapy to enable optimal objective responses in those patients who were classified as non-responders. Without being bound by theory of operation, the iAge-chAge score can provide information on the ability of the subject’s immune system to provide a robust response with an immunotherapy or treatments that work in combination with the subject’s immune system (e.g., antimicrobial treatments, vaccines). Again without being bound by theory of operation, the MIG levels can provide information on the robustness of the patient’s current acute immune response to disease. Higher MIG levels indicate the patient has a robust acute immune system that is responding to the disease state.

[010] Cancer patients with lower iAge-chAge scores and/or higher MIG can proceed to treatment with immunotherapy. Cancer patients with higher iAge-chAge scores and/or lower MIG levels, can be pretreated to lower their iAge-chAge score. Optionally or in the alternative, the cancer patients can be treated to raise their MIG levels prior to immunotherapy treatment. Lowering the iAge-chAge score can increase the ability of the patient’s immune system to mount a robust response to the cancer. Similarly, raising the MIG levels can increase the patient’s baseline response of the patient’s immune system to the cancer prior to immunotherapy.

[Oi l] Patients with a higher iAge or iAge-chAge after primary therapy for cancer (e.g., surgery) respond to adjuvant immunotherapy with lower levels of recurrence. Patients with a high level of EOTAXIN and/or MIG after primary therapy for cancer (e.g., surgery) also respond to adjuvant immunotherapy with lower levels of recurrence. Patients with both a higher iAge and/or iAge-chAge and/or a high level of EOTAXIN and/or MIG after primary therapy for cancer (e.g., surgery) respond to adjuvant immunotherapy with lower levels of recurrence. Patients with a lower iAge and/or iAge-chAge score have higher levels of recurrence, and when the cancer recurs those patient’s iAge and/or iAge-chAge scores increase and can exceed the iAge and iAge-chAge scores of the nonrecurrence patients. Patients with a lower level of EOTAXIN and/or MIG have higher levels of recurrence. Patients with a lower iAge or iAge-chAge score and a lower level of EOTAXIN and/or MIG have higher levels of recurrence, and when the cancer recurs those patient’s iAge and iAge-chAge scores increase and can exceed the iAge and iAge-chAge scores of the nonrecurrence patients.

[012] Patients with a lower iAge and/or iAge-chAge and/or low level of EOTAXIN and/or MIG after primary therapy for cancer (e.g., surgery) can be treated to raise their iAge and/or iAge-chAge and/or the level of EOTAXIN and/or MIG to improve the patient’s response to adjuvant immunotherapy.

[013] An inflammatory age scoring system (iAge) can be used to classify patients into those who have improved response and outcomes for cancer immunotherapy. The inflammatory age scoring system can be used to guide initial therapy targeting inflammation to improve outcomes of patients receiving treatment for cancer, and to reduce risk of cancer recurrence (e.g., prophylactic treatment). MIG, EOTAXIN, Mip-la, LEPTIN, IL-ip, IL-5, IFN-a and IL-4 (positive contributors) and TRAIL, IFN-y, CXCL1, IL-2, TGF-a, PAI-1 and LIF (negative contributors) are related to iAge and can be used to make up the iAge score.

[014] The disclosure describes a method for treating subjects with immunotherapy (e.g., cancer patients), vaccines (e.g., subjects who will benefit from vaccination), and antipathogen therapeutics (e.g., antibiotics, antivirals, antifungals, etc.) whereby subjects can be stratified based on their inflammatory age levels; and can receive individualized interventions to reduce inflammatory age and improve clinical and immune responses to the therapeutic treatment (e.g., cancer immunotherapy, vaccination, anti-pathogen therapeutic).

[015] An inflammatory age scoring system (iAge) can be used to classify subjects (e.g., cancer patients, vaccination subjects, subjects with an infectious disease) into those who have an immune system that can mount an effective response (e.g., mount an objective clinical response to immunotherapy, produce a protective response to a vaccine, or mount an immune response against a pathogen) versus those who will not. The inflammatory age scoring system can be used to guide initial therapy targeting inflammation to enable optimal objective responses in those patients who were classified as non-responders. The iAge can also be used to stratify subjects for different courses of vaccines or antipathogen therapy. A cytokine response score (CRS) can also be used to classify cancer patients into those who will mount an objective clinical response to immunotherapy versus those who will not.

[016] Based on a subject’s iAge, CRS, and/or Jak-STAT responses the subject can be classified as a responder or a nonresponder for the immunotherapy. Patients who are classified as nonresponders can be treated to lower their iAge, increase their CRS, and/or increase their Jak-STAT response so that the subject moves into a responder category. Classifications are made by comparing the subjects iAge, CRS, and/or Jak- STAT response to those of patients of similar chronological age. When a subject’s iAge, CRS, and/or Jak-STAT response places them at a younger iAge for their age cohort, or a more responsive CRS and/or Jak-STAT score the subject can be a responder for immunotherapy. Subjects with older iAge for their age cohort, and/or lower scores for CRS and/or Jak-STAT can be treated to lower their iAge and/or increase their CRS and/or Jak-STAT score so that they move into a responder group for immunotherapy.

[017] In an aspect, the disclosure describes compositions which can be used to improve the iAge. Treatments can include, for example, combinations of components that can alter the level of an iAge marker to healthier levels (lowers iAge) for one or more of the iAge markers: TRAIL, GroA, IFNg, MIG, or Eotaxin. Such combinations can include a combination of one or more of the following: iron bisglycinate, iron, biotin, caffeine, manganese chloride, niacin, carrageenan, betacarotene, leutin, zinc-sulfate, vitamin D2, guar gum, kawain, L-methionine, indole-3 - carbinol, and/or picetannol.

[018] The disclosure also describes methods for identifying drugs, food compounds and other molecules that modify iAge (or cAge). These methods identify drugs, food compounds, and other molecules that interact with and modify the levels of certain markers involved with the iAge (or cAge) determination. These drugs, food compounds, and other molecules can be used with subjects to modify their iAge (or cAge) and so change the cohort in which the subject stratifies and so alter the response of the subject to treatment and/or risk of disease.

BRIEF DESCRIPTION OF THE DRAWINGS

[019] FIG. 1A, IB and 1C show graphs of iAge, naive CD8(+) T-cells, and Jak STAT signaling responses.

[020] FIG. 2 shows the stratification of cancer patients by iAge and CRS into responders and nonresponders.

[021] FIG. 3 shows the stratification of cancer patients using iAge.

[022] FIG. 4 depicts the fold change in MIG mRNA and SIRT3 mRNA after passage of cells following differentiation into endothelial cells from hiPSCs.

[023] FIG. 5 is a bar graph showing the relative expression levels of CXCR3 in different cell types.

[024] FIG. 6 shows the four immunotypes of the super-healthy group of patients. [025] FIG. 7 shows the six immunotypes of the normal group of patients.

[026] FIG. 8 shows the average levels of Eotaxin, TRAIL, GroA, IFNg, and MIG (after normalization of the data as discussed below) for each the super-healthy immunotypes (SHI -4). [027] FIG. 9 shows the average levels of Eotaxin, TRAIL, GroA, IFNg, and MIG (after normalization of the data as discussed below) for each the normal immunotypes (Nl-6).

[028] FIG. 10 shows bar graphs for the iAge - chAge of patients that responded to immunotherapy and patients who had disease progression.

[029] FIG. 11 shows bar graphs for the mean fluorescence intensity of measurements for the markers EOTAXIN, GroA, INFg, MIG and TRAIL prior to immunotherapy.

[030] FIG. 12 shows bar graphs for the iAge of patients who responded to adjuvant immunotherapy and patients that did not respond to adjuvant immunotherapy.

[031] FIG. 13 shows bar graphs for the mean fluorescence intensity of measurements for the markers EOTAXIN, GroA, INFg, MIG and TRAIL after primary treatment and prior to adjuvant treatment.

DETAILED DESCRIPTION

[032] Before the various embodiments are described, it is to be understood that the teachings of this disclosure are not limited to the particular embodiments described, and as such can, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present teachings will be limited only by the appended claims.

[033] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. Although any methods and materials similar or equivalent to those described herein can also be used in the practice or testing of the present teachings, some exemplary methods and materials are now described.

[034] It must be noted that as used herein and in the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. It is further noted that the claims can be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,” “only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation. Numerical limitations given with respect to concentrations or levels of a substance are intended to be approximate, unless the context clearly dictates otherwise. Thus, where a concentration is indicated to be (for example) 10 pg, it is intended that the concentration be understood to be at least approximately or about 10 pg.

[035] As will be apparent to those of skill in the art upon reading this disclosure, each of the individual embodiments described and illustrated herein has discrete components and features which can be readily separated from or combined with the features of any of the other several embodiments without departing from the scope or spirit of the present teachings. Any recited method can be carried out in the order of events recited or in any other order which is logically possible.

Definitions

[036] In reference to the present disclosure, the technical and scientific terms used in the descriptions herein will have the meanings commonly understood by one of ordinary skill in the art, unless specifically defined otherwise. Accordingly, the following terms are intended to have the following meanings.

[037] As used herein, “activation” is defined to be a physiological condition upon exposure to a substance, allergen, drug, protein, chemical, or other stimulus, or upon removal of a substance, allergen, drug, protein, chemical or other stimulus.

[038] As used herein, an “antibody” is defined to be a protein functionally defined as a ligand-binding protein and structurally defined as comprising an amino acid sequence that is recognized by one of skill as being derived from the variable region of an immunoglobulin. An antibody can consist of one or more polypeptides substantially encoded by immunoglobulin genes, fragments of immunoglobulin genes, hybrid immunoglobulin genes (made by combining the genetic information from different animals), or synthetic immunoglobulin genes. The recognized, native, immunoglobulin genes include the kappa, lambda, alpha, gamma, delta, epsilon and mu constant region genes, as well as myriad immunoglobulin variable region genes and multiple D-segments and J-segments. Light chains are classified as either kappa or lambda. Heavy chains are classified as gamma, mu, alpha, delta, or epsilon, which in turn define the immunoglobulin classes, IgG, IgM, IgA, IgD and IgE, respectively. Antibodies exist as intact immunoglobulins, as a number of well characterized fragments produced by digestion with various peptidases, or as a variety of fragments made by recombinant DNA technology. Antibodies can derive from many different species (e.g., rabbit, sheep, camel, human, or rodent, such as mouse or rat), or can be synthetic. Antibodies can be chimeric, humanized, or humaneered. Antibodies can be monoclonal or polyclonal, multiple or single chained, fragments or intact immunoglobulins.

[039] As used herein, an “antibody fragment” is defined to be at least one portion of an intact antibody, or recombinant variants thereof, and refers to the antigen binding domain, e.g., an antigenic determining variable region of an intact antibody, that is sufficient to confer recognition and specific binding of the antibody fragment to a target, such as an antigen. Examples of antibody fragments include, but are not limited to, Fab, Fab', F(ab')2, and Fv fragments, scFv antibody fragments, linear antibodies, single domain antibodies such as sdAb (either VL or VH), camelid VHH domains, and multi-specific antibodies formed from antibody fragments. The term “scFv” is defined to be a fusion protein comprising at least one antibody fragment comprising a variable region of a light chain and at least one antibody fragment comprising a variable region of a heavy chain, wherein the light and heavy chain variable regions are contiguously linked via a short flexible polypeptide linker, and capable of being expressed as a single chain polypeptide, and wherein the scFv retains the specificity of the intact antibody from which it is derived. Unless specified, as used herein an scFv may have the VL and VH variable regions in either order, e.g., with respect to the N-terminal and C-terminal ends of the polypeptide, the scFv may comprise VL-linker-VH or may comprise VH-linker-VL.

[040] As used herein, an “antigen” is defined to be a molecule that provokes an immune response. This immune response may involve either antibody production, or the activation of specific immunologically-competent cells, or both. The skilled artisan will understand that any macromolecule, including, but not limited to, virtually all proteins or peptides, including glycosylated polypeptides, phosphorylated polypeptides, and other post-translation modified polypeptides including polypeptides modified with lipids, can serve as an antigen. Furthermore, antigens can be derived from recombinant or genomic DNA. A skilled artisan will understand that any DNA, which comprises a nucleotide sequences or a partial nucleotide sequence encoding a protein that elicits an immune response therefore encodes an “antigen” as that term is used herein. Furthermore, one skilled in the art will understand that an antigen need not be encoded solely by a full length nucleotide sequence of a gene. It is readily apparent that the present invention includes, but is not limited to, the use of partial nucleotide sequences of more than one gene and that these nucleotide sequences are arranged in various combinations to encode polypeptides that elicit the desired immune response. Moreover, a skilled artisan will understand that an antigen need not be encoded by a “gene” at all. It is readily apparent that an antigen can be synthesized or can be derived from a biological sample, or can be a macromolecule besides a polypeptide. Such a biological sample can include, but is not limited to a tissue sample, a tumor sample, a cell or a fluid with other biological components. [041] As used herein, the terms “Chimeric Antigen Receptor” and the term “CAR” are used interchangeably. As used herein, a “CAR” is defined to be a fusion protein comprising antigen recognition moieties and cell-activation elements.

[042] As used herein, a “CAR T-cell” or “CAR T-lymphocyte” are used interchangeably, and are defined to be a T-cell containing the capability of producing CAR polypeptide, regardless of actual expression level. For example a cell that is capable of expressing a CAR is a T-cell containing nucleic acid sequences for the expression of the CAR in the cell.

[043] As used herein, an “effective amount” or “therapeutically effective amount” are used interchangeably, and defined to be an amount of a compound, formulation, material, or composition, as described herein effective to achieve a particular biological result.

[044] As used herein, an “epitope” is defined to be the portion of an antigen capable of eliciting an immune response, or the portion of an antigen that binds to an antibody. Epitopes can be a protein sequence or subsequence that is recognized by an antibody.

[045] As used herein, an “expression vector” and an “expression construct” are used interchangeably, and are both defined to be a plasmid, virus, or other nucleic acid designed for protein expression in a cell. The vector or construct is used to introduce a gene into a host cell whereby the vector will interact with polymerases in the cell to express the protein encoded in the vector/construct. The expression vector and/or expression construct may exist in the cell extrachromosomally or integrated into the chromosome. When integrated into the chromosome the nucleic acids comprising the expression vector or expression construct will be an expression vector or expression construct.

[046] As used herein, “heart failure” often called congestive heart failure (CHF) or congestive cardiac failure (CCF), means a condition that occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is typically diagnosed by patient physical examination and confirmed with echocardiography. Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term heart failure is sometimes incorrectly used for other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.

[047] As used herein, “heterologous” is defined to mean the nucleic acid and/or polypeptide is not homologous to the host cell. Alternatively, “heterologous” means that portions of a nucleic acid or polypeptide that are joined together to make a combination where the portions are from different species, and the combination is not found in nature.

[048] As used herein, the term “impaired immune function” is defined to be any reduction in immune function in an individual, as compared to a fully healthy individual. Individuals with an impaired immune function are readily identifiable by substantially increased abundance of CD8+ CD28- cells or more broadly by reduced cytokine responses, increased baseline phosphoprotein levels and other co-occurring measure.

[049] As used herein, the term “inflammasome” is defined as cytosolic multiprotein complexes that are composed of an inflammasome-initiating sensor, apoptosis- associated speck-like protein containing a CARD (Caspase Activation and Recruitment Domain) acts as an adaptor protein and the protease-caspase- 1. Inflammasome-initiating sensors include members of the NLRs the pyrin and HIN domain-containing (also known as PYHIN, Aim 2-like receptors, or ALRs; e.g., Aim2), or the TRIM (e.g., pyrin) family. Complex assembly leads to caspase-1- dependent cleavage of cytokines pro-interleukin ip (pro-IL-ip) and pro-IL-18 into secreted mature forms. In addition, inflammasomes initiate pyroptotic cell death.

[050] As used herein, a “single chain antibody” (scFv) is defined as an immunoglobulin molecule with function in antigen-binding activities. An antibody in scFv (single chain fragment variable) format consists of variable regions of heavy (VH) and light (VL) chains, which are joined together by a flexible peptide linker.

Immunological Age

[051] The Jak/STAT signaling pathway is critical for meeting the multiple challenges encountered by the immune system, from fighting infections to maintaining immune tolerance. Clearly STATs are also involved in the development and function of the immune system in humans and play a key role in maintaining immune surveillance of cancer (Nature. 2007; 450(7171):903-7; Nat Rev Cancer (2009) 9:798-809).

[052] The Jak-STAT pathway can be profoundly altered with aging and this is one major cause of immune dysfunction in older adults. A cytokine response score (CRS) can be used to predict immune decline and reduction in immune surveillance of cancer.

[053] An inflammatory age scoring system (iAge) can also be used to predict age- associated multimorbidity and mortality. iAge can be extremely sensitive as a biomarker of cardiovascular health since elevated levels predict left ventricular remodeling and arterial stiffness even in very healthy older subject with no clinical or laboratory cardiovascular risk factors. iAge can also identify subclinical immunodeficient young patients (10% of subjects 16-35 years old) who cannot mount responses to any strain of the influenza vaccine in any of the years studied (up to 6 years follow-up). These subjects are characterized by having an older-like immunological phenotype with regards to their immune cell composition, ex vivo responses to multiple acute stimuli, and expression of gene modules associated with advanced age.

[054] Since the cytokine response score CRS and iAge are independent measures of inflammation, diminished Jak-STAT signaling pathway in T cells, and low naive CD8(+) T cell counts (FIG. 1 A-C) these measures can be used to stratify cancer patients with respect to their clinical responses to immunotherapy. The methods described herein use blood inflammatory markers CRS and iAge to stratify cancer patients into responder and nonresponders groups for immunotherapy. The nonresponders can be treated to reduce their iAge and/or increase their CRS (and/or Jak-STAT score) so that the nonresponders obtain iAge and/or CRS (and/or Jak- STAT score) that places them into a responder group.

[055] The procedure involves the extraction of peripheral blood samples by venipuncture, or by any appropriate method, from candidate cancer patients prior to infusion with immunotherapy treatment (FIG. 2). Immunotherapy treatment may comprise the use of certain molecules including antibodies, small molecules, etc. against inhibitory immune receptors. Blood serum is separated from blood cells by centrifugation of clotted blood, or by any other appropriate method (FIG. 2). [056] Construction of iAge: For serum protein determination, the resulting sera can be mixed with antibody -linked magnetic beads on 96-well filter-bottom plates and can be incubated at room temperature for 2 h followed by overnight incubation at 4°C. Room temperature incubation steps can be performed on an orbital shaker at 500-600 rpm. Plates can be vacuum filtered and washed twice with wash buffer, then incubated with biotinylated detection antibody for 2 h at room temperature. Samples can be then filtered and washed twice as above and re-suspended in streptavidin-PE. After incubation for 40 minutes at room temperature, two additional vacuum washes can be performed, and the samples can be re-suspended in Reading Buffer. Each sample can be measured in duplicate or triplicate. Plates can be read using a Luminex 200 instrument with a lower bound of 100 beads per sample per cytokine and mean fluorescence intensity (MFI) is recorded.

[057] To derive inflammatory age (iAge) (FIG. 2), the mean fluorescence intensity can be normalized and used for multiple regression analysis, which is computed using the following regression coefficients: MIG: 0.6357, TRAIL: -0.3760, IFNG: -0.3235, EOTAXIN: 0.2912, GROA: -0.2723, IL2: -0.2063, TGFA: -0.1978, PAI1 : -0.1587, LIF: -0.1587, LEPTIN: 0.1549, MIP1A: 0.1547, IL1B: 0.1471. The MFI can be multiplied by the regression coefficient for the protein, and these numbers can be all added together to give the iAge of the subject. Table 1 below lists the ranges of iAge within chronological age decades.

Table 1. iAge Ranges

[058] Those markers with positive regression coefficients increased in serum concentration with age (MIG, EOTAXIN, LEPTIN, MIP1 A, and IL1B) and those with negative regression coefficients decreased in serum concentration with age (TRAIL, IFNG, GROA, IL2, TGFA, PAI1, and LIF).

[059] iAge can also be derived from using 4, 5, 6, 7, 8, 9, 10, or 11 of the markers EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, MIP1A, PAI1, TRAIL, and/or TGFA. Regression coefficients for these markers can be, for example, EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, -0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, -0.04, -0.7, -0.61, -0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, - 0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, -0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, -0.61, -1.1, -1.6, -0.36, -0.52, 0.012, - 0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1, 2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1), IL1B (e.g., -0.4, 0.45, 0.42, 0.62, 0.35, 0.49, -0.5, -0.39, -0.68, -0.33, -0.75, - 0.58, 0.0071, 0.5, -0.91, 0.6, -0.083, -0.73, -0.81, 0.36, 0.53, -0.47, -0.38, -0.88, 0.29, -0.46, -0.17, 0.098, 0.46, 0.13, -0.059, 0.3, 0.55, -0.61, -0.36, -0.44, 0.31, -0.19, -0.05, 0.082, -0.043, -0.52, -0.43, -0.34, -0.84, -1.0), IL2 (e.g., -0.6, -2.9, -2.4, -1.4, -1.9, - 1.3, -1.8, -3.2, -2.7, -2.8, -2.3, -2.2, -1.7, -1.2, -3.1, -2.1, -1.6, -2.5, -2.0, -3.0, -2.6, - 1.5), LEPTIN (e.g., 0.46, 0.39, 0.41, 0.42, 0.4, 0.43, 0.44, 0.37, 0.45, 0.38, 0.36, 0.77), LIF (-0.31, 1.7, 0.52, -0.32, 1.3, 1.2, -0.61, 1.6, 2.1, -0.14, 1.8, 1.5, 2.0, 0.59, - 0.91, -0.25, 0.35, 1.1, -1.3, -0.21, -0.22, 0.13, -1.7, -1.2, -0.7, -1.1, -0.048, -0.27, 1.9, - 0.35, -0.0056, -0.59, -1.5, -0.42, -1.8), MIP1A (e.g., 0.38, 0.51, 0.48, 0.59, 0.36, 0.4, 0.5, 0.27, 0.28, -0.47, 0.26, 0.18, -0.65, -0.4, 0.35, -0.073, 0.52, -0.084, 0.11, 0.86, - 0.39, -0.025, 0.53, 0.45, -0.13, 0.29, 0.22, 0.1, 0.15, -0.16, 0.094, 0.027, 0.13, 0.55, 0.084, 0.81, -0.11, 0.49, 0.41, 0.33), PAI1 (e.g., -0.28, -0.31, -0.13, -0.25, -0.26, - 0.064, -0.14, -0.33, -0.066, -0.067, -0.009, -0.076, -0.079, -0.078, -0.02, -0.15, -0.22, - 0.21, -0.091, -0.03, -0.16, -0.17, -0.092, -0.096, -0.12, -0.032, 0.0038, -0.042, -0.065, -0.045, -0.068, -0.056, -0.051, -0.098), TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, - 0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, - 0.46, -0.23, 0.034, -0.71, -0.17, 0.1, -1.7, 0.3, -0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, - 0.85, -0.76, 0.91, -1.5, -1.0, -1.4), and/or TGFA (e.g., -0.069, -0.58, -0.43, 0.39, -0.79, -0.52, -0.44, -0.14, -0.7, 0.41, -0.25, 0.34, 0.057, -0.24, 0.33, 0.18, 0.27, 0.15, -0.3, - 0.00047, 0.21, -0.17, -0.1, -0.21, 0.09, -0.15, -0.092, 0.22, 0.16, 0.46, -0.099, -0.041, - 0.53, -0.36, -0.61, -0.11, -0.77, 0.013, -0.18, -0.22, -0.51, -3.0, -0.59, -0.42, -1.4). [060] For example, iAge can be derived from EOTAXIN, GROA, IFNG, and MIG, or EOTAXIN, GROA, IFNG, and IL1B, or EOTAXIN, GROA, IFNG, and IL2, or EOTAXIN, GROA, IFNG, and LEPTIN, or EOTAXIN, GROA, IFNG, and LIF, or EOTAXIN, GROA, IFNG, and MIP1 A, or EOTAXIN, GROA, IFNG, and PAI1, or EOTAXIN, GROA, IFNG, and TRAIL, or EOTAXIN, GROA, IFNG, and TGF A, or EOTAXIN, GROA, MIG, and IL IB, or EOTAXIN, GROA, MIG, and IL2, or EOTAXIN, GROA, MIG, and LEPTIN, EOTAXIN, GROA, MIG, and LIF, or EOTAXIN, GROA, MIG, and MIP1 A, or EOTAXIN, GROA, MIG, and PAI1, or EOTAXIN, GROA, MIG, and TRAIL, or EOTAXIN, GROA, MIG, and TGF A, or EOTAXIN, GROA, IL1B, and IL2, or EOTAXIN, GROA, IL1B, and LEPTIN, EOTAXIN, GROA, IL1B, and LIF, or EOTAXIN, GROA, IL1B, and MIP1 A, or EOTAXIN, GROA, IL1B, and PAI1, or EOTAXIN, GROA, IL1B, and TRAIL, or EOTAXIN, GROA, IL IB, and TGF A, or EOTAXIN, GROA, IL2, and LEPTIN, EOTAXIN, GROA, IL2, and LIF, or EOTAXIN, GROA, IL2, and MIP1 A, or EOTAXIN, GROA, IL2, and PAI1, or EOTAXIN, GROA, IL2, and TRAIL, or EOTAXIN, GROA, IL2, and TGF A, or EOTAXIN, GROA, IL2, and LIF, or EOTAXIN, GROA, LEPTIN, and MIP1A, or EOTAXIN, GROA, LEPTIN, and PAI1, or EOTAXIN, GROA, LEPTIN, and TRAIL, or EOTAXIN, GROA, LEPTIN, and TGF A, or EOTAXIN, GROA, LIF, and MIP1 A, or EOTAXIN, GROA, LIF, and PAI1, or EOTAXIN, GROA, LIF, and TRAIL, or EOTAXIN, GROA, LIF, and TGF A, or EOTAXIN, GROA, MIP1 A, and PAI1, or EOTAXIN, GROA, MIP1 A, and TRAIL, or EOTAXIN, GROA, MIP1A, and TGF A, or EOTAXIN, GROA, PAI1, and TRAIL, or EOTAXIN, GROA, PAI1, and TGF A, EOTAXIN, GROA, TRAIL, and TGFA.

[061] iAge can also be derived, for example, from EOTAXIN, GROA, IFNG, MIG, and IL IB, or EOTAXIN, GROA, IFNG, MIG, and IL2, or EOTAXIN, GROA, IFNG, MIG, and LEPTIN, or EOTAXIN, GROA, IFNG, MIG, and LIF, or EOTAXIN, GROA, IFNG, MIG, and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, and PAI1, or EOTAXIN, GROA, IFNG, MIG, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, and TGFA, or EOTAXIN, GROA, IFNG, IL IB, and LEPTIN, or EOTAXIN, GROA, IFNG, IL1B, and LIF, or EOTAXIN, GROA, IFNG, IL1B, and MIP1 A, or EOTAXIN, GROA, IFNG, IL1B, and PAI1, or EOTAXIN, GROA, IFNG, IL1B, and TRAIL, or TGFA, or EOTAXIN, GROA, IFNG, LIF and MIP1 A, or EOTAXIN, GROA, IFNG, LIF and PAI1, or EOTAXIN, GROA, IFNG, LIF and TRAIL, or EOTAXIN, GROA, IFNG, LIF and TGFA, or EOTAXIN, GROA, IFNG, MIP1 A and PAI1, or EOTAXIN, GROA, IFNG, MIP1 A and TRAIL, or EOTAXIN, GROA, IFNG, MIP1 A and TGFA, or EOTAXIN, GROA, IFNG, PAI1 and TRAIL, or EOTAXIN, GROA, IFNG, PAI1 and TGFA, or EOTAXIN, GROA, IFNG, TRAIL and TGFA.

[062] iAge can also be derived from, for example, EOTAXIN, GROA, IFNG, MIG, IL1B, and IL2, or EOTAXIN, GROA, IFNG, MIG, IL1B, and LEPTIN, or EOTAXIN, GROA, IFNG, MIG, IL IB, and LIF, or EOTAXIN, GROA, IFNG, MIG, IL1B, and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL IB, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL2, and LEPTIN, or EOTAXIN, GROA, IFNG, MIG, IL2 and LIF, or EOTAXIN, GROA, IFNG, MIG, IL2 and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL2 and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL2 and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL2 and TGFA, or EOTAXIN, GROA, IFNG, MIG, LEPTIN, and LIF, or EOTAXIN, GROA, IFNG, MIG, LEPTIN, and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, LEPTIN, and PAI1, or EOTAXIN, GROA, IFNG, MIG, LEPTIN, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, LEPTIN, and TGFA, or EOTAXIN, GROA, IFNG, MIG, LIF and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, LIF and PAI1, or EOTAXIN, GROA, IFNG, MIG, LIF and TRAIL, or EOTAXIN, GROA, IFNG, MIG, LIF and TGFA, or EOTAXIN, GROA, IFNG, MIG, MIP1 A, and PAI1, or EOTAXIN, GROA, IFNG, MIG, MIP1 A, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, MIP1 A, and TGFA, or EOTAXIN, GROA, IFNG, MIG, PAI1, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, PAI1, and TGFA, or EOTAXIN, GROA, IFNG, MIG, TRAIL, and TGFA.

[063] iAge can also be derived from, for example, EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, and LEPTIN, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, and LIF, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL IB, IL2, and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL IB, LEPTIN, and LIF, or EOTAXIN, GROA, IFNG, MIG, IL1B, LEPTIN, and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, LEPTIN, and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, LEPTIN, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL IB, LEPTIN, and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, LIF, and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, LIF, and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, LIF, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL IB, LIF, and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, MIP1 A, and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, MIP1A, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, MIP1A, and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL IB, TRAIL, and TGFA.

[064] iAge can also be derived from, for example, EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN and LIF, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL IB, IL2, LEPTIN and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL IB, IL2, LEPTIN and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LIF and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LIF and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LIF and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL IB, IL2, LIF and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, MIP1 A and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, MIP1 A and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, MIP1 A and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, PAI1 and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, PAI1 and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, TRAIL, and TGFA.

[065] iAge can also be derived from, for example, EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF and MIP1 A, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, MIP1 A and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, MIP1 A and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, MIP1A and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL IB, IL2, LEPTIN, PAI1 and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, PAI1 and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL IB, IL2, LEPTIN, TRAIL, and TGFA.

[066] iAge can also be derived from, for example, EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, MIP1 A and PAI1, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, MIP1 A and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, MIP1 A and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, PAI1, and TRAIL, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, PAI1, and TGFA, or EOTAXIN, GROA, IFNG, MIG, IL1B, IL2, LEPTIN, LIF, TRAIL, and TGFA.

[067] Examples of combination of markers for calculating iAge with coefficients are: EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, -0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, -0.04, -0.7, -0.61, -0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IL1B (e.g., -0.4, 0.45, 0.42, 0.62, 0.35, 0.49, -0.5, -0.39, -0.68, -0.33, -0.75, -0.58, 0.0071, 0.5, -0.91, 0.6, -0.083, - 0.73, -0.81, 0.36, 0.53, -0.47, -0.38, -0.88, 0.29, -0.46, -0.17, 0.098, 0.46, 0.13, -0.059, 0.3, 0.55, -0.61, -0.36, -0.44, 0.31, -0.19, -0.05, 0.082, -0.043, -0.52, -0.43, -0.34, - 0.84, -1.0), and TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, -0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, -0.46, -0.23, 0.034, - 0.71, -0.17, 0.1, -1.7, 0.3, -0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, -0.85, -0.76, 0.91, - 1.5, -1.0, -1.4); or EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, -0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, -0.04, -0.7, -0.61, - 0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, -0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, -0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, -0.61, -1.1, -1.6, -0.36, -0.52, 0.012, -0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1, 2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1) and TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, -0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, -0.46, -0.23, 0.034, -0.71, - 0.17, 0.1, -1.7, 0.3, -0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, -0.85, -0.76, 0.91, -1.5, -1.0, -1.4); or EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, - 1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, -0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, -0.04, -0.7, -0.61, -0.86, -

1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, -0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, -0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, -0.61, -1.1, -1.6, -0.36, -0.52, 0.012, - 0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1, 2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1), IL2 (e.g., -0.6, -2.9, -2.4, -1.4, -1.9, -1.3, -1.8, -3.2, -2.7, -2.8, -2.3, -2.2, -1.7, -

1.2, -3.1, -2.1, -1.6, -2.5, -2.0, -3.0, -2.6, -1.5), and TRAIL (e.g., 0.81, 0.71, -0.92, - 0.2, -0.77, -0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, -0.46, -0.23, 0.034, -0.71, -0.17, 0.1, -1.7, 0.3, -0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, -0.85, -0.76, 0.91, -1.5, -1.0, -1.4); or EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0,

2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, - 0.99, -0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, -0.04, -0.7, -0.61, -0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, -0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, - 0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, - 0.61, -1.1, -1.6, -0.36, -0.52, 0.012, -0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1, 2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1), IL2 (e.g., -0.6, -2.9, -2.4, -1.4, -1.9, -1.3, -1.8, -3.2, -2.7, -2.8, -2.3, -2.2, -1.7, -1.2, -3.1, -2.1, -1.6, -2.5, -2.0, -3.0, -2.6, -1.5), TGFa (e.g., -0.069, -0.58, -0.43, 0.39, -0.79, -0.52, -0.44, -0.14, -0.7, 0.41, -0.25, 0.34, 0.057, -0.24, 0.33, 0.18, 0.27, 0.15, -0.3, -0.00047, 0.21, -0.17, -0.1, -0.21, 0.09, -0.15, -0.092, 0.22, 0.16, 0.46, -0.099, -0.041, -0.53, -0.36, -0.61, -0.11, -0.77, 0.013, -0.18, - 0.22, -0.51, -3.0, -0.59, -0.42, -1.4), and TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, - 0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, - 0.46, -0.23, 0.034, -0.71, -0.17, 0.1, -1.7, 0.3, -0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, - 0.85, -0.76, 0.91, -1.5, -1.0, -1.4); or , EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6,

2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, - 0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, - 0.45, -0.04, -0.7, -0.61, -0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, -0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, -0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, -0.61, -

1.1, -1.6, -0.36, -0.52, 0.012, -0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1,

2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1), TGFa (e.g., -0.069, -0.58, -0.43, 0.39, -0.79, -0.52, - 0.44, -0.14, -0.7, 0.41, -0.25, 0.34, 0.057, -0.24, 0.33, 0.18, 0.27, 0.15, -0.3, -0.00047, 0.21, -0.17, -0.1, -0.21, 0.09, -0.15, -0.092, 0.22, 0.16, 0.46, -0.099, -0.041, -0.53, - 0.36, -0.61, -0.11, -0.77, 0.013, -0.18, -0.22, -0.51, -3.0, -0.59, -0.42, -1.4), LIF (e.g., - 0.31, 1.7, 0.52, -0.32, 1.3, 1.2, -0.61, 1.6, 2.1, -0.14, 1.8, 1.5, 2.0, 0.59, -0.91, -0.25, 0.35, 1.1, -1.3, -0.21, -0.22, 0.13, -1.7, -1.2, -0.7, -1.1, -0.048, -0.27, 1.9, -0.35, - 0.0056, -0.59, -1.5, -0.42, -1.8), IL2 (e.g., -0.6, -2.9, -2.4, -1.4, -1.9, -1.3, -1.8, -3.2, - 2.7, -2.8, -2.3, -2.2, -1.7, -1.2, -3.1, -2.1, -1.6, -2.5, -2.0, -3.0, -2.6, -1.5), and TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, -0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, - 0.74, 0.85, -0.084, 0.52, -1.8, 0.62, -0.46, -0.23, 0.034, -0.71, -0.17, 0.1, -1.7, 0.3, - 0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, -0.85, -0.76, 0.91, -1.5, -1.0, -1.4); or EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, -0.98, -0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, -0.04, -0.7, -0.61, -0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, - 0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, -0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, -0.61, -1.1, -1.6, -0.36, -0.52, 0.012, - 0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1, 2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1), TGFa (e.g., -0.069, -0.58, -0.43, 0.39, -0.79, -0.52, -0.44, -0.14, -0.7, 0.41, -0.25, 0.34, 0.057, -0.24, 0.33, 0.18, 0.27, 0.15, -0.3, -0.00047, 0.21, -0.17, -0.1, -0.21, 0.09, -0.15, -0.092, 0.22, 0.16, 0.46, -0.099, -0.041, -0.53, -0.36, -0.61, -0.11, -0.77, 0.013, - 0.18, -0.22, -0.51, -3.0, -0.59, -0.42, -1.4), LIF (e.g., -0.31, 1.7, 0.52, -0.32, 1.3, 1.2, - 0.61, 1.6, 2.1, -0.14, 1.8, 1.5, 2.0, 0.59, -0.91, -0.25, 0.35, 1.1, -1.3, -0.21, -0.22, 0.13, -1.7, -1.2, -0.7, -1.1, -0.048, -0.27, 1.9, -0.35, -0.0056, -0.59, -1.5, -0.42, -1.8), IL2 (e.g., -0.6, -2.9, -2.4, -1.4, -1.9, -1.3, -1.8, -3.2, -2.7, -2.8, -2.3, -2.2, -1.7, -1.2, -3.1, -

2.1, -1.6, -2.5, -2.0, -3.0, -2.6, -1.5), PALI (e.g., -0.28, -0.31, -0.13, -0.25, -0.26, - 0.064, -0.14, -0.33, -0.066, -0.067, -0.009, -0.076, -0.079, -0.078, -0.02, -0.15, -0.22, - 0.21, -0.091, -0.03, -0.16, -0.17, -0.092, -0.096, -0.12, -0.032, 0.0038, -0.042, -0.065, -0.045, -0.068, -0.056, -0.051, -0.098), and TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, -0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, -0.46, -0.23, 0.034, -0.71, -0.17, 0.1, -1.7, 0.3, -0.78, -1.6, -1.1, 1.9, -0.6, 0.82, -0.68, - 0.85, -0.76, 0.91, -1.5, -1.0, -1.4); or EOTAXIN (e.g., 0.79, 1.9, 2.3, 2.0, 2.1, 1.6, 2.2, 1.4, 1.2, 1.5, 1.7, 1.0, 1.3, -1.2), GROA (e.g., -0.47, -0.84, -0.43, -0.24, -0.99, -0.98, - 0.46, -0.18, -0.56, -0.36, 2.0, 0.051, -0.48, -0.39, -0.8, -0.13, -0.15, -0.16, -0.2, -0.45, - 0.04, -0.7, -0.61, -0.86, -1.1, -0.44, -0.11, -0.27, -0.68, -0.51, -0.34, -0.92, -1.0, -1.2), IFNG (e.g., -0.26, -0.98, -0.97, -0.64, -0.56, -0.46, -0.31, -0.66, -0.9, -0.2, -0.25, -1.4, -0.085, -0.73, -0.8, -0.38, -0.086, -0.16, -0.22, -1.2, -0.53, -0.28, -0.86, -0.61, -1.1, -

1.6, -0.36, -0.52, 0.012, -0.68, -1.5, -1.0, -1.3), MIG (e.g., 0.21, 1.9, 2.3, 2.0, 2.1, 2.2, 1.8, 1.6, 1.2, 1.7, 1.5, 1.1), TGFa (e.g., -0.069, -0.58, -0.43, 0.39, -0.79, -0.52, -0.44, - 0.14, -0.7, 0.41, -0.25, 0.34, 0.057, -0.24, 0.33, 0.18, 0.27, 0.15, -0.3, -0.00047, 0.21, - 0.17, -0.1, -0.21, 0.09, -0.15, -0.092, 0.22, 0.16, 0.46, -0.099, -0.041, -0.53, -0.36, - 0.61, -0.11, -0.77, 0.013, -0.18, -0.22, -0.51, -3.0, -0.59, -0.42, -1.4), LIF (e.g., -0.31,

1.7, 0.52, -0.32, 1.3, 1.2, -0.61, 1.6, 2.1, -0.14, 1.8, 1.5, 2.0, 0.59, -0.91, -0.25, 0.35,

1.1, -1.3, -0.21, -0.22, 0.13, -1.7, -1.2, -0.7, -1.1, -0.048, -0.27, 1.9, -0.35, -0.0056, - 0.59, -1.5, -0.42, -1.8), IL2 (e.g., -0.6, -2.9, -2.4, -1.4, -1.9, -1.3, -1.8, -3.2, -2.7, -2.8, - 2.3, -2.2, -1.7, -1.2, -3.1, -2.1, -1.6, -2.5, -2.0, -3.0, -2.6, -1.5), PAI-1 (e.g., -0.28, - 0.31, -0.13, -0.25, -0.26, -0.064, -0.14, -0.33, -0.066, -0.067, -0.009, -0.076, -0.079, - 0.078, -0.02, -0.15, -0.22, -0.21, -0.091, -0.03, -0.16, -0.17, -0.092, -0.096, -0.12, - 0.032, 0.0038, -0.042, -0.065, -0.045, -0.068, -0.056, -0.051, -0.098), LEPTIN (e.g., 0.46, 0.39, 0.41, 0.42, 0.4, 0.43, 0.44, 0.37, 0.45, 0.38, 0.36, 0.77), and TRAIL (e.g., 0.81, 0.71, -0.92, -0.2, -0.77, -0.48, -0.37, 0.74, 0.47, 0.33, 1.2, 0.42, 0.5, 0.76, -0.74, 0.85, -0.084, 0.52, -1.8, 0.62, -0.46, -0.23, 0.034, -0.71, -0.17, 0.1, -1.7, 0.3, -0.78, - 1.6, -1.1, 1.9, -0.6, 0.82, -0.68, -0.85, -0.76, 0.91, -1.5, -1.0, -1.4).

[068] MIG (monokine induced by gamma interferon) is a small cytokine belonging to the CXC chemokine family. MIG is one of the chemokines which plays a role to induce chemotaxis, promote differentiation and multiplication of leukocytes, and cause tissue extravasation. MIG regulates immune cell migration, differentiation, and activation. Tumor-infiltrating lymphocytes are a key for clinical outcomes and prediction of the response to checkpoint inhibitors. In vivo studies suggest the axis plays a tumorigenic role by increasing tumor proliferation and metastasis. MIG predominantly mediates lymphocytic infiltration to the focal sites and suppresses tumor growth. MIG binds to C-X-C motif chemokine 3 of the CXCR3 receptor.

[069] TRAIL (TNF-related apoptosis-inducing ligand) is a cytokine that is produced and secreted by most normal tissue cells. It is thought to cause apoptosis primarily in tumor cells by binding to certain death receptors. TRAIL has also been designated CD253 (cluster of differentiation 253) and TNFSF-1O (tumor necrosis factor (ligand) superfamily, member 10). TRAIL is described in Wiley et al Immunity 1005 3: 673- 82 as well as Pitti J. Biol. Chem. 1996 271 : 12687-90.

[070] IFNG (otherwise known as interferon gamma, IFNy or type II interferon) is a dimerized soluble cytokine that is the only member of the type II class of interferons. IFNG is critical for innate and adaptive immunity against viral, some bacterial and protozoan infections. IFNG is an important activator of macrophages and inducer of Class II major histocompatibility complex (MHC) molecule expression. IFNG is described In Schoenborn et al Adv. Immunol. 2007 96: 4I-IOI as well as Gray Nature. 1982 298: 859-63.

[071] Eotaxin (also known as C-C motif chemokine 11 or eosinophil chemotactic protein) is a small cytokine belonging to the CC chemokine family. Eotaxin selectively recruits eosinophils by inducing their chemotaxis, and therefore, is implicated in allergic responses. The effects of eotaxin is mediated by its binding to a G-protein-linked receptor known as a chemokine receptor. Chemokine receptors for which CCLI I is a ligand include CCR2, CCR3 and CCR5. Eotaxin is described in Kitaura et al The Journal of Biological Chemistry I 996 271: 7725-30 and Jose et al The Journal of Experimental Medicine 1994 I 79: 881-7.

[072] GROA (also known as CXCLI, the GROI oncogene, GROa, KC, neutrophil activating protein 3 (NAP-3) and melanoma growth stimulating activity, alpha (MSGA-a)) is secreted by human melanoma cells, has mitogenic properties and is implicated in melanoma pathogenesis. GROA is expressed by macrophages, neutrophils and epithelial cells, and has neutrophil chemoattractant activity. This chemokine elicits its effects by signaling through the chemokine receptor CXCR2. GROA is described in Haskill et al Proc. Natl. Acad. Sci. U.S.A. 190 87 (19): 7732-6. [073] IL-2 is one of the key cytokines with pleiotropic effects on the immune system. It is a 15.5 - 16 kDa protein that regulates the activities of white blood cells (leukocytes, often lymphocytes) that are responsible for immunity. The major sources of IL-2 are activated CD4+ T cells, activated CD8+ T cells, NK cells, dendritic cells and macrophages. IL-2 is an important factor for the maintenance of CD4+ regulatory T cells and plays a critical role in the differentiation of CD4+ T cells into a variety of subsets. It can promote CD8+ T-cell and NK cell cytotoxicity activity, and modulate T-cell differentiation programs in response to antigen, promoting naive CD4+ T-cell differentiation into T helper-1 (Thl) and T helper-2 (Th2) cells while inhibiting T helper- 17 (Th 17) differentiation.

[074] TGFA (transforming growth factor alpha) is a polypeptide of 5.7 kDa that is partially homologous to EGF. TGFA is a growth factor that is a ligand for the epidermal growth factor receptor, which activates a signaling pathway for cell proliferation, differentiation and development. TGFA also is a potent stimulator of cell migration. TGFA can be produced in macrophages, brain cells, and keratinocytes. TGFA can induce epithelial development. TGFA can also upregulate TLR expression and function augmenting host cell defense mechanisms at epithelial surfaces. TGFA may act as either a transmembrane-bound ligand or a soluble ligand. TGFA has been associated with many types of cancers, and it may also be involved in some cases of cleft lip/palate. Alternatively spliced transcript variants encoding different isoforms have been found for this gene.

[075] PAI1 (plasminogen activator inhibitor-1) is a member of the serine proteinase inhibitor (serpin) superfamily. PAI1 is the principal inhibitor of tissue plasminogen activator (tPA) and urokinase (uPA), and hence is an inhibitor of fibrinolysis. PAI1 is also a regulator of cell migration. PAI1 can play a role in a number of age-related, conditions including, for example, inflammation, atherosclerosis, insulin resistance, obesity, comorbidities, and Werner syndrome. PAI1 can play a host protective role during the acute phase of infection by regulating interferon gamma release. IFNG regulates PAI-1 expression, which suggests an intricate interplay between PAI-1 and IFNG. PAI1 can also activate macrophages through Toll-like receptor 4 (TLR4) and can promote migration of pro-cancer M2 macrophages into tumors.

[076] LIF (leukemia inhibitory factor) is interleukin 6 class cytokine with pleiotropic effects impacting several different systems. When LIF levels drop, cells differentiate. LIF has the capacity to induce terminal differentiation in leukemic cells. Its activities include the induction of hematopoietic differentiation in normal and myeloid leukemia cells, the induction of neuronal cell differentiation, and the stimulation of acute-phase protein synthesis in hepatocytes. The protein encoded by this gene is a pleiotropic cytokine with roles in several different systems. It is involved in the induction of hematopoietic differentiation in normal and myeloid leukemia cells, induction of neuronal cell differentiation, regulator of mesenchymal to epithelial conversion during kidney development, and may also have a role in immune tolerance at the maternal-fetal interface. Alternatively spliced transcript variants encoding multiple isoforms have been observed for this gene. LIF functions through both autocrine and paracrine manners. LIF binds to its specific receptor LIFR, then recruits gpl30 to form a high affinity receptor complex to induce the activation of the downstream signal pathways including JAK/STAT3, PI3K/AKT, ERK1/2 and mTOR signaling. Further studies have clearly proven that LIF is a multifunctional protein which has a broad biological functions in neuronal, hepatic, endocrine, inflammatory and immune systems. LIF regulates the embryonic stem cell self-renewal and is an indispensable factor to maintain mouse embryonic stem cell pluripotency. The expression of LIF is induced under inflammatory stress as an anti-inflammatory agent.

[077] LEPTIN is secreted by white adipocytes into the circulation and plays a major role in the regulation of energy homeostasis. LEPTIN binds to the leptin receptor in the brain, which activates downstream signaling pathways that inhibit feeding and promote energy expenditure. LEPTIN also has several endocrine functions, and is involved in the regulation of immune and inflammatory responses, hematopoiesis, angiogenesis, reproduction, bone formation and wound healing. LEPTIN can directly link nutritional status and pro-inflammatory T helper 1 immune responses, and a decrease of LEPTIN plasma concentration during food deprivation can lead to an impaired immune function. LEPTIN is associated with the pathogenesis of chronic inflammation, and elevated circulating LEPTIN levels in obesity appear to contribute to low-grade inflammation which makes obese individuals more susceptible to increased risk of developing cardiovascular diseases, type II diabetes, and degenerative disease including autoimmunity and cancer. Reduced levels of LEPTIN such as those found in malnourished individuals have been linked to increased risk of infection and reduced cell-mediated immune responses. Mutations in this gene and its regulatory regions cause severe obesity and morbid obesity with hypogonadism in human patients. A mutation in this gene has also been linked to type 2 diabetes mellitus development.

[078] MIP1 A (macrophage inflammatory protein) is a member of the CC or beta chemokine subfamily. MIP1A regulates leukocyte activation and trafficking. MIP1A acts as a chemoattractant to a variety of cells including monocytes, T cells, B cells and eosinophils. MIP1 A plays a role in inflammatory responses through binding to the receptors CCR1, CCR4 and CCR5.

[079] IL-1B (Interleukin- 1 beta) is a member of the interleukin 1 cytokine family. IL- IB is an important mediator of the inflammatory response, and is involved in a variety of cellular activities, including cell proliferation, differentiation, and apoptosis. LL1B is produced by activated macrophages as a proprotein, which is proteolytically processed to its active form by caspase 1 (CASP1/ICE).

[080] Construction of CRS: Separation of immune cells may comprise the use of differential centrifugation of blood by density gradient (FIG. 2). The resulting cell pellet can be suspended in warm media, wash twice and resuspended at 0.5xl0^A6 viable cells/mL. 200 uL of cell sample can be plated per well in 96-well deep-well plates. After resting for 1 hour at 37°C, cells can be stimulated by adding 50 ul of cytokine (IFNa, IFNg, IL-6, IL-7, IL- 10, IL-2, or IL-21) (FIG. 2) and incubated at 37°C for 15 minutes. The cells can be fixed with paraformaldehyde, permeabilized with methanol, and kept at -80C overnight. Each well can then be bar-coded using a combination of Pacific Orange and Alexa-750 dyes (Invitrogen, Carlsbad, CA) and pooled in tubes. The cells can be washed with FACS buffer (PBS supplemented with 2% FBS and 0.1% soium azide), and stained with the following antibodies (all from BD Biosciences, San Jose, CA): CD3 Pacific Blue, CD4 PerCP-Cy5.5, CD20 PerCp- Cy5.5, CD33 PE-Cy7, CD45RA Qdot 605, pSTAT-1 AlexaFluor488, pSTAT-3 AlexaFluor647, pSTAT-5 PE. The samples can be washed and resuspended in FACS buffer. 100,000 cells per stimulation condition are collected using DIVA 6.0 software on an LSRII flow cytometer (BD Biosciences). Data analysis can be performed using FlowJo v9.3 by gating on live cells based on forward versus side scatter profiles, then on singlets using forward scatter area versus height, followed by cell subset-specific gating.

[081] Fold-change difference due to stimulation can be computed as the ratio of the cell, cytokine stimulation, phosphoprotein measure to the raw, un-normalized, cell- phosphoprotein matching baseline that was measured on the same plate. The data can be normalized by scaling individuals by the average of the assay on the day in which they were measured.

[082] To construct the Cytokine Response Score (CRS) (FIG. 2) 15 reproducible age-associated normalized cytokine responses can be expressed as fold increases over baseline (unstimulated) and the fold increases for the following can be summed: CD8+ cells, stimulate with IFNa and measure pSTATl, 3 and 5; CD8+ cells, stimulate with IL6 and measure pSTATl, 3 and 5, CD8+ cells, stimulate with IFNg and measure pSTATl, CD8+ cells, stimulate with IL21 and measure pSTATl; CD4+ cells, stimulate with IFNa and measure pSTAT5, CD4+ cells, stimulate with IL6 and measure pSTAT5, CD20+ cells, stimulate with IFNa and measure pSTATl, Monocytes stimulate with IL10 and measure pSTAT3, Monocytes stimulate with IFNg and measure pSTAT3, Monocytes stimulate with IFNa and measure pSTAT3, and Monocytes stimulate with IL6 and measure pSTAT3.

[083] IFNA (Interferon alpha) is a member of the type I interferon class. And has thirteen (13) variants in humans. IFNA is secreted by hematopoietic cells, predominately plasmacytoid dendritic cells. IFNA can have either protective or deleterious roles. IFNA can be induced by ssRNA, dsRNA, and cytosolic DNA from viruses or bacteria. IFNA can induce caspase- 11 expression, which contributes to activation of non-canonical inflammasome. Use of recombinant IFNA has been shown to be effective in reducing the symptoms and duration of the common cold. [084] IFNG (Interferon gamma) is a member of the type II interferon class. The encoded protein is secreted by cells of both the innate and adaptive immune systems. The active protein is a homodimer that binds to the interferon gamma receptor which triggers a cellular response to viral and microbial infections. Mutations in this gene are associated with an increased susceptibility to viral, bacterial and parasitic infections and to several autoimmune diseases.

[085] IL6 is a cytokine with pleiotropic effects on inflammation, immune response, and hematopoiesis. IL6 is promptly and transiently produced in response to infections and tissue injuries, contributes to host defense through the stimulation of acute phase responses, hematopoiesis, and immune reactions. IL6 functions in inflammation and the maturation of B cells. In addition, IL6 has been shown to be an endogenous pyrogen capable of inducing fever in people with autoimmune diseases or infections. IL6 is primarily produced at sites of acute and chronic inflammation, where it is secreted into the serum and induces a transcriptional inflammatory response through interleukin 6 receptor, alpha. IL6 is implicated in a wide variety of inflammation- associated disease states, including susceptibility to diabetes mellitus and systemic juvenile rheumatoid arthritis. Dysregulated, continual synthesis of IL-6 plays a pathological effect on chronic inflammation and autoimmunity. Alternative splicing results in multiple transcript variants.

[086] IL10 is a cytokine with pleiotropic effects in immunoregulation and inflammation. IL- 10 is an anti-inflammatory cytokine and during infection it inhibits the activity of Thl cells, NK cells, and macrophages, all of which are required for optimal pathogen clearance but also contribute to tissue damage. IL 10 can directly regulate innate and adaptive Thl and Th2 responses by limiting T cell activation and differentiation in the lymph nodes as well as suppressing proinflammatory responses in tissues. It also enhances B cell survival, proliferation, and antibody production. This cytokine can block NF-kappa B activity, and is involved in the regulation of the JAK-STAT signaling pathway. Knockout studies in mice suggested the function of this cytokine as an essential immunoregulator in the intestinal tract.

[087] IL21 is a member of the common-gamma chain family of cytokines with immunoregulatory activity. IL21 plays a role in both the innate and adaptive immune responses by inducing the differentiation, proliferation and activity of multiple target cells including macrophages, natural killer cells, B cells, cytotoxic T cells, and epithelial cells. IL21 is important to anti-tumor and antiviral responses and also exerts major effects on inflammatory responses that promote the development of autoimmune diseases and inflammatory disorders.

[088] pSTATl (phosphorylated signal transducer and activator of transcription 1) mediates cellular responses to interferons (IFNs), cytokine KITLG/SCF and other cytokines and other growth factors. Following type I IFN (IFN-alpha and IFN-beta) binding to cell surface receptors, signaling via protein kinases leads to activation of Jak kinases (TYK2 and JAK1) and to tyrosine phosphorylation of STAT1 and STAT2. The phosphorylated STATs dimerize and associate with ISGF3G/IRF-9 to form a complex termed ISGF3 transcription factor, that enters the nucleus (PubMed:28753426). ISGF3 binds to the IFN stimulated response element (ISRE) to activate the transcription of IFN-stimulated genes (ISG), which drive the cell in an antiviral state. In response to type II IFN (IFN-gamma), STAT1 is tyrosine- and serine-phosphorylated (PubMed:26479788). It then forms a homodimer termed IFN- gamma-activated factor (GAF), migrates into the nucleus and binds to the IFN gamma activated sequence (GAS) to drive the expression of the target genes, inducing a cellular antiviral state.

[089] pSTAT 3 (phosphorylated signal transducer and activator of transcription 3) mediates cellular responses to interleukins, KITLG/SCF, LEP and other growth factors. Once activated, recruits coactivators, such as NCOA1 or MED1, to the promoter region of the target gene. Binds to the interleukin-6 (IL-6)-responsive elements identified in the promoters of various acute-phase protein genes. Activated by IL31 through IL3 IRA. Acts as a regulator of inflammatory response by regulating differentiation of naive CD4+ T-cells into T-helper Thl7 or regulatory T-cells (Treg): deacetylation and oxidation of lysine residues by LOXL3, disrupts STAT3 dimerization and inhibits its transcription activity.

[090] pSTAT 5 (phosphorylated signal transducer and activator of transcription 5) is activated by Janus-activated kinases (JAK) downstream of cytokine receptors.

STAT5 proteins are activated by a wide variety of hematopoietic and nonhematopoietic cytokines and growth factors, all of which use the JAK-STAT signaling pathway as their main mode of signal transduction. STAT5 proteins critically regulate vital cellular functions such as proliferation, differentiation, and survival. STAT5 plays an important role in the maintenance of normal immune function and homeostasis, both of which are regulated by specific members of IL-2 family of cytokines, which share a common gamma chain (y(c)) in their receptor complex. STAT5 critically mediates the biological actions of members of the y(c) family of cytokines in the immune system. Essentially, STAT5 plays a critical role in the function and development of Tregs, and consistently activated STAT5 is associated with a suppression in antitumor immunity and an increase in proliferation, invasion, and survival of tumor cells.

Immunotypes

[091] Markers which are significant contributors to iAge were used in deriving immunotypes. The markers used are combinations of Eotaxin, GroA, INFg, MIG, TRAIL, IL-2, TGFA, PALI, and LIF. Four, five, six, seven, eight, or nine markers can be used to derive immunotypes. For example, five markers Eotaxin, GroA, INFg, MIG, and TRAIL can be used.

[092] Using information from 1,642 samples, the levels of these markers were subjected to a Principal Component Analysis. In a PC A, the levels of the markers can be standardized so that each contributes equally. This standardized data can then be subject to a covariance matrix computation to see if some of the variables are behaving in a correlated fashion. Eigenvectors and Eigenvalues can be calculated for the covariance matrix to identify the Principle Components. Principal components are new variables that are constructed as linear combinations or mixtures of the initial variables. Principal Components represent the directions of the data that explain a maximal amount of variance, that is to say, the lines that capture most information of the data. Components of lesser value can be discarded and more significant components can be kept (reducing the dimensionality of the data set). This data can be recast along the Principal Component axes.

[093] The PCA of the patient data produced two groups: a super-healthy group and a normal health group. The super healthy group was divided into four immunotypes 1- 4 which are shown in FIG. 6. In FIG. 6, the level of each protein marker was standardized (50 percentile = 0 with positive values indicating a higher contribution to iAge) and minus 4 was the level of marker in patients with an iAge 20 years younger than their chronological age (lower/younger iAge correlates with better health outcomes). Immunotype SHI had low iAge score levels for Eotaxin, GroA, IFNg, and MIG (indicating a lower contribution to iAge), but high iAge score levels of TRAIL (indicating a higher contribution to iAge). Immunotype SH2 had low iAge scores for Eotaxin and TRAIL, high iAge score levels of GroA and INFg, and moderate iAge score levels for MIG. Immunotype SH3 had low iAge score levels for all five markers (Eotaxin, GroA, IFNg, MIG, TRAIL). Immunotype SH4 had low iAge scores for GroA, IFNg, and TRAIL, high iAge score levels of MIG, and moderate iAge score levels for Eotaxin. [094] The normal group was divided into six Immunotypes 1-6 which are shown in FIG. 7. In FIG. 7, the level of each protein marker was standardized (50 percentile = 0 ) and minus 4 was the level of marker in patients with an iAge 20 years younger than their chronological age. In addition, two additional components were added for the PC A of the normal group: number of markers in the minus direction (low iAge), and the difference between iAge and chronological age. Immunotype N1 had negative iAge score levels for Eotaxin and TRAIL, and high iAge score levels for GroA, IFNg and MIG. Immunotype N2 had moderate iAge score levels for Eotaxin, GroA, IFNg, and MIG, and high iAge score levels for TRAIL. Immunotype N3 had moderate iAge score levels for MIG and TRAIL, and high iAge score levels for Eotaxin, GroA, and IFNg. Immunotype N4 had moderate iAge score levels for Eotaxin and MIG, and high iAge score levels for GroA, IFNg, and TRAIL.

Immunotype N4 had moderate iAge score levels for MIG and TRAIL, and high iAge score levels for Eotaxin, GroA, and IFNg. Immunotype N5 had low iAge score levels for TRAIL, and high iAge score levels for GroA, IFNg, MIG, and TRAIL. Immunotype N6 had moderate iAge score levels for GroA and IFNg, and high iAge score levels for Eotaxin, MIG, and TRAIL.

[095] FIG. 8 and 9 show that each of the ten immunotypes has a different signature for the five markers (different levels of the five markers after the markers are normalized as discussed above, i.e., normalized so zero = 50^th percentile and 4 = level in patients with an iAge 20 years younger than their chronological age). Thus, a common treatment of each immunotype can be provided to members of the immunotype to lower the iAge of any member of the immunotype which will lower iAge and improve the patients health, well-being and longevity.

Immunosenescence

[096] The immune system undergoes marked shifts in composition and function with aging, a pattern of changes that are together termed “immunosenescence”. [097] Immunosenescence impacts both the innate and adaptive arms of the immune system and major features of immunosenescence include alteration in immune cell subset frequencies, defective antigen presentation, reduced cytotoxic function, and restricted T cell repertoire (Pawelec G, Larbi A. (2008), Immunity and ageing in man: Annual Review 2006/2007. Exper Gerontol 43:34-38; Weiskopf D, Weinberger B, GrubeckLoebenstein B. (2009), The aging of the immune system. Transpl Int. 22: 1041-1050, both of which are incorporated by reference in their entirety for all purposes).

[098] Other changes occurring during immunosenescence include reduction in cytokine signaling responses, increased baseline levels of phospho-STAT, and elevation in memory cell populations (Shen-Orr et al. (2016). Defective Signaling in the JAK-STAT Pathway Tracks with Chronic Inflammation and Cardiovascular Risk in Aging Humans, Cell Systems. 3(4):374-384.E4, which is incorporated by reference in its entirety for all purposes). Of notable clinical importance, immunosenescence also results in defects in antibody responses, with many older individuals failing to generate protective antibody titers following vaccination (Furman D et al. 2013). Apoptosis and other immune biomarkers predict influenza vaccine responsiveness. Molecular Systems Biology 9:659, which is incorporated by reference in its entirety for all purposes).

[099] Immunosenescence impacts both the host's capacity to respond to infections and the development of long-term immune memory, especially by vaccination. Immunosenescence is associated with the accumulation of memory and effector cells as a result of repeated infections and by continuous exposure to antigens (inhalant allergens, food, etc.). This chronic inflammation characterizes immunosenescence and can have a significant impact on survival and fragility. Immunosenescence can also be associated with remodeling of the immune system caused by oxidative stress. [0100] Immunosenescence can occur from an imbalance between inflammatory and anti-inflammatory mechanisms producing chronic inflammation. This chronic inflammation can be due to chronic antigen stimulation occurring over the course of life and to the oxidative stress that involves the production of oxygen free radicals and toxic products. These factors are able to modify the potential of apoptotic lymphocytes, and this remodeling of the lymphocyte compartment and the chronic expression of proinflammatory cytokines are implicated in the processes of longevity and diseases related to immunosenescence.

[0101] Canonical acute inflammation proteins (C -reactive protein, Interleukin-6, etc.) have been associated with immunosenescence in previous studies, but the relationship with systemic chronic inflammation has not yet been established. Using a well- known marker for immunosenescence (the frequency of naive CD 8 (+) T cells) contribution of iAge to immunosenescence was estimated after controlling for Age, CMV, and sex by a multiple regression model. Age was the strongest contributor to changes in naive CD8 (+) T cells followed by iAge, CMV (negative contributors) and sex (frequency of total CD8 (+) T cells in females was 24% vs. 30% in males). iAge was significantly correlated with the frequency of naive CD8 (+) T cells to a similar extent to CMV positivity. Chronological age was the strongest contributor (P < 10- ¹⁵), followed by iAge (P < 10^-5), CMV (P < 10^-3) and gender (P = 0.012) (A). [0102] The effect of chronic inflammation on the immune response was also measured using a functional immune assay (phospho-flow) in which cells are stimulated ex vivo and the phosphorylation of various intracellular proteins is measured by using antibodies against phosphorylated forms of these proteins. In particular, the responses to four independent stimuli (Interferon-alpha, Interleukin-6, Interleukin- 10 and Interleukin-21) were measured in a total of 818 individuals and the fold-increase in phospho-STATl, -STAT3 and -STAT5 in B cells, total CD4 (+) T cells (and the CD45RA(+) and CD45RA(-) subsets), total CD8 (+) T cells (and the CD45RA(+) and CD45RA(-) subsets), and in monocytes were determined. Multiple regression analysis controlling age, CMV and sex, surprisingly showed there was a general decrease of the B cell and T cell responses to stimuli and an overall potentiation of the monocyte responses associated with increasing iAge (combined P < 10^-5).

[0103] These results demonstrate that iAge is an important immune predictor of immune function decline (immunosenescence) and can be used as a ‘metric’ for immunological health.

[0104] Immunosenescence is associated with lowered ability of the immune system to kill cancer cells, protect against infections from pathogenic organisms, and produce efficacious response to vaccines. Treating a subject to lower their iAge can reduce the immunosenescence in the subject and improve the ability of the subject’s immune system to kill cancer cells, protect against infections from pathogenic organisms, and produce efficacious responses to vaccines. Agents and methods for lowering iAge and thereby reducing immunosenescence are described below.

Immunotherapies

[0105] In recent years, there has been a sharp rise in the development and implementation of cancer immunotherapies against cancer. The approval of anti- cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and anti-programmed cell death protein 1 (PD-1) antibodies has resulted in significant improvements in disease outcomes for a variety of cancers. Unlike chemo- and radiotherapy, which aim to interfere with tumor cell growth and survival, immunotherapies indirectly target the tumor by boosting the anti-tumor immune responses of the patient. Despite the huge success of these therapies in many forms of cancer, the success rates are generally low and biomarkers to define objective clinical responses are still lacking.

[0106] The biological foundation of current cancer immunotherapies is the concept of cancer immune surveillance, which proposes that the immune system eliminates tumor cells because these possess new antigens and trigger an immune reaction with regression of the tumor and no clinical signs of its existence. In a seminal study to test this theory, it was shown that chemically-induced sarcomas grew faster and more aggressively in immune-incompetent mice than in wild type animals because the former lack lymphocytes (have a engineered mutation of the recombination-activating (RAG) gene) or their inability to respond to JFNy, either because of the loss of the IFNy receptor gene, or the STAT-1 gene. Immune surveillance was shown by using mice with a double mutation RAG2^-/-/STATl^-/- which spontaneously developed tumors. These tumors resemble some of the major malignancies of humans, such as breast, lung, or colon. Cancer immunoediting was shown by transplanting tumors between mice. When a tumor was transplanted from an immune incompetent mouse to a immune competent mouse, 40% of the tumors were rejected. Whereas no rejection occured when transplants were performed using tumors from syngeneic immune-competent mice. This clearly demonstrated that immunoediting had occurred in immune-competent animals, even if they were incapable of rejecting their own tumor, enabling their escape from immune-surveillance. After decades of follow-up work a novel theory of tumor immunity was introduced. The theory proposed three steps: 1) elimination of tumors at early stages (immune surveillance hypothesis), 2) equilibrium which refers to the state in which the immune system controls the tumor, and 3) escape when tumor cells are immune-edited and grow without immune control. This three E’s theory is still the theory accepted worldwide as the basis to understand the interaction of cancer cells with the immune system. The theory also paved the way for the exploding field of cancer immunotherapy. [0107] Immunotherapy for cancer boosts the body's natural defenses to fight cancer. It uses substances made by the body or in a laboratory to improve or restore immune system function. Cancer immunotherapies include, for example, monoclonal antibodies, immune checkpoint inhibitors, cancer vaccines, immune cells modified with, for example, chimeric antigen receptors, and other nonspecific immunotherapies that boost the immune system function or action by, for example, specifically targeting cancer cells, overcoming inhibition of the immune system (e.g., by myeloid suppressor cells), etc.

[0108] Monoclonal antibodies for treating cancer include, for example, anti-CD20 antibody (e.g., Bexxar®, Zevalin®, Rituxan®, Gazyvaro®, Arzerra®), anti-Her2 antibody (e.g., Herceptin®, Kadcyla®, Perjeta®), anti-CD30 antibody (e.g., Adcetris®), anti-CD19 and anti-CD3 bispecific antibody (e.g., Blincyto®), anti-VegF antibody (e.g., Avastin®, Cyramza®), anti-EGFR antibody (e.g., Erbitux®, Portrazza®, Vectibix®), anti-PDGFR-a antibody (e.g., Lartruvo®), anti-CD38 antibody (e.g., Darzalex®), antiSLAMF7 antibody (e.g., Empliciti®), anti-GD2 antibody (e.g., Unituxin®), anti-CD19 antibody (e.g., Blincyto®), anti-RANKL antibody (e.g., Xgeva®, Prolia®), anti-EpCAM and anti-CD3 antibody (e.g., Removab®), anti-EpCAM antibody (e.g., Proxinium®), anti-CD52 antibody (e.g., Campath®), and anti-CD33 antibody (e.g., Mylotarg®).

[0109] Checkpoint inhibitors for treating cancer include, for example, Nivolumab (Opdivo), Pembrolizumab (Keytruda), Atezolizumab (Tecentriq), Ipilimumab (Yervoy), Durvalumab (Imfinzi®), Avelumab (Bavencio®), Lirilumab, and BMS- 986016 (Relatlimab). Nivolumab, Atezolizumab, Pembrolizumab, Durvalumab, and Avelumab act at the checkpoint protein PD-1/PD-L1 and inhibit apoptosis of antitumor immune cells. Ipilimumab acts at CTLA4 and prevents CTLA4 from downregulating activated Tcells in the tumor. Lirilumab acts at KIR and facilitates activation of Natural Killer cells. BMS-986016 acts at LAG3 and activates antigenspecific T-lymphocytes and enhances cytotoxic T cell-mediated lysis of tumor cells. [0110] Chimeric Antigen Receptors for treating cancer include, for example, an antiCD19 CAR in T-cells (e.g., Kymriah® and Yescarta®). CAR therapy can also be directed at a variety of tumor-associated antigens including, for example, 4- IBB, 5T4, adenocarcinoma antigen, alpha-fetoprotein, BAFF, B-lymphoma cell, C242 antigen, CA125, carbonic anhydrase 9 (CA-IX), C-MET, CCR4, CD152, CD19, CD20, CD21, CD22, CD23 (IgE receptor), CD28, CD30 (TNFRSF8), CD33, CD4, CD40, CD44 v6, CD51, CD52, CD56, CD74, CD80, CEA, CNTO888, CTLA-4, DR5, EGFR, EpCAM, CD3, FAP, fibronectin extra domain-B, folate receptor 1, GD2, GD3 ganglioside, glycoprotein 75, GPNMB, HER2/neu, HGF, human scatter factor receptor kinase, IGF-1 receptor, IGF-I, IgGl, Ll-CAM, IL-13, IL-6, insulin-like growth factor I receptor, alpha 5βiintegrin, integrin avβ3 , MORAb-009, MS4A1, MUC1, mucin CanAg, Nglycolylneuraminic acid, NPC-1C, PDGF-Ra, PDL192, phosphatidyl serine, prostatic carcinoma cells, RANKL, RON, ROR1, SCH 900105, SDC1, SLAMF7, TAG-72, tenascin C, TGF 02, TGF-p., TRAIL-R1, TRAIL-R2, tumor antigen CTAA16.88, VEGFA, VEGFR-1, VEGFR2, 707-AP, ART-4, B7H4, BAGE, p-catenin/m, Bcr-abl, MN/C IX antibody, CAMEL, CAP-1, CASP-8, CD25, CDC27/m, CDK4/m, CT, Cyp-B, DAM, ErbB3, ELF2M, EMMPRIN, ETV6-AML1, G250, GAGE, GnT-V, GplOO, HAGE, HLA-A*0201-R170I, HPV-E7, HSP70-2M, HST-2, hTERT (or hTRT), iCE, IL-2R, IL5, KIAA0205, LAGE, LDLR/FUT, MAGE, MART-l/melan-A, MART-2/Ski, MC1R, myosin/m, MUM-1, MUM-2, MUM-3, NA88-A, PAP, proteinase-3, pl90 minor bcr-abl, Pml/RARa, PRAME, PSA, PSM, PSMA, RAGE, RU1 or RU2, SAGE, SART-1 or SART-3, survivin, TPI/m, TRP-1, TRP-2, TRP-2/INT2, WT1, NY-Eso-1 or NY-Eso-B or vimentin. [0111] Cancer vaccines include, for example, human papilloma virus (HPV) vaccine, dendritic cell vaccines (e.g., Provenge® for prostate cancer), tumor cell vaccines, antigen vaccines, oncolytic virus vaccines (e.g., Imlygic™), Non-Hodgkin’s lymphoma and mantle cell lymphoma vaccine (e.g., BioVaxID™), breast cancer vaccine (e.g., Neuvax™), brain cancer vaccine (e.g., DCVax™, CDX-110™), pancreatic cancer vaccine (e.g., GV AX Pancreas, HyperAcute™ Pancreas), colorectal cancer vaccine (e.g., Imprime PGG®), bladder cancer vaccine (e.g., BCG™), solid tumor vaccine (e.g., OK432™), lung cancer and gastrointestinal cancer vaccine (e.g., PSK™), cervical cancer vaccine (e.g., Schizophyllan™), and stomach cancer vaccine (e.g., Lentinan™).

[0112] Other immunotherapies for treating cancer include, for example, an IL-2 diphtheria toxin fusion protein (e.g., Ontak®).

Disease, iAge, and Individual Markers

[0113] In healthy subjects, low iAge for an age cohort indicates improved immunocompetence for fighting disease (e.g., cancer, infectious diseases, etc.) During disease, a subject can mount an acute immune response to the disease and lower iAge minus cAge for an age cohort indicates improved outcomes with therapy against the disease.

[0114] For example, patients with an iAge-chAge of -21 or less and MIG levels of about 25-35 pg/ml or more, can proceed to immunotherapy treatment. Patients with an iAge-chAge of -10 or more, and MIG levels of 5 pg/ml or less, can receive treatments to lower their iAge-chAge, and increase the level of MIG, priming the patient for immunotherapy. Patients with an iAge-chAge of -20 to -11 and MIG levels of 5 to 20 pg/ml can also receive treatments to lower their iAge and raise their MIG levels. Once the patients treated to lower iAge and raise MIG reach the threshold of iAge-chAge = -21 and MIG level of 25-35 pg/ml, the patients can proceed to immunotherapy treatment.

[0115] Without be being bound by the theory of operation, the iAge - chAge score indicates the immunocompetence of the subjects immune system. A lower score indicates a healthier immune system that can respond to an immunological challenge in acute disease. A higher iAge - chAge score indicates that the subjects immune system has been degraded, likely from chronic, systemic, low-grade inflammation. High MIG levels in the patient can be indicative of an active acute immune response to the disease state of the subject (e.g., immune response to the cancer). Both these scores together show patients that are immunocompetent and have immune systems that can work with a therapy (e.g., immunotherapy) to combat a cancer. By treating the patient prior to immunotherapy to improve their iAge - chAge score can improve the immunocompetence of the subject’s immune system. This should improve the outcome for the subject when they receive immunotherapy.

[0116] Higher iAge or iAge - chAge and higher levels of EOTAXIN and/or MIG are indicative of improved response to adjuvant immunotherapy after primary treatment of a cancer (e.g., surgery or radiation). If a subject has lower iAge or iAge - chAge, and/or lower levels of EOTAXIN and/or MIG, the subject can be treated to raise iAge, iAge - chAge, EOTAXIN, and/or MIG prior to adjuvant immunotherapy. Patients with an iAge of 61 or more, and/or EOTAXIN levels of 21-23 pg/ml or more and/or MIG levels of 5 pg/ml or more, can proceed to adjuvant treatment with immunotherapy after a primary treatment. Patients with an iAge of 50 or less and/or EOTAXIN levels of 14 pg/ml or less and/or MIG levels of 1 pg/ml or less, can receive treatments to raise their iAge, increase their EOTAXIN levels, and/or increase their MIG levels. Patients with an iAge score of 51-59, and/or EOTAXIN levels of 14-20 pg/ml, and/or MIG levels of 1-4 pg/ml can also receive treatments to raise their iAge, increase their EOTAXIN levels, and/or increase their MIG levels.

[0117] Without be being bound by the theory of operation, the iAge and iAge - cAge scores indicates the immunocompetence of the subjects immune system. The higher baseline scores after primary treatment can indicate that the subject is having a robust immune response to the cancer cells and antigens released by the primary treatment. Combining this robust response with adjuvant immunotherapy produces better outcomes in subjects. A similar relationship is reflected in the higher EOTAXIN and MIG levels which both indicate a robust response by the immune system (e.g., EOTAXIN relates to action by eosinophils and MIG promotes chemotaxis by leukocytes and differentiation into cytotoxic lymphocytes and natural killer cells).

Immunotherapy

[0118] Immunotherapy or biological therapy include, for example, the treatment of disease by activating or suppressing the immune system. Immunotherapies can be designed to elicit or amplify an immune response, and immunotherapies can be designed to reduce or suppress the immune system. Immunotherapies include, for example, checkpoint inhibitors, immune cell therapies (e.g., adoptive cell therapies, T-cell therapies and NK cell therapies), chimeric antigen receptors, engineered T-cell receptors, antibody therapies (e.g., naked antibodies and antibody drug conjugates), vaccines, adjuvant immunotherapy, and immune system modulators (e.g., cytokines). [0119] Checkpoint inhibitors include agents that act at immune checkpoints including, for example, cytotoxic T-lymphocyte-associated antigen 4 (CTLA4), programmed cell death protein (PD-1), Killer-cell Immunoglobulin-like Receptors (KIR), and Lymphocyte Activation Gene- 3 (LAG3). Examples of checkpoint inhibitors that may be used in an immunotherapy include, for example, Nivolumab (Opdivo®), Pembrolizumab (Keytruda®), Cemiplimab (Libtayo®), Atezolizumab (Tecentriq®), Avelumab (Bavencio®), Durvalumab (Imfinzi®), Ipilimumab (Yervoy®), Lirilumab, and BMS-986016. Nivolumab, Atezolizumab and Pembrolizumab act at the checkpoint protein PD-1 and inhibit apoptosis of anti -tumor immune cells. Some checkpoint inhibitors prevent the interaction between PD-1 and its ligand PD-L1. Ipilimumab acts at CTLA4 and prevents CTLA4 from downregulating activated T-cells in the tumor. Lirilumab acts at KIR and facilitates activation of Natural Killer cells. BMS-986016 acts at LAG3 and activates antigenspecific T-lymphocytes and enhances cytotoxic T cell-mediated lysis of tumor cells. [0120] Antibodies or cell therapies (e.g., chimeric antigen receptors) can target tumor associated antigens including, for example, mesothelin, disialoganglioside (GD2), Her-2, MUC1, GPC3, EGFRVIII, CEA, CD19, EGFR, PSMA, GPC2, folate receptor p, IgG Fc receptor, PSCA, PD-L1, EPC AM, Lewis Y Antigen, L1CAM, FOLR, CD30, CD20, EPHA2, PD-1, C-MET, ROR1, CLDN18.2, NKG2D, CD133, TSHR, CD70, ERBB, AXL, Death Receptor 5, VEGFR-2, CD123, CD80, CD86, TSHR, ROR2, CD 147, kappa IGG, IL- 13, MUC16, IL-13R, NY-ESO-1, IL13RA2, DLL3, FAP, LMP1, TSHR, BCMA, NECTIN-4, MG7, AFP (alpha-fetoprotein), GP100, B7- H3, Nectin-4, MAGE-A1, MAGE-A4, MART-1, HBV, MAGE-A3, TAA, GP100, Thyroglobulin, EBV, HPV E6, PRAME, HERV-E, WT1, GRAS G12V, p53, TRAIL, MAGE-A10, HPV-E7, KRAS G12D, MAGE-A6, CD19, BCMA, CD22, CD123, CD20, CD30, CD33, CD 138, CD38, CD7, SLAMF7, IGG FC, MUC1, Lewis Y Antigen, CD133, ROR1, FLT3, NKG2D, Kappa light chain, CD34, CLL-1, TSLP, CD10, PD-L1, CD44V6, EBV, CD5, GPC3, CD56, integrin B7, CD70, MUCL, CKIT, CLDN18.2, TRBC1, TAC1, CD56, CD4, CD2, CD18, CD27, CD37, CD72, CD79A, CD79B, CD83, CD117, CD172, ERBB3, ERBB4, DR5, HER2, CS1, IL- 1RAP, ITGB7, SLC2A14, SLC4A1, SLC6A11, SLC7A3, SLC13A5, SLC19A1, SLC22A12, SLC34A1, slc45A3, SLC46A2, Fra, IL-13Ra2, ULBP3, ULBP1, CLD18, NANOG, CEACAM8, TSPAN16, GLRB, DYRK4, SV2C, SIGLEC8, RBMXL3, HIST1HIT, CCR8, CCNB3, ALPPL2, ZP2, OTUB2, LILRA4, GRM2, PGG1, NBIF3, GYP A, ALPP, SPATA19, FCRLI, FCRLA, CACNG3, UPK3B, 12UMO4, MUC12, HEPACAM, BPI, ATP6V0A4, HMMR, UPK1A, ADGRV1, HERC5, C3AR1, FASLG, NGB, CELSR3, CD3G, CEACAM3, TNFRSFBC, MS4AB, S1PR5, EDNRB, SCN3A, ABCC8, ABCB1, ANO1, KCND2, HTR4, CACNB4, HTR4, CNR2, 26LRB, EXOCI, ENTPP1, ICAM3, ABCGB, SCN4B, SPN, CD68, ITGAL, ITGAM, SCTR, CYYR1, CLCN2, SLARA3, and JAG3.

[0121] Adoptive cell therapies include, for example, Kymriah® (tisagenlecleucel), Abecma® (idecabtagene vicleucel), Yescarta® (axicabtagene ciloleucel), Breyanzi® (lisocabtagene maraleucel), and Tecartus® (brexucabtagene autoleucel).

Types of Cancer

[0122] Cancers that can be treated with the methods described herein, include, for example, the approved indications for the FDA approved immunotherapies, such as melanoma, non-small cell lung cancer, Head and Neck squamous cell cancer, classical Hodgkin’s lymphoma, primary mediastinal large B-cell lymphoma, urothelial carcinoma, microsatellite instability-high cancer, gastric cancer, cervical cancer, hepatocellular carcinoma, Merkel Cell carcinoma, renal cell carcinoma (Keytruda®); advanced or metastatic urothelial carcinoma, unresectable, stage III non-small cell lung cancer (Imfinzi®); unresectable or metastatic melanoma, metastatic non-small cell lung cancer, advanced renal cell carcinoma, classical Hodgkin’s lymphoma, recurrent or metastatic squamous cell carcinoma, advanced or metastatic urothelial carcinoma, microsatellite instability high, or mismatch repair deficient metastatic colorectal cancer, hepatocellular carcinoma (Opdivo®); urothelial carcinoma, non-small cell lung cancer, triple negative breast cancer, small cell lung cancer (Tecentriq®); metastatic non-small cell lung cancer, recurrent non-small cell lung cancer, bladder cancer (Opdivo® in combination with Yervoy®); metastatic Merkel cell carcinoma (Bavencio®); unresectable of metastatic melanoma, advanced renal cell carcinoma, microsatellite instability high, or mismatch repair deficient metastatic colorectal cancer (Yervoy®); refractory diffuse B-cell lymphoma, relapsed or refractory acute lymphoblastic leukemia (Kymriah®); or diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, High grade B-cell lymphoma (Yescarta®).

[0123] Cancers that can be treated with the methods described herein, also include, for example the indications under development such as, acute myeloid leukemia, bladder cancer, squamous cell carcinoma of the head and neck, chronic lymphocytic leukemia, multiple myeloma, metastatic solid malignancies (Lirilumab™); or melanoma, advanced colorectal cancer, advanced Chordoma, metastatic melanoma, gastro/esophageal cancer, solid tumors, gastric cancer, advanced renal cell cancer, advanced non-small cell lung cancer (Relatlimab™).

[0124] Other cancers that can be treated with the methods herein include, for example, sarcoma, carcinoma, melanoma, chordoma, malignant histiocytoma, mesothelioma, glioblastoma, neuroblastoma, medulloblastoma, malignant meningioma, malignant schwannoma, leukemia, lymphoma, myeloma, myelodysplastic syndrome, myeloproliferative disease. In some embodiments, the cancer is a leukemia, lymphoma, myeloma, myelodysplastic syndrome, and/or myeloproliferative disease.

Vaccines

[0125] Vaccines can be substances used to stimulate a protective immune response in a subject (e.g., an antibody response or a cell mediated response) and provide immunity against one or several diseases. Vaccines protect against more than many debilitating or life-threatening diseases/infectious agents, including for example, adenovirus, anthrax, cervical cancer, chicken pox, cholera, dengue, diphtheria, Haemophilus influenza, hepatitis A, hepatitis B, hepatitis E, HPV, influenza, Japanese encephalitis, malaria, measles, meningitis, meningococcal (MenACWY), serogroup B meningococcal, mumps, pneumococcus, polio, rabies, rotavirus, rubella, shingles, small pox, tetanus, tuberculosis, typhoid, varicella, whooping cough, and yellow fever.

[0126] Vaccines can be prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease. Examples of vaccine types include, for example, live or attenuated vaccines (e.g., measles, mumps, rubella, varicella, influenza, coronavirus, rotavirus, zoster, yellow fever), inactivated or killed vaccines (e.g., polio, hepatitis A, rabies), toxoid (inactivated toxoid) vaccines (e.g., diphtheria, and tetanus), and subuni t/conjugate vaccines (e.g., hepatitis B, influenza, coronavirus, Haemophilus influenza type b, pertussis, pneumococcal, meningococcal, HPV).

[0127] Attenuated vaccines can be made in several different ways. Some of the most common methods involve passing the disease-causing virus through a series of cell cultures or animal embryos (typically chick embryos). Using chick embryos as an example, the virus is grown in different embryos in a series. With each passage, the virus becomes better at replicating in chick cells, but loses its ability to replicate in human cells. A virus targeted for use in a vaccine may be grown through — “passaged” through — upwards of 200 different embryos or cell cultures. Eventually, the attenuated virus will be unable to replicate well (or at all) in human cells, and can be used in a vaccine. All of the methods that involve passing a virus through a nonhuman host produce a version of the virus that can still be recognized by the human immune system, but cannot replicate well in a human host. When the resulting vaccine virus is given to a human, it will be unable to replicate enough to cause illness, but will still provoke an immune response that can protect against future infection.

[0128] Killed or inactivated vaccines can be created by inactivating a pathogen, typically using heat or chemicals such as formaldehyde or formalin. This destroys the pathogen’s ability to replicate, but keeps it “intact” so that the immune system can still recognize it. (“Inactivated” is generally used rather than “killed” to refer to viral vaccines of this type, as viruses are generally not considered to be alive.) Because killed or inactivated pathogens can’t replicate at all, they can’t revert to a more virulent form capable of causing disease (as discussed above with live, attenuated vaccines). However, these vaccines tend to provide a shorter length of protection than live vaccines, and are more likely to require boosters to create long-term immunity. [0129] Immunizations created using inactivated toxins are called toxoids. Toxoids can actually be considered killed or inactivated vaccines, but are sometimes given their own category to highlight the fact that they contain an inactivated toxin, and not an inactivated form of bacteria.

[0130] Both subunit and conjugate vaccines contain only pieces of the pathogens they protect against. Subunit vaccines use only part of a target pathogen to provoke a response from the immune system. This may be done by isolating a specific protein from a pathogen and presenting it as an antigen on its own. The acellular pertussis vaccine and influenza vaccine (in shot form) are examples of subunit vaccines. Another type of subunit vaccine can be created via genetic engineering. Conjugate vaccines can be made using a combination of two different components. Conjugate vaccines, however, are made using pieces from the coats of bacteria. These coats are chemically linked to a carrier protein, and the combination is used as a vaccine.

Pathogens

[0131] Pathogenic organisms are capable of causing disease in a subject. A human pathogen is capable of causing illness in humans. Common examples of pathogenic organisms include specific strains of bacteria such as, for example, Actinomyces israelii, Bacillus anthracis, Bacteroides fragilis, Bordetella pertussis, Borrelia, Brucella, Campylobacter jejuni, Chlamydophila psittaci, Cory neb acterium diphtheria, Ehrlichia, Enterococcus, Francisella tularensis, Haemophilus influenza, Helicobacter pylori, Klebsiella pneumoniae, Legionella pneumophila, Leptospira species, Listeria monocytogenes, Mycobacterium, Mycoplasma pneumoniae, Pseudomonas aeruginosa, Nocardia asteroids, Rickettsia rickettsia, Salmonella, Shigella, Treponema pallidum, Vibrio cholera, Yersinia pestis, Listeria E. coli, Staphylococcus, Streptococcus, Neisseria, Clostridia, Chlamydia, mycoplasmas.

[0132] Pathogenic organisms also include viruses such as, for example, adenoviruses, herpesviruses, influenza, coronavirus, hepatitis, poxviruses, papovaviruses, paramyxoviruses, coronaviruses, picornaviruses, Reoviruses, togaviruses, flaviviruses, arenaviruses, rhabdoviruses, retroviruses, hepadnaviruses, Cryptosporidium.

[0133] Pathogenic organisms include fungi such as, for example, Candida, Aspergillus, Cryptococcus, Histoplasma, Pneumocystis, and Stachybotrys. [0134] Pathogens also include the above organisms which are the target of vaccines. [0135] Anti-pathogen therapies can include, for example, antibiotics for bacterial pathogens, anti-viral therapies for viral pathogens, and anti-fungal therapies for fungal pathogens. Antibodies can also be administered for the treatment of certain infectious diseases caused by bacteria, viruses or fungi.

Cancer Treatments Using iAge

[0136] Subjects with cancer who are candidates for immunotherapy (as described above) have their blood drawn and an iAge and CRS are calculated as described above. If the subject’s iAge places them in the youngest iAge quartile for their age group (see Table 1) they can be classified as responders and move forward with the immunotherapy. If the subject’s iAge places them in the middle two quartiles, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can be treated with the immunotherapy. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest quartile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge quartile.

[0137] Alternatively, if the subject’s iAge places them in the youngest iAge quintile for their age group (see Table 1) they can be classified as responders and move forward with the immunotherapy. If the subject’s iAge places them in the middle three quintiles, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can be treated with the immunotherapy. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest quintile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge quintile.

[0138] Still alternatively, if the subject’s iAge places them in the youngest iAge tertile for their age group (see Table 1) they can be classified as responders and move forward with the immunotherapy. If the subject’s iAge places them in the middle tertile, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak- STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can be treated with the immunotherapy. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest tertile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge tertile.

[0139] Subjects who are candidates for vaccinations (e.g., the elderly) can have their blood drawn and an iAge and CRS are calculated as described above. If the subject’s iAge places them in the youngest iAge quartile for their age group (see Table 1) they can be classified as responders and move forward with the vaccination. If the subject’s iAge places them in the middle two quartiles, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can be vaccinated. Subjects whose Jak- STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest quartile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge quartile. Subjects classified as nonresponders can also be treated with higher doses of vaccines and/or more aggressive vaccine formulations (e.g., cocktails of antigens, adjuvants, and/or immunostimulants) to account for the immunosenescence in the subject.

[0140] Alternatively, if the subject’s iAge places them in the youngest iAge quintile for their age group (see Table 1) they can be classified as responders and move forward with the vaccination. If the subject’s iAge places them in the middle three quintiles, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak- STAT activity places them in the highest quartile can be classified as responders and can be vaccinated. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest quintile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge quintile. Subjects classified as nonresponders can also be treated with higher doses of vaccines and/or more aggressive vaccine formulations (e.g., cocktails of antigens, adjuvants, and/or immunostimulants) to account for the immunosenescence in the subject. [0141] Still alternatively, if the subject’s iAge places them in the youngest iAge tertile for their age group (see Table 1) they can be classified as responders and move forward with the vaccination. If the subject’s iAge places them in the middle tertile, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can be vaccinated. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest tertile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge tertile.

Subjects classified as nonresponders can also be treated with higher doses of vaccines and/or more aggressive vaccine formulations (e.g., cocktails of antigens, adjuvants, and/or immunostimulants) to account for the immunosenescence in the subject.

[0142] Subjects who have been exposed to a pathogenic organism, are infected with a pathogenic organism, and/or are susceptible to infection by a pathogenic organism can have their blood drawn and an iAge and CRS are calculated as described above. If the subject’s iAge places them in the youngest iAge quartile for their age group (see Table 1) they can be classified as responders and move forward with standard treatment for the pathogenic organism. If the subject’s iAge places them in the middle two quartiles, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below).

Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can move forward with standard treatment for the pathogenic organism. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest quartile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge quartile. Subjects classified as nonresponders can also be treated with more aggressive therapies and/or higher doses of therapeutics to account for the immunosenescence in the subject.

[0143] Alternatively, if the subject’s iAge places them in the youngest iAge quintile for their age group (see Table 1) they can be classified as responders and move forward with standard treatment for the pathogenic organism. If the subject’s iAge places them in the middle three quintiles, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose Jak-STAT activity places them in the highest quartile can be classified as responders and can move forward with standard treatment for the pathogenic organism. Subjects whose Jak-STAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest quintile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge quintile. Subjects classified as nonresponders can also be treated with more aggressive therapies and/or higher doses of therapeutics to account for the immunosenescence in the subject.

[0144] Still alternatively, if the subject’s iAge places them in the youngest iAge tertile for their age group (see Table 1) they can be classified as responders and move forward with standard treatment for the pathogenic organism. If the subject’s iAge places them in the middle tertile, the subject’s blood cells (e.g., CD4+ and CD8+ cells) are stimulated and Jak-STAT activity is measured (see, e.g., Example 1 below). Subject’s whose JakSTAT activity places them in the highest quartile can be classified as responders and can move forward with standard treatment for the pathogenic organism. Subjects whose JakSTAT activity places them in the lower three quartiles can be classified as nonresponders and are treated to lower iAge (and increase their Jak-STAT score) into a responder group. If the subject’s iAge places them in the oldest tertile, they can be classified as nonresponders and are treated to lower their iAge (see below) into a responder group of a younger iAge tertile. Subjects classified as nonresponders can also be treated with more aggressive therapies and/or higher doses of therapeutics to account for the immunosenescence in the subject.

Agents for Modifying iAge [0145] In addition to using iAge to classify patients (FIG. 3), these can be used to derive individual inflammatory profiles by comparing subject’s individual protein levels with those of a population (e.g., of similar chronological age). The resulting signatures (or barcodes) are used for protein-compound association (PCI) analysis using the drugbank database (www.drugbank.ca) and a personalized initial therapy to reduce iAge can be generated (FIG. 3). Patients following personalized recommendations can be monitored weekly for changes in iAge until they reach optimal levels (below group average for a given age bracket) and they convert into a responder treatment phenotype (FIG. 3). The patient is then classified as a responder and is suitable for immunotherapy treatment.

[0146] A subject may reduce their iAge with treatments that raise the levels of TRAIL, IFNG, GROA, IL2, TGFA, PAI1, and/or LIF to their optimal levels for a person’s chronological age. A subject may also reduce their iAge with treatments that lower the levels of MIG, EOTAXIN, LEPTIN, IL-1B, and/or MIP1 A to their optimal levels for a person’s age.

[0147] A subject’s iAge can be modified by administering TRAIL, IFNG, GROA, IL2, TGFA, PAI1, and/or LIF (lowers iAge) or administering MIG, EOTAXIN, LEPTIN, IL-1B, and/or MIP1 A (raises iAge) to the subject. The TRAIL, IFNG, GROA, IL2, TGFA, PAI1, LIF, MIG, EOTAXIN, LEPTIN, IL-1B, and/or MIP1 A can be recombinantly produced, or can be purified from blood or other natural sources. Any of the foregoing can also be modified to enhance the plasma residence time or the half-life of the protein in the body using any number of methods that are known in the art. For example, such methods can include derivatizing the protein with human serum albumin (HAS) or a portion thereof, the neonatal Fc receptor (FcRn), an unstructured polypeptide, a carboxy -terminal peptide, a synthetic polymer (e.g., PEG), or a natural water soluble polymer (e.g., dextran, hyaluronic acid, etc.). Examples include those described in U.S. Patent No. 7,531,324, which is incorporated by reference in its entirety for all purposes.

[0148] A subject’s iAge can be modified by administering anti-TRAIL antibody, anti- IFNG antibody, anti-GROA antibody, anti-IL2 antibody, anti-TGFA antibody, anti- PAI1 antibody, and/or anti-LIF antibody (raises iAge) or administering anti-MIG antibody, anti -EOTAXIN antibody, anti -LEPTIN antibody, anti -IL- IB antibody, and/or anti-MIPlA antibody (lowers iAge) to the subject. The anti-TRAIL antibody, anti-IFNG antibody, anti-GROA antibody, anti-IL2 antibody, anti-TGFA antibody, anti-PAIl antibody, anti-LIF antibody, anti-MIG antibody, anti-EOTAXIN antibody, anti-LEPTIN antibody, anti-IL-lB antibody, and/or anti-MIPl A antibody can be recombinantly produced. The anti-TRAIL antibody, anti-IFNG antibody, anti-GROA antibody, anti-IL2 antibody, anti-TGFA antibody, anti-PAIl antibody, anti-LIF antibody, anti-MIG antibody, anti-EOTAXIN antibody, anti-LEPTIN antibody, anti- IL-1B antibody, and/or anti-MIPl A antibody can be neutralizing antibody and/or can have an appropriate constant region(s) that allow the antibody-antigen complex to be cleared from the subject. Constant regions that promote clearance are well-known in the art and include, for example, IgG format antibodies (IgGl, IgG2, IgG3, and/or IgG4), IgM format antibodies, etc. that are species matched to the subject.

[0149] A subject may also reduce their iAge by reducing any systemic chronic inflammation, using any of the following, whether alone or in combination: (1) pharmacological treatment, including without limitation anti-inflammatory drugs (NS AIDs such as, for example, aspirin, ibuprofen, naproxen, diclofenac, celecoxib, oxaprozin, piroxicam, indomethacin, meloxicam, fenoprofen, diflunisal, etodolac, ketorolac, meclofenamate, nabumetone) or corticosteroids (e.g., glucocorticoids, mineralocorticoids); (2) neutraceuticals or nutritional supplements, including without limitation fish oil, lipoic acid, and curcumin, or spices/herbs such as ginger, garlic, turmeric, hyssop, cannabis, Harpagophytum procumbens, and cayenne; (3) dietary change, including without limitation increasing the intake of foods that are high in antioxidants and polyphenols, such as olive oil, leafy greens (e.g., kale and spinach), broccoli, avocados, green tea, bell peppers, chili peppers, mushrooms, dark chocolate, cocoa, tomatoes, fatty fish (e.g., salmon, sardines, herring, anchovies, and mackerel), nuts (walnuts and almonds), and fruits (e.g., cherries, blackberries, blueberries, raspberries, strawberries, grapes, and oranges), and/or decreasing the intake of foods that can increase inflammation such as refined carbohydrates (e.g., white bread and pastries), high-fructose com syrup, refined sugar, processed and packaged food, fried foods, red meat, excessive alcohol, and processed meat; and (4) lifestyle changes including without limitation eliminating or reducing smoking and alcohol intake, maintaining a healthy body weight, and reducing stress levels.

[0150] Agents that can lower MIG (and so improve this iAge marker) include, for example arsenic trioxide, Roxarsone, Selenium, and/or a variety of antibodies. Antibodies include, for example, MIG-2F5.5 (anti -human CXCL9 antibody, BioLegend Cat. # 740072), Anti-human CXCL9 antibody, NS J Bioreagents, Cat # R30501, Mouse MAb clone 49106 (anti-human CXCL9, R&D Systems Cat # MAB392), Mouse monoclonal MAb for human CXCL9 (neutralizing, GeneTex, Cat # GTX52673), Mouse monoclonal anti-human CXCL9 antibody (OriGene, Cat# PM1209P), MIG Antibody (MM0220-7F11) (Novus Biologicals, NBP2-12236), MIG Antibody (1F5) (Novus Biologicals, H00004283-M06), Mouse MAb anti human CXCL9 (ThermoFisherCat #MA5-23746, Cat #MA5-30320, Cat #MA5-23628, Cat #MA5-23544).

[0151] Arsenic tri oxide (AS2O3), a component of traditional Chinese medicine, has been used successfully for the treatment of acute promyelocytic leukemia (APL), and AS2O3 is of potential therapeutic value for the treatment of other promyelocytic malignancies and some solid tumors including breast cancer. AS2O3 treatment changed the expression level of several genes that involved in cell cycle regulation, signal transduction, and apoptosis. Notably, AS2O3 treatment increased the mRNA and protein levels of the cell cycle inhibitory proteins, p21 and p27. Interestingly, knocking down p21 or p27 individually did not alter As2O3-induced apoptosis and cell cycle arrest; however, the simultaneous down-regulation of both p21 and p27 resulted in attenuating of Gl, G2/M arrest and reduction in apoptosis, thus indicating that p21 and p27 as the primary molecular targets of AS2O3.

[0152] Roxarsone is an organoarsonic acid where the organyl group is 4-hydroxy-3- nitrophenyl. It has a role as a coccidiostat, an antibacterial drug, an agrochemical and an animal growth promotant. It is an organoarsonic acid and a member of 2- nitrophenols. Roxarsone was found to exhibit a higher angiogenic index than As¹¹¹ at lower concentrations. Increased endothelial nitric oxide synthase (eNOS) activity was observed for roxarsone but not for Asⁿⁱ-induced angiogenesis. However, As¹¹¹ caused more rapid and pronounced phosphorylation of eNOS.

[0153] Selenium (Se) is a potential anticarcinogenic nutrient, and the essential role of Se in cell growth is well recognized but certain cancer cells appear to have acquired a survival advantage under conditions of Se-deficiency. Se can exert its effects through increasing the expression of a humoral defense gene (A2M) and tumor suppressor- related genes (IGFBP3, HHIP) while decreasing pro-inflammatory gene (MIG, HSPB2) expression.

[0154] Agents that can raise MIG include, for example, 3-Fucosyllactose, Ascorbyl palmitate, Cellulose acetate, Ethyl cellulose, Gelatin, Ozone, Propylene glycol alginate, Rebaudioside D, Rebaudioside E, Starch acetate, Starch, pregelatinized, Sucrose acetate isobutyrate, Acetyl tributyl citrate, Ammonium alginate, Ascorbic Acid, Calcium alginate, Calcium ascorbate, Caramel, Cellulose, Dextrin, Ethyl acetate, Ethyl butyrate, Ethyl formate, Ethyl vanillin, Ferrous ascorbate, Inulin, Iron octanoate, Lacto-N-neotetraose, Lacto-N-tetraose, Maltodextrin, Natamycin, Olestra, Phosphatidylserine, Polydextrose, and/or Potassium alginate.

[0155] Agents that can raise EOTAXIN include, for example, 3-Fucosyllactose, Acetyl tributyl citrate, Ascorbyl palmitate, Cellulose acetate, Dextran, Ethyl cellulose, Gelatin, Glyceryl behenate, Invert sugar, Ozone, Potassium glycerophosphate, Propylene glycol alginate, quercetin, Rebaudioside D, Rebaudioside E, Starch acetate, Starch, pregelatinized, Sucrose acetate isobutyrate, and/or zinc chloride.

[0156] Agents that raise LIF levels include Aminodarone, arsenic tri oxide, Azathioprine, Estradiol, Chlorambucil, Clomiphene, Coumaphos, Cyclosporine, decitabine, Cisplatin, Vincristine, Formaldehyde, Glucose, Hydrogen Peroxide, letrozole, Lindane, Methotrexate, Quercetin, Oxyquinoline, resorcinol, resveratrol, Silicon Dioxide, Tretinoin, and troglitazone.

[0157] The expression of LIF is regulated by many cytokines. In normal human bone marrow stromal cells, IL-la, IL-ip, TGF-P and tumor necrosis factor-a (TNF-a) can all increase the transcription of LIF mRNA. The induction of LIF by IL-ip and TNF- a was also observed in gingival fibroblasts and several cell types in human airways. In addition, the induction of LIF expression by other cytokines, including IL-6, IL-2 has been observed in different cell types, including airway smooth-muscles and MT-2 cells. The expression of LIF can also be inhibited by some factors, including la, 25- dihydroxyvitamin D3 and dexamethasone. The analysis of the LIF promoter revealed that transcription factor STAT5 can bind to the LIF promoter and induce its expression in myeloid cell lines. In addition, the LIF promoter region contains several ETS binding sites. The binding of ETS transcription factors to the LIF promoter is critical for the induction of LIF in response to T cell activators.

[0158] Clomiphene is an ovulatory stimulant designated chemically as 2-[p-(2- chloro-l,2-diphenylvinyl)phenoxy]tri ethylamine citrate (1 : 1). It has the molecular formula of C26H28C1NO • C6H8O7 and a molecular weight of 598.09. Clomiphene is capable of interacting with estrogen-receptor-containing tissues, including the hypothalamus, pituitary, ovary, endometrium, vagina, and cervix. It may compete with estrogen for estrogen-receptor-binding sites and may delay replenishment of intracellular estrogen receptors. Clomiphene initiates a series of endocrine events culminating in a preovulatory gonadotropin surge and subsequent follicular rupture. The first endocrine event in response to a course of clomiphene therapy is an increase in the release of pituitary gonadotropins.

[0159] Coumaphos is an organothiophosphate insecticide, an organic thiophosphate and an organochlorine compound. It has a role as an agrochemical, an acaricide, an antinematodal drug, an avicide and an EC 3.1.1.8 (cholinesterase) inhibitor. Coumaphos is used for control of a wide variety of insects on cattle and parasitic mites (Varroa jacobson) on bees. It is also used in veterinary medicine for the treatment of screwworms, maggots, and ear ticks on livestock. In humans coumaphos causes muscarinic effects (parasympathetic), nicotinic effects (sympathetic and motor), and CNS effects associated with massive overstimulation of the chlorinergic system.

[0160] Lindane also known as gamma-hexachlorocyclohexane (y-HCH), gammaxene, and Gammallin is an organochlorine chemical and an isomer of hexachlorocyclohexane that has been used both as an agricultural insecticide and as a pharmaceutical treatment for lice and scabies. Lindane is a neurotoxin that interferes with GABA neurotransmitter function by interacting with the GAB AA receptor- chloride channel complex at the picrotoxin binding site. In humans, lindane affects the nervous system, liver, and kidneys, and may well be a carcinogen.

[0161] Oxy quinoline is a heterocyclic phenol and Oxy quinoline Sulfate is its salt, both of which are described as cosmetic biocides for use in cosmetic formulations. Oxyquinoline can be used as an antiseptic, disinfectant, and has pesticide properties. Oxy quinoline is also a chelating agent which has been used for the quantitative determination of metal ions.

[0162] Decitabine (5-aza-2'-deoxy cytidine or 5-Aza-Cdr) is a cytosine analogue that was first synthesized in the early 1960s by Pliml and Sorm and is currently marketed as Dacogen® by Eisai (Tokyo, Japan). It differs from deoxycytidine by the substitution of nitrogen for carbon at the 5-position of the pyrimidine ring. It was noted to have an antileukemic effect in cell lines, with more potency in vitro than cytarabine. Initially, its cytotoxicity was attributed to its ability to impair DNA synthesis and cause DNA damage similar to other antimetabolites. At low doses, decitabine induces differentiation by reversing DNA methylation-induced gene silencing. Once inside a cell, decitabine is phosphorylated and activated by the enzyme deoxycytidine kinase to its triphosphate form aza-dCTP. It then competes with and replaces cytosine in the CpG (cytosine-guanosine dinucleotide) islands that occur in clusters in promoter regions. During subsequent cell divisions, aza-dCTP inhibits methylation of the promoter by forming a covalent bond with the enzyme DNA methyltransferase (DNMT), and thereby traps and contributes to degradation of the enzyme.

[0163] Chlorambucil and Cisplatin are alkylating agents used to treat cancer. Chlorambucil is in the class of nitrogen mustards, and Cisplatin is a platinum basedagent. Chlorambucil produces its anti-cancer effects by interfering with DNA replication and damaging the DNA in a cell. The DNA damage induces cell cycle arrest and cellular apoptosis via the accumulation of cytosolic p53 and subsequent activation of Bcl-2-associated X protein, an apoptosis promoter. Cisplatin crosslinks DNA in several different ways, interfering with cell division by mitosis. The damaged DNA elicits DNA repair mechanisms and activates apoptosis.

[0164] Vincristine is a chemotherapy drug that belongs to a group of drugs called vinca alkaloids. Vincristine works by stopping the cancer cells from separating into 2 new cells. Vincristine works partly by binding to the tubulin protein, stopping the tubulin dimers from polymerizing to form microtubules, causing the cell to be unable to separate its chromosomes during the metaphase. The cell then undergoes apoptosis.

[0165] Letrozole is an aromatase inhibitor which is used in the treatment of hormonally -responsive breast cancer after surgery. Letrozole is also for ovulation induction. Letrozole blocks the production of estrogens in this way by competitive, reversible binding to the heme of its cytochrome P450 unit. Letrozole has shown to reduce estrogen levels by 98 percent while raising testosterone levels.

[0166] Tretinoin is a derivative of vitamin A. It is used on the skin (topically) in the treatment of mild to moderate acne and on skin that has been damaged by excessive exposure to the sun. Tretinoin irritates the skin and causes the cells of the skin to grow (divide) and die more rapidly, increasing the turnover of cells. Tretinoin can also induce acute promyelocytic leukemia cells to differentiate and stops them from proliferating; in people there is evidence that it forces the primary cancerous promyelocytes to differentiate into their final form.

[0167] Estradiol is the main circulating oestrogen in women and reaches a plasma concentration of 30-400 pg/mL before menopause. Estradiol regulates growth and the development of the reproductive system, also, helps to maintain the osseous tissue, the central nervous system and the vasodilatation in the vascular tissue. The protective effect of Estradiol in the vasculature and against cardiovascular disease (CVD) has been demonstrated in several hormone replacement studies. Estradiol activates BK channels via a process that requires the presence of the pi subunit. Valverde et al. were the first to propose that Estradiol affected BK channels by binding to pi, but it is still a matter of debate whether the agonistic action of Estradiol on BK channels is caused by its binding to the pi subunit or to the a/pi complex. Moreover, the molecular nature of the Estradiol binding site and the mode of action of the hormone are at present unknown. Acute application of Estradiol (100 nM) decreases smooth muscle excitability by activating BK channels. Notably, Estradiol or its membrane-impermeant form (E2-BSA) can induce a fast increase in BK channel activity in MCF-7 breast epithelial cancer cells with an EC50 of 80 pM reaching a maximal effect at 10 nM34. Rapid effects of Estradiol have also been reported in neurons of the area postrema where nanomolar concentrations of E2 can decrease the firing rate most probably by increasing BK current35. All these examples underscore the physiological importance of the regulation of BK channels by E2 and made worthwhile efforts in determining the molecular nature of the interaction between this hormone and the BK channel.

[0168] Cyclosporine has been a core component of immunosuppression in both immune dysregulatory disorders and organ transplantation. For immune disorders involving ophthalmologic, dermatologic, hematologic, gastroenterologic, neurologic, or musculoskeletal systems, cyclosporine has demonstrated marked efficacy in relieving clinical symptoms and reversing pathological developments. Additionally, after the drug’s implementation in transplantation medicine, rates of acute rejection and one-year graft survival have improved dramatically.

[0169] Methotrexate is a chemotherapy agent and immune system suppressant. It is used to treat cancer, autoimmune diseases, ectopic pregnancy, and for medical abortions. Types of cancers it is used for include breast cancer, leukemia, lung cancer, lymphoma, and osteosarcoma. Types of autoimmune diseases it is used for include psoriasis, rheumatoid arthritis, and Crohn's disease. It can be given by mouth or by injection. Methotrexate is an antimetabolite of the antifolate type. It is thought to affect cancer and rheumatoid arthritis by two different pathways. For cancer, methotrexate competitively inhibits dihydrofolate reductase (DHFR), an enzyme that participates in the tetrahydrofolate synthesis. The affinity of methotrexate for DHFR is about 1000-fold that of folate. DHFR catalyses the conversion of dihydrofolate to the active tetrahydrofolate. Folic acid is needed for the de novo synthesis of the nucleoside thymidine, required for DNA synthesis. Also, folate is essential for purine and pyrimidine base biosynthesis, so synthesis will be inhibited. Methotrexate, therefore, inhibits the synthesis of DNA, RNA, thymidylates, and proteins. For the treatment of rheumatoid arthritis (immune suppression), multiple mechanisms appear to be involved, including the inhibition of enzymes involved in purine metabolism, leading to accumulation of adenosine; inhibition of T cell activation and suppression of intercellular adhesion molecule expression by T cells; selective down-regulation of B cells; increasing CD95 sensitivity of activated T cells; and inhibition of methyltransferase activity, leading to deactivation of enzyme activity relevant to immune system function. Another mechanism of MTX is the inhibition of the binding of interleukin 1-beta to its cell surface receptor.

[0170] Troglitazone is an antidiabetic and anti-inflammatory drug, and a member of the drug class of the thiazolidinediones. Troglitazone is an oral antihyperglycemic agent which acts primarily by decreasing insulin resistance. Troglitazone is used in the management of type II diabetes. Troglitazone binds to nuclear receptors (PPAR) that regulate the transcription of a number of insulin responsive genes critical for the control of glucose and lipid metabolism. Troglitazone decrease nuclear factor kappa- B (NF-KB) and increase its inhibitor (IKB).

[0171] Azathioprine is a purine analogue with cytotoxic and immunosuppressive activity. Azathioprine is a prodrug that is converted by hepatic xanthine oxidase to its active metabolite 6-mercaptopurine (6-MP). 6-MP is further metabolized by hypoxanthine-guanine phosphoribosyltransferase (HGPRT) into 6-thioguanosine-5'- phosphate (6-thio-GMP) and 6-thioinosine monophosphate (6-thio-IMP), both inhibit nucleotide conversions and de novo purine synthesis. This leads to inhibition of DNA, RNA, and protein synthesis. As a result, cell proliferation may be inhibited, particularly in lymphocytes and leukocytes. Azathioprine an immunosuppressive agent in organ transplantation to prevent rejection and in autoimmune diseases as a corticosteroid sparing agent.

[0172] Quercetin, a flavonoid found in fruits and vegetables, has unique biological properties that may improve mental/physical performance and reduce infection risk. These properties form the basis for potential benefits to overall health and disease resistance, including anti-carcinogenic, anti-inflammatory, antiviral, antioxidant, and psychostimulant activities, as well as the ability to inhibit lipid peroxidation, platelet aggregation and capillary permeability, and to stimulate mitochondrial biogenesis. Quercetin is a naturally occurring polar auxin transport inhibitor. Quercetin inhibits lipopolysaccharide (LPS)-induced tumor necrosis factor a (TNF-a) production in macrophages and LPS-induced IL-8 production in lung A549 cells. Moreover, in glial cells it was even shown that quercetin can inhibit LPS-induced mRNA levels of TNF-a and interleukin IL-la, this effect of quercetin resulted in a diminished apoptotic neuronal cell death induced by microglial activation. Quercetin inhibits production of inflammation-producing enzymes (cyclooxygenase (COX) and lipoxygenase (LOX)). It limits LPS-induced inflammation via inhibition of Src- and Syk-mediated phosphatidylinositol-3 -Kinase (PI3K)-(p85) tyrosine phosphorylation and subsequent Toll Like Receptor 4 (TLR4)/MyD88/PI3K complex formation that limits activation of downstream signaling pathways in RAW 264.7 cells. It can also inhibit FcsRI-mediated release of pro-inflammatory cytokines, tryptase and histamine from human umbilical cord blood-derived cultured mast cells (hCBMCs); this inhibition appears to involve in inhibition of calcium influx, as well as phosphoprotein kinase C (PKC).

[0173] Resorcinol is an organic compound with the formula CeFL^OFfL. Resorcinol is used as an antiseptic and disinfectant in topical pharmaceutical products in the treatment of skin disorders and infections such as acne, seborrheic dermatitis, eczema, psoriasis, corns, calluses, and warts. It is also used to treat corns, calluses, and warts. It exerts a keratolytic activity.

[0174] Agents that reduce expression of CXCR3 (the receptor for MIG) include, for example, formaldehyde and taurine. Agents that are antagonists for CXCR3 include, for example, piperazinyl-piperi dines (e.g., SCH546738), 8-azaquinazolinones (e.g., AMG 487), 3-phenyl-3H-quinazolin-4-ones, aryl piperazine, 4-aryl-5- piperazinylthiazoles, arylpiperazines, benzetimide derivatives, imidazolidines, imidazolium, lysergic acid derivative, diaminocyclobutenediones, zinc phthalocyanine, and NBI-74330. (See Andrews et al., J. Med. Chem. 59:2894-917 (2016), which is incorporated by reference in its entirety for all purposes). Chemical structures for specific antagonists of CXCR3 are found in Andrews 2016, and are hereby incorporated by reference in their entirety for all purposes. A few of the specific structures are shown below:



GALDERMA RESEARCH & DEVELOPMENT

[0175] Other small molecule antagonists are found, for example, in US20060036093, W02009/105435, which all are incorporated by reference in their entirety for all purposes. [0176] Any of the foregoing antibodies or fragments thereof (collectively antibodies) can be engineered for use in humans by methods such as, for example, chimerization, humanization, humaneering, etc, which are known in the art.

[0177] In addition, any of the foregoing antibodies or fragments thereof (collectively antibodies) can include a protracting moiety that extends a half-life (T1/2) or/and the duration of action of the antibody. The protracting moiety can extend the circulation T1/2, blood T1/2, plasma T1/2, serum T1/2, terminal T1/2, biological T1/2, elimination T1/2 or functional T1/2, or any combination thereof, of the antibody. One or more protracting moieties can be combined (covalently or noncovalently) with an antibody. Protracting moieties include, for example, hydrophilic polymers (e.g., PEG, dextran, etc.), a synthetic polymer, glycosylation, human serum albumin (HSA) or a portion thereof (e.g., domain III) that binds to the neonatal Fc receptor (FcRn), or a carboxyterminal peptide (CTP).

[0178] Additional agents (drugs, foods and other molecules) that can alter iAge by affecting genes involved in systemic chronic inflammation comprising MIG, TNFSF10, IFNg, CCL11 or CXCL1 are listed below in Tables 2, 3 and 4. These molecules were obtained using methods described below with a combined confidence score >500 (q value of <0.05, nominal p value of <0.005) Table 2 shows drugs and other molecules that can change iAge by interacting with immune genes involved in the inflammatory response including MIG, TNFSF10, IFNg, CCL11 or CXCL1 and changing the levels of these proteins in the subject. Table 3 shows food compounds and other molecules that can change iAge by interacting with immune genes involved in the inflammatory response including MIG, TNFSF10, IFNg, CCL11 or CXCL1 and changing the levels of these proteins in the subject. Table 4 shows drugs that can upregulate or downregulate MIG, TNFSF10, IFNg, CCL11 or CXCL1, and whether the up- or down-regulation is beneficial (lowers) or detrimental (raises) to iAge. Other drugs and other molecules that interact with genes/proteins involved in inflammation and/or the inflammatory response can be used to reduce the iAge of the subject through indirect effects on the levels of the iAge markers which are described above. Other food compounds or other molecules that interact with genes/proteins involved in inflammation and/or the inflammatory response can be used to reduce the iAge of the subject through indirect effects on the levels of the iAge markers which are described above. [0179] Any of the foregoing can also be modified to enhance the plasma residence time or the half-life of the agent in the body using any number of methods that are known in the art. For example, such methods can include derivatizing the agent with human serum albumin (HAS) or a portion thereof, the neonatal Fc receptor (FcRn), an unstructured polypeptide, a carboxy-terminal peptide, a synthetic polymer (e.g., PEG), or a natural water soluble polymer (e.g., dextran, hyaluronic acid, etc.). Examples include those described in U.S. Patent No. 7,531,324, which is incorporated by reference in its entirety for all purposes.

[0180] In an aspect, a patient can be treated prior to immunotherapy treatment to lower the patient’s iAge so as to prime the T-cells and other immune cells to interact with the immunotherapy. Without being bound by theory, patients may perform poorly with an immunotherapy when their T-cells and other immune cells are in an exhausted state or are close to exhaustion (e.g., because chronic inflammation has reduce the number of naive T-cells and other immune cells to interact with the immunotherapy). Chronic inflammation can also bias the production of memory cells so that the memory cells have reduced capability for expansion. By lowering a patient’s iAge prior to treatment, the patients immune cells may be placed into a resting state that will allow immune cells to recover from exhaustion and near exhaustion states.

[0181] In an aspect, a patient can receive treatments to cycle their iAge down (resting state) and up (acute immune response) to potentially increase the immune response with an immunotherapy. Treatments can be administered to a patient to lower their iAge, and then an immunotherapy and other the disease state (e.g., cancer) can interact with the immune system to activate an acute immune response that drives the iAge up. Other agents can also be administered to the patient to drive up the iAge of the patient, or both the treatment plus disease and iAge raising agents can drive up the patient’s iAge.

[0182] Treatments to cycle a patient’s iAge down and up can be derived from the patient’s iAge immunotype (described above). Treatments for patient’s of different immunotype are described herein.

Methods for Determining the Effect of a Substance on iAge

[0183] Compounds that can modify iAge are identified from DrugBank and FooDB using a compound-gene interaction database, machine learning for drug repurposing and food compound mapping for anti-inflammatory activity, and medication usage studies from the 1KIP cohort.

[0184] The STITCH database v. 5.0 can be used as the compound-gene interaction database to find immune genes with which a drug or food compound interacts. Compound-protein interactions are extracted from the STITCH database v5.0 by matching the InChi keys of drugs/food compounds. STITCH collects information from multiple sources and individual scores from each source are combined into an overall confidence score.

[0185] An immune gene set ( n = 4275 ) is obtained from the HIM CHip panel. The immune gene set is then matched with the two compound - gene interaction datasets above to extract immune genes that interact with drugs or food compounds. The immune gene set is used in the STITCH database, and FDA-approved drugs ( n = 1692 ) are selected from the DrugBank database and food compounds ( n = 7962 ) are selected from the FoodDB database as previously described in Veselkov et 1., Sci Rep. 2019; 9: 9237, PMCID: PMC6610092, which is incorporated by reference in its entirety for all purposes.

[0186] All interactions with a combined confidence score of less than 500 are removed. The Ensemble peptide identifiers for protein are then converted to HGNC gene symbols using Biomart (version 2.42.0). As a result, there are 1617 immune genes interact with drugs and 1774 immune genes interact with food compounds. After pre-processing, two data sets are obtained: i) drug-gene interaction dataset containing 1670 drugs, 9642 genes with 118,342 interaction ii) food compound - gene interaction dataset containing 3447 compounds, 10,942 genes, and 166,43 linteractions.

[0187] To investigate compound - immunity association, statistical significance for the enrichment of compound genes in the immune gene set is calculated using Fisher’s exact test. The universal gene set contains all genes that interact with at least one compound. The compound with low p-value interacts with a higher proportion of the immune gene set than that expected by chance. The statistical analysis is performed using R.

[0188] FDA-approved drugs ( n = 1692) are selected from the DrugBank database as previously described in Veselkov et 1., Sci Rep. 2019; 9: 9237, PMCID:

PMC6610092, which is incorporated by reference in its entirety for all purposes. The set of drugs is mapped to the DrugCentral database via InChi keys to identify drugs indicated for anti-inflammatory treatment ( n= 49 ), that are denoted as ‘positive class’ . All drugs with no known association with anti-inflammatory activity are denoted as ‘negative class’. This set of drugs will be used as a training set to train machine learning models. Food compounds ( n = 7962 ) are selected from the FoodDB database as previously described. The set of food compounds will be used as a test data set.

[0189] Compound-protein interactions are extracted from the STITCH database v5.0 by matching the InChi keys of drugs/food compounds. STICH collects information from multiple sources and individual scores from each source are combined into an overall confidence score. The threshold for the significant score is not set at a fixed value and considered as an adjustable parameter for ML model optimization.

[0190] Gene-gene interactions are extracted from public sources including STRING, UniProt, COSMIC, BioPlex, and NCBI Gene as previously described in Veselkov et 1., Sci Rep. 2019; 9: 9237, PMCID: PMC6610092, which is incorporated by reference in its entirety for all purposes. This results in a gene-gene interactome dataset containing 20,256 genes with ~ 11 million interactions.

[0191] The gene profile for each compound is represented as a sparse matrix, in which a ‘ 1’ indicates genes that directly interact with the compound and a ‘0’ for all other genes. The network propagation ( Random Walk with Restart ) algorithm is then applied to spread this gene profile on to the human interactome. As a result, a genome-wide profile of gene scores is obtained for each compound. The restart parameter ‘c’ is considered as an adjustable parameter for ML model optimization. [0192] ML can use Linear SVM as a classifier for optimization. The interaction score threshold can be set at 600, the restart parameter ‘c’ for network propagation can be set at 0.1. Linear SVM can be used to identify anti-inflammatory drugs based on their genome-wide profile obtained from network propagation. The regularization parameter ‘C; can be optimized during the model training using a nested cross- validation strategy. The F-score, that balances sensitivity and specificity, is used to evaluate the outcome of each model. The best model is defined as a model with the highest F-score.

[0193] The anti-inflammatory ‘likeness’ of drugs is calculated using the selected model. These values are used to identify potential drugs for anti-inflammatory repurposing. Similarly, the selected model is applied to the food compound dataset. The probability estimates for the anti-inflammatory activity of each food compound are calculated. Food compounds with high anti-inflammatory probability (i.e, > 0.8) are selected for validation.

[0194] Medication prescribed for 1KIP cohorts are divided into 23 groups. Medication usage is represented as a sparse matrix, in which ‘ 1 ’ indicates the patient took at least one of the drugs in that group and ‘0’ indicates none of the drugs in that group was not taken.

[0195] Several analyses were performed as follows: build a model to predict iAge based on medication usage using lasso method implemented in ‘glmnet’ package; study correlation between medication usage and cytokine/chemokine levels using PLS method implemented in ‘pls’ package; and build a model to predict cytokine/chemokine levels based on medication usage using lasso in ‘glmnet’ and lasso with interaction in ‘glinternet’.

[0196] Additional ways to find agents that can lower iAge include a deep neural network approach implemented using DeepCOP (Woo et. al. 2019, Bioinformatics 36(3): 813-818, which is incorporated by reference in its entirety for all purposes). Level 5 expression scores from the LINCS L1000 study can be used to label genes as up- or down- regulated if scores were more than a 50% perturbation above the topthreshold. Compounds in LINCS LI 000 and compounds from FooDB were represented using calculated Morgan Fingerprints from SMILES using RDkit. Genes were represented as commonly occurring gene ontologies (at least three times). The deep neural network was trained on LINCS L1000 compounds on CD34 and HUVEC cells, independently, using the target genes plus the imputed expression for the genes that encode the Inflammatory Age proteins. Predicted expression probabilities for the compounds in FooDB were used to score these interventions. Compounds that only upregulate anti-inflammatory markers and downregulate pro-inflammatory markers are considered as possible interventions.

[0197] The network propagation algorithm can be implemented using the method in (Veselkov., et al, 2019, Scientific Reports (9) 9237). The assumption is that compounds with similar network profiles would have similar effect of regulation of a certain gene. Compound-gene interactions can be extracted from the STITCH database v5.0. STITCH collects information from multiple sources and individual scores from each source are combined into an overall confidence score. Gene-gene interactions can be extracted from public sources including STRING, UniProt, COSMIC, BioPlex, and NCBI Gene as previously described in Veselkov et al, 2019. This results in a gene-gene interactome dataset containing 20,256 genes with ~ 11 million interactions.

[0198] The gene profile for each compound can be represented as a sparse matrix, in which a ‘ 1’ indicates genes that directly interact with the compound and a ‘0’ for all other genes. The network propagation ( Random Walk with Restart ) algorithm can then applied to spread this gene profile onto the gene-gene interactome. As a result, a genome-wide profile of gene scores can be obtained for each compound. The restart parameter ‘c’ can be considered as an adjustable parameter for ML model optimization.

[0199] The LINCS compounds that are already known the regulation direction for a certain gene can be used to train a linear SVM classification model using network propagation profile as features. The regularization parameter ‘C; can be optimized during the model training using a nested cross-validation strategy. The F-score, that balances sensitivity and specificity, can be used to evaluate the outcome of each model. The best model can be defined as a model with the highest F-score. The selected model can then be applied to the FooDB compound dataset. The probability estimates for the desired regulation direction of each food compound can be calculated and can be used as a score to determine the probability of each intervention.

Treating Immunotypes to Lower iAge

[0200] Table 5 below lists the protein markers that can have their levels changed to improve the iAge for patients in the different immunotypes.

Table 5. Protein Markers to Change for Each Immunotype

[0201] Table 6 below shows GRAS (generally regarded as safe) compounds that can be used to lower each of the five protein markers in the Immunotypes. Table 6. GRAS Compounds for Each Protein Marker

The level of one or more of the five protein markers can be improved for iAge by providing a patient with one or more of the GRAS compounds listed in Table 6.

Table 5 above lists the proteins markers to improve for each immunotype. Table 6 identifies GRAS compounds that can be used for each protein marker to improve iAge. For example, a patient in Immunotype SHI can be administered one or more of iron, biotin and/or caffeine. Table 7 below shows the GRAS compounds that can be used to improve iAge for the ten immunotypes.

Table 7. GRAS Compounds for Improving iAge of Each Immunotype

[0202] Table 7 shows other agents that can be administered to patients to improve the levels of Eotaxin, GroaA, IFNg, MIG, and/or TRAIL and lower the patient’s iAge. The agents to be used can depend upon the patient’s immunotype (see Table 5, 6 and 7). Combinations of agents can be made (e.g., see Table 7) for individual immunotypes using agents from Table 6.

[0203] Additional agents that can be used to improve the levels of Eotaxin, GroaA, IFNg, MIG, and/or TRAIL and lower the patient’s iAge are in Table 8. The agents in Table 5 can be used as described above to improve the levels of Eotaxin, GroaA, IFNg, MIG, and/or TRAIL and lower the iAge of patients in certain immunotypes. In addition, combinations of one or more of these agents in Table 8 can be used to improve the levels of Eotaxin, GroA, IFNg, MIG, and/or TRAIL and lower the iAge of patients in certain immunotypes.

[0204] The inventions disclosed herein will be better understood from the experimental details which follow. However, one skilled in the art will readily appreciate that the specific methods and results discussed are merely illustrative of the inventions as described more fully in the claims which follow thereafter. Unless otherwise indicated, the disclosure is not limited to specific procedures, materials, or the like, as such may vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting.

EXAMPLES

Example 1 : iAge correlates with naive CD8(+) T cells and with the ex vivo Jak-STAT signaling responses to stimulation

[0205] The frequency of circulating naive CD8(+) T cells decline with high iAge (A) and iAge can predict poor ex vivo Jak-STAT signaling responses to stimulation (B and C). A total of 96 cytokine-cell-STAT combinations were analyzed with respect of a subject’s iAge. These included eight cell types: B cells, CD4(+) T cells (and their CD45(+) and (-) subsets), CD8(+) T cells (and their CD45(+) and (-) subsets), and monocytes; four cytokines: Interleukin-6 (IL-6), IL- 10, IL-21 and Interferonalpha; and three STAT proteins (STAT1, 3 and 5). FIG. IB: volcano plot, result of a multiple regression analysis with permutation tests to estimate false discovery rates (Benjamini -Hochberg FDR) (y-axis) as a function of the regression coefficients obtained for iAge after adjusting for Age, Gender and cytomegalovirus status. FIG. 1C: normalized ex vivo CD8(+) T cell phosphor-STAT-1 responses to Interleukin-6. The lower tertile for iAge shows significantly more robust responses than the higher tertile for iAge (C).

[0206] iAge is negatively correlated with naive CD8(+) T cells and with the ex vivo Jak-STAT signaling responses to stimulation.

Example 2: Stratification of cancer patients using iAge and CRS

[0207] A blood sample is obtained from patients prior to immunotherapy treatment. Serum and immune cells are separated by standard methods. Serum samples are used to measure protein concentration for inflammatory age (iAge) determination; and cells are cytokine-stimulated ex vivo to measure phosphorylation of intracellular signal transducer and activator of transcription (STAT) proteins to derive a cytokine response score (CRS). iAge and CRS can independently predict patient’s response to immunotherapy treatment. FIG. 2 shows a flow diagram of this process.

[0208] iAge and CRS can be used to stratify cancer patients prior to treatment as responders versus non-responder for immunotherapy.

Example 3 : Stratification of cancer patients using iAge

[0209] iAge can be used to classify cancer patients into responder and non-responders to immunotherapy treatment (A), and to derive iAge individual inflammatory protein signature (barcode), which is fed to iAge personalized recommendation engine to create an individualized initial therapy aimed to reduce iAge, inform medical decision and hence, convert those non-responder patients into responder patients (suitable for immunotherapy) (B). FIG. 3 shows a flow diagram of this process.

[0210] iAge is used to stratify patients for cancer immunotherapy and help convert non-responders into responder for immunotherapy.

Example 4: Endothelial cells derived from hiPSCs produce MIG

[0211] Human induced pluripotent stem cells (hiPSCs) were obtained from isolated fibroblasts (N = 5, in duplicates) using the Yamanaka factors (Takahashi and Yamanaka, 2006) and differentiated them into endothelial cells (hiPSC-ECs) under well-defined conditions as previously described (Hu et al., 2016).

[0212] Expression levels of MIG and SIRT3 were measured by RT-PCR. A significant age-dependent increase in MIG mRNA expression levels is observed (P < 0.01), which reaches a plateau after the sixth cell passage. (See FIG. 4) Concomitant with the increase in MIG, down-regulation in SIRT3 mRNA can be observed after the second cell passage (P < 0.01). (See FIG. 4)

Example 5: Expression of CXCR3 in Endothelial Cells

[0213] Human induced pluripotent stem cells were made as described in Example 4. Expression of the MIG receptor, CXCR3, was measured in young cardiomyocytes derived from hiPSCs (hiPSC-CM) as well as in hiPSC-ECs (endothelial cells derived from hiPSC), HUVEC cells, freshly isolated fibroblasts and hiPSCs.

[0214] Elevated expression of CXCR3 is observed in hiPSC-ECs, HUVEC cells but not in other cell types (F) suggesting that the endothelium but not other cell subsets is a target of MIG and potentially other CXCR3 ligands as well. (See FIG. 5) Example 6: MIG Impairs Endothelial Cell Function

[0215] Mouse thoracic aortas were carefully dissected, and vessels were cut into small rings and mounted on an isometric wire myograph chambers (Danish Myo Technology) and subjected to a normalization protocol. Following normalization, the vessels were incubated with either PBS or different concentrations of recombinant mouse MIG (R&D systems, catalog number 492-MM). A concentration-dependent contraction curve was created by accumulative application of the prostaglandin agonist U46619. Subsequently, concentration-dependent relaxation curves of Acetylcholine were conducted on these vessels and percent relaxation calculated for each dose.

[0216] FIG. 6 shows a line graph of percent relaxation of mouse thoracic aortic sections to Acetylcholine after exposure to different amounts of MIG. FIG. 6 shows impaired vascular reactivity with increasing concentrations of MIG. MIG causes a dose-dependent effect on vasorelaxation in treated aortas demonstrating that MIG impairs vascular function, and can contribute to arterial stiffness and premature aging of the cardiovascular system.

Example 7: Compositions for Treating Immunotypes

[0217] Tables 2 to 4 show agents that can be used to lower iAge by improving the levels of the markers Eotaxin, GroA, IFNg, MIG, and/or TRAIL. Table 3 shows how the treatment of certain markers correlates to immunotype, and Table 4 shows combinations of agents that can administer to patients in the different immunotypes to improve their iAge. [0218] Table 6 below, shows dosages that can be used in formulating the agents into compositions that can be administered to patients of certain immunotypes.

Table 6. Dose of Agents for Improving Levels of an iAge Marker in a Patient

[0219] For example, treatment of patients from Immunotypes SH2 or N1 can improve the levels of GroA, IFNg, and MIG. A composition for improving GroA can have iron bisglycinate, manganese chloride, and niacin. The dose of each of these per day is 245 mg iron bisglycinate, 9 mg manganese chloride, and 250 mg niacin. A composition for improving IFNg can have manganese chloride, beta carotene, leutin, and zinc sulfate. The dose of each of these is 15 mg beta-carotene, 20 mg leutin, 220 mg zinc sulfate, and the manganese chloride doses is the same as for GroA. A composition for improving MIG can have vitamin d2, niacin, and guar gum. The dose of each of these is 0.05 mg vitamin d2, 1000 mg guar gum, and dose of niacin is the same as for GroA. These compositions can be combined into one dosage form, placed in separate dosage forms, or the components of each can be mixed and matched into separate dosage forms for administering to a patient.

[0220] Using Tables 2, 3, and 4 combined with the dosing in Table 5 one can make dosage forms containing agents that can improve the iAge of patients in any of the immunotypes as was shown above for Immunotypes SH2 or Nl.

Example 8: iAge, MIG and Response to Immunotherapy

[0221] iAge, chAge, and the levels of MIG, EOTAXIN, GroA, IFNg and Trail were measured in patients who received immunotherapy (anti-PDl antibodies or anti-PDl antibodies + anti-CTLA4 antibodies) for cancer (e.g., melanoma, bladder cancer, renal cancer and non-small cell lung cancer). Patients who had a complete or partial response to immunotherapy had an average iAge-chAge score of about -21, and patients who did not respond to immunotherapy had an average iAge-chAge score of about -10. In addition, patients who had a complete or partial response to immunotherapy had average MIG levels of about 25-35 pg/ml, and patients who did not respond to immunotherapy had average MIG levels of about 5 pg/ml.

[0222] When MIG levels are measured prior to treatment patients who responded to immunotherapy had higher levels of MIG compared to patients who did not respond to immunotherapy.

Example 9: iAge, MIG and Response to Adjuvant Therapy

[0223] iAge, chAge, and the levels of MIG, EOTAXIN, GroA, IFNg and Trail were measured in patients who received adjuvant immunotherapy after primary therapy for their cancer (e.g., surgery). Patients who had no cancer recurrence had an average iAge score of about 61 and patients who had cancer recurrence had an average iAge score of about 50. In addition, patients who had no cancer recurrence had an average EOTAXIN level of about 22-24 pg/ml, and patients who had cancer recurrence had an average EOTAXIN level of about 14 pg/ml. Patients who had no cancer recurrence also had an average MIG level of about 5 pg/ml, and patients who had cancer recurrence had an average MIG level of about 1 pg/ml.

[0224] When EOTAXIN levels are measured at about 1, 3, 5, 7, 9, 11, 13, and 15 months patients no recurrence of cancer had higher levels of EOTAXIN than patients with recurring cancer until the cancer recurs. After cancer recurrence these patients had rising levels of EOTAXIN. When MIG levels are measured at 1, 3, 5, 7, 9, 11, 13, and 15 months, patients no recurrence of cancer had higher levels of MIG than patients with recurring cancer until the cancer recurs.

[0225] All publications, patents and patent applications discussed and cited herein are incorporated herein by reference in their entireties. It is understood that the disclosed invention is not limited to the particular methodology, protocols and materials described as these can vary. It is also understood that the terminology used herein is for the purposes of describing particular embodiments only and is not intended to limit the scope of the present invention which will be limited only by the appended claims.

[0226] Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments of the invention described herein. Such equivalents are intended to be encompassed by the following claims.

Claims

CLAIMS What is claimed is:

1. A method for immunotherapy, comprising of the steps of: measuring a patient’s iAge and a MIG level; selecting a patient with an iAge-chAge less than or equal to -21 and a MIG level of 25 to 35 pg/ml or more; and providing the selected patients with the immunotherapy.

2. The method of claim 1, wherein the immunotherapy is a checkpoint inhibitor, an adoptive cell therapy, an antibody, a vaccine, or an immune system modulator.

3. The method of claim 2, wherein the checkpoint inhibitor is an anti-PDl antibody, or an anti-CTLA4 antibody.

4. The method of claim 2, wherein the checkpoint inhibitor is a Nivolumab, a Pembrolizumab, a Cemiplimab, an Atezolizumab, an Avelumab, a Durvalumab, or a Ipilimumab.

5. The method of claim 2, wherein the adoptive cell therapy is a tisagenlecleucel, an idecabtagene vicleucel, an axicabtagene ciloleucel, a lisocabtagene maraleucel, and a brexucabtagene autoleucel.

6. A method for immunotherapy, comprising of the steps of: measuring a patient’s iAge and a MIG level; selecting a patient with an iAge-chAge more than or equal to -10 and a MIG level of 5 to 10 pg/ml or less; providing the selected patients with a treatment that decreases the patient’s iAge and increases the MIG level; and providing the selected patients with the immunotherapy.

7. The method of claim 6, wherein the immunotherapy is a checkpoint inhibitor, an adoptive cell therapy, an antibody, a vaccine, or an immune system modulator.

8. The method of claim 6, wherein the agent for lowering iAge is an iron bisglycinate, a manganese chloride, an indole -3-carbinol, a L-methionine, a Piceatannol, a biotin, a caffeine, a beta-carotene, a leutin, or a zinc sulfate.

9. The method of claim 8, wherein the agent for raising the MIG is a 3- Fucosyllactose, an Ascorbyl palmitate, a Cellulose acetate, an Ethyl cellulose, a Gelatin, an Ozone, a Propylene glycol alginate, a Rebaudioside D, a Rebaudioside E, a Starch acetate, a Starch, pregelatinized, a Sucrose acetate isobutyrate, an Acetyl tributyl citrate, an Ammonium alginate, an Ascorbic Acid, a Calcium alginate, a Calcium ascorbate, a Caramel, a Cellulose, a Dextrin, an Ethyl acetate, an Ethyl butyrate, an Ethyl formate, an Ethyl vanillin, a Ferrous ascorbate, an Inulin, an Iron octanoate, a Lacto-N-neotetraose, a Lacto-N-tetraose, a Maltodextrin, a Natamycin, an Olestra, a Phosphatidylserine, a Polydextrose, or a Potassium alginate.

10. The method of claim 9, wherein the agent for lowering iAge is a vitamin D2, a niacin, or a guar gum.

11. A method for adjuvant immunotherapy, comprising of the steps of: measuring a patient’s iAge and an EOTAXIN level after the patient has received a primary treatment; selecting a patient with an iAge more than or equal to 61 and an EOTAXIN level of 22-24 pg/ml or more; and providing the selected patients with the adjuvant immunotherapy.

12. The method of claim 11, wherein the adjuvant immunotherapy is a checkpoint inhibitor, an adoptive cell therapy, an antibody, a vaccine, or an immune system modulator.

13. The method of claim 12, wherein the checkpoint inhibitor is an anti-PDl antibody, or an anti-CTLA4 antibody.

14. The method of claim 12, wherein the checkpoint inhibitor is a Nivolumab, a Pembrolizumab, a Cemiplimab, an Atezolizumab, an Avelumab, a Durvalumab, or a Ipilimumab.

15. The method of claim 12, wherein the adoptive cell therapy is a tisagenlecleucel, an idecabtagene vicleucel, an axicabtagene ciloleucel, a lisocabtagene maraleucel, and a brexucabtagene autoleucel.

16. A method for adjuvant immunotherapy, comprising of the steps of: measuring a patient’s iAge and an EOTAXIN level after the patient has received a primary treatment; selecting a patient with an iAge more less or equal to 50 and an EOTAXIN level of 14 pg/ml or less; providing the selected patients with a treatment that increases the patient’s iAge and increases the EOTAXIN level; and providing the selected patients with the immunotherapy.

17. The method of claim 16, wherein the adjuvant immunotherapy is a checkpoint inhibitor, an adoptive cell therapy, an antibody, a vaccine, or an immune system modulator.

18. The method of claim 16, wherein the agent for increasing iAge is a 3- Fucosyllactose, an Ascorbyl palmitate, a Cellulose acetate, an Ethyl cellulose, a Gelatin, an Ozone, a Propylene glycol alginate, a Rebaudioside D, a Rebaudioside E, a Starch acetate, a Starch, pregelatinized, a Sucrose acetate isobutyrate, an Acetyl tributyl citrate, an Ammonium alginate, an Ascorbic Acid, a Calcium alginate, a Calcium ascorbate, a Caramel, a Cellulose, a Dextrin, an Ethyl acetate, an Ethyl butyrate, an Ethyl formate, an Ethyl vanillin, a Ferrous ascorbate, an Inulin, an Iron octanoate, a Lacto-N-neotetraose, a Lacto-N-tetraose, a Maltodextrin, a Natamycin, an Olestra, a Phosphatidylserine, a Polydextrose, or a Potassium alginate.

19. The method of claim 16, wherein the agent for increasing EOTAXIN is a 3- Fucosyllactose, an Acetyl tributyl citrate, an Ascorbyl palmitate, a Cellulose acetate, a Dextran, an Ethyl cellulose, a Gelatin, a Glyceryl behenate, an Invert sugar, an Ozone, a Potassium glycerophosphate, a Propylene glycol alginate, a quercetin, a Rebaudioside D, a Rebaudioside E, a Starch acetate, a Starch, a pregelatinized, a Sucrose acetate isobutyrate, or a zinc chloride.

20. The method of claim 16, wherein the patient’s MIG levels are 5 pg/ml or less; and further comprising the step of providing the selected patients with a treatment that increases the MIG levels.

21. The method of claim 20, wherein the agent for increasing MIG is a 3- Fucosyllactose, an Ascorbyl palmitate, a Cellulose acetate, an Ethyl cellulose, a Gelatin, an Ozone, a Propylene glycol alginate, a Rebaudioside D, a Rebaudioside E, a Starch acetate, a Starch, pregelatinized, a Sucrose acetate isobutyrate, an Acetyl tributyl citrate, an Ammonium alginate, an Ascorbic Acid, a Calcium alginate, a Calcium ascorbate, a Caramel, a Cellulose, a Dextrin, an Ethyl acetate, an Ethyl butyrate, an Ethyl formate, an Ethyl vanillin, a Ferrous ascorbate, an Inulin, an Iron octanoate, a Lacto-N-neotetraose, a Lacto-N-tetraose, a Maltodextrin, a Natamycin, an Olestra, a Phosphatidylserine, a Polydextrose, or a Potassium alginate.

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