Publications by authors named "Joshua Knowles"

Background and objectives Falls research has explored the characteristics of patients with a brain injury who experienced falls and the nature of these falls. However, the characteristics of falls with consequence have not yet been investigated. This study aimed to explore the consequences of patient falls in inpatient brain injury rehabilitation.

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Background: We previously reported significant correlations between a direct measure of insulin sensitivity (IS) and blood levels of proteins measured using the Proximity Extension Assay (PEA) in two European cohorts. However, protein correlations with IS within non-European populations, in response to short-term interventions that improve IS, and any causal associations with IS have not yet been established.

Methods: We measured 1,470 proteins using the PEA in the plasma of 1,015 research participants at Stanford University who underwent one or more direct measures of IS.

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Given that the extracellular matrix polymer hyaluronan (HA) has been implicated in longevity, we asked whether 4-methylumbelliferone (4-MU), an inhibitor of HA synthesis, impacts lifespan in mice. We designed a prospective study of long-term administration of 4-MU with conventional C57BL/6J mice. We find that 4-MU extends median survival from 122 weeks (control) to 154 weeks (4-MU), an increase of 32 weeks ( < 0.

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Article Synopsis
  • - Mavacamten is a groundbreaking drug approved for treating obstructive hypertrophic cardiomyopathy (oHCM), showing notable improvements in heart function and symptoms in 50 real-world patients.
  • - Patients experienced significant reductions in heart wall thickness and related complications, with only a small number needing to temporarily stop treatment due to minor decreases in heart function.
  • - The approach taken at the care center allowed for the rapid introduction and monitoring of this new therapy, reinforcing mavacamten's safety and effectiveness outside of traditional clinical trial settings.
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Background And Aims: Metabolic dysfunction-associated fatty liver disease (MASLD) is the most prevalent chronic liver pathology in western countries, with serious public health consequences. Efforts to identify causal genes for MASLD have been hampered by the relative paucity of human data from gold standard magnetic resonance quantification of hepatic fat. To overcome insufficient sample size, genome-wide association studies using MASLD surrogate phenotypes have been used, but only a small number of loci have been identified to date.

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There are multiple independent genetic signals at the () locus associated with type 2 diabetes risk, fasting glucose, ectopic fat, height, and bone mineral density. We have previously shown that loss of in pancreatic beta cells reduces insulin content and impairs islet cell development and function. However, RREB1 is a widely expressed transcription factor and the metabolic impact of RREB1 loss remains unknown.

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Background: Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post-caesarean section ultrasound-guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment.

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Article Synopsis
  • Statin drugs, which help lower cholesterol and prevent cardiovascular disease, may cause adverse effects in women, especially new-onset diabetes and muscle weakness.
  • Research in female mice shows that these negative effects are linked to lower levels of the omega-3 fatty acid DHA, as well as issues with cellular function and energy production.
  • Administering fish oil to provide DHA can mitigate these adverse effects, and the study suggests that genetic factors related to the X chromosome may increase women's risk, highlighting the potential of DHA supplementation as a helpful therapy.
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Familial hypercholesterolemia (FH) is a genetic disorder affecting the metabolism of lipoprotein, characterized by elevated levels of plasma concentrations of low-density lipoprotein cholesterol (LDLC). The most common FH cause is mutations within the gene that encodes for the LDL receptor (LDLR) protein. Two induced pluripotent stem cell (iPSC) lines were generated from patients with FH, each carrying a single heterozygous mutation in the LDLR gene, one is a missense mutation, c.

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Background: As a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care of participants. To determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as an exemplar actionable condition.

Methods: The MVP-ROAR Study consists of a completed single-arm pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention.

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Chemerin is a chemokine/adipokine, regulating inflammation, adipogenesis and energy metabolism whose activity depends on successive proteolytic cleavages at its C-terminus. Chemerin levels and processing are correlated with insulin resistance. We hypothesized that chemerin processing would be higher in individuals with type 2 diabetes (T2D) and in those who are insulin resistant (IR).

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APOE codes for apolipoprotein E (ApoE), which plays an important role in lipid and lipoprotein metabolism and homeostasis of tissue lipid content. Several variants in APOE have been associated with inherited dyslipidemias, and a subsequent increased risk of developing premature coronary artery disease (CAD). However, these variants and their impact on risk can be thought of on a spectrum, with some being more monogenic in nature, and others contributing in a polygenic/multifactorial manner.

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Metformin is a widely prescribed anti-diabetic medicine that also reduces body weight. There is ongoing debate about the mechanisms that mediate metformin's effects on energy balance. Here, we show that metformin is a powerful pharmacological inducer of the anorexigenic metabolite N-lactoyl-phenylalanine (Lac-Phe) in cells, in mice and two independent human cohorts.

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Objective: The development of clinical research informatics tools and workflow processes associated with re-engaging biobank participants has become necessary as genomic repositories increasingly consider the return of actionable research results.

Materials And Methods: Here we describe the development and utility of an informatics application for participant recruitment and enrollment management for the Veterans Affairs Million Veteran Program Return Of Actionable Results Study, a randomized controlled pilot trial returning individual genetic results associated with familial hypercholesterolemia.

Results: The application is developed in Python-Flask and was placed into production in November 2021.

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Stem cells are a resourceful tool for investigating cardiovascular disease in the context of race and gender. Once derived from blood or skin cells, the reprogrammed induced pluripotent stem cells (iPSCs) adopt an embryonic-like pluripotent state, enabling researchers to develop drug screening or disease modeling platforms. Here, we generated two iPSC lines from peripheral blood mononuclear cells (PBMCs) of two healthy African American patients.

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Background & Aims: Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver pathology in western countries, with serious public health consequences. Efforts to identify causal genes for NAFLD have been hampered by the relative paucity of human data from gold-standard magnetic resonance quantification of hepatic fat. To overcome insufficient sample size, genome-wide association studies using NAFLD surrogate phenotypes have been used, but only a small number of loci have been identified to date.

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Article Synopsis
  • The study focuses on ARO-APOC3, an RNA interference therapy aimed at lowering triglyceride levels by inhibiting the APOC3 protein that hinders triglyceride clearance.
  • The trial assessed safety, pharmacodynamics, and pharmacokinetics in healthy participants and those with hypertriglyceridemia, with doses administered via subcutaneous injections.
  • Results showed that while there were some mild liver enzyme changes in a few participants receiving ARO-APOC3, these were asymptomatic and resolved, and the treatment significantly reduced APOC3 levels compared to the placebo group.
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  • The study aimed to assess trends in lipid levels, cholesterol awareness, and statin use among people with severe dyslipidemia (high LDL-C levels ≥190 mg/dL) from 2011 to 2020.
  • Results showed that the prevalence of severe dyslipidemia remained stable at 5.4%, with LDL-C and triglyceride levels not significantly changing during this period.
  • Awareness of hypercholesterolemia and cholesterol evaluations were steady at around 50% and 75%, respectively, while only about 34% of individuals with severe dyslipidemia used statins, possibly explaining the lack of change in LDL-C levels.
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Metformin is a widely prescribed anti-diabetic medicine that also reduces body weight. The mechanisms that mediate metformin's effects on energy balance remain incompletely defined. Here we show that metformin is a powerful pharmacological inducer of the anorexigenic metabolite Lac-Phe in mice as well as in two independent human cohorts.

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The evolution of the electronic health record, combined with advances in data curation and analytic technologies, increasingly enables data sharing and harmonization. Advances in the analysis of health-related and health-proxy information have already accelerated research discoveries and improved patient care. This American Heart Association policy statement discusses how broad data sharing can be an enabling driver of progress by providing data to develop, test, and benchmark innovative methods, scalable insights, and potential new paradigms for data storage and workflow.

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Elevated triglycerides and non-high-density lipoprotein cholesterol (HDL-C) are risk factors for atherosclerotic cardiovascular disease (ASCVD). ARO-ANG3 is an RNA interference therapy that targets angiopoietin-like protein 3 (ANGPTL3), a regulator of lipoprotein metabolism. This first-in-human, phase 1, randomized, placebo-controlled, open-label trial investigated single and repeat ARO-ANG3 doses in four cohorts of fifty-two healthy participants and one cohort of nine participants with hepatic steatosis, part of a basket trial.

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Article Synopsis
  • - CROP-Seq merges CRISPR interference for gene silencing with single-cell RNA sequencing to explore adipogenesis and how fat cells develop.
  • - Researchers used human preadipocyte cells transduced with a library of sgRNAs, capturing individual cells at various stages of fat cell development for analysis.
  • - The study identified over 400 differentially expressed genes and validated the knockdown effects on genes that are critical for fat cell formation, suggesting this method can uncover new regulators linked to metabolic diseases.
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