- Perry, Andrew;
- Zhao, Shilin;
- Gajjar, Priya;
- Murthy, Venkatesh;
- Lehallier, Benoit;
- Miller, Patricia;
- Nair, Sangeeta;
- Neill, Colin;
- Carr, J;
- Fearon, William;
- Kapadia, Samir;
- Kumbhani, Dharam;
- Gillam, Linda;
- Lindenfeld, JoAnn;
- Farrell, Laurie;
- Marron, Megan;
- Tian, Qu;
- Newman, Anne;
- Murabito, Joanne;
- Gerszten, Robert;
- Nayor, Matthew;
- Lindman, Brian;
- Shah, Ravi;
- Elmariah, Sammy
While frailty is a prominent risk factor in an aging population, the underlying biology of frailty is incompletely described. Here, we integrate 979 circulating proteins across a wide range of physiologies with 12 measures of frailty in a prospective discovery cohort of 809 individuals with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation. Our aim was to characterize the proteomic architecture of frailty in a highly susceptible population and study its relation to clinical outcome and systems-wide phenotypes to define potential novel, clinically relevant frailty biology. Proteomic signatures (specifically of physical function) were related to post-intervention outcome in AS, specifying pathways of innate immunity, cell growth/senescence, fibrosis/metabolism, and a host of proteins not widely described in human aging. In published cohorts, the frailty proteome displayed heterogeneous trajectories across age (20-100 years, age only explaining a small fraction of variance) and were associated with cardiac and non-cardiac phenotypes and outcomes across two broad validation cohorts (N > 35,000) over ≈2-3 decades. These findings suggest the importance of precision biomarkers of underlying multi-organ health status in age-related morbidity and frailty.