High serum angiotensin-converting enzyme 2 activity as a biomarker of frailty in nursing home residents

Angiotensin converting enzyme 2 in patients with sepsis associate with comorbidities but neither with mortality nor with organ failure

High levels of circulating angiotensin converting enzyme 2 (ACE2) are associated with several chronic diseases and mortality risk. Less is known about the prognostic value of ACE2 in patients with sepsis. In the present study, we aimed to investigate the association between plasma ACE2 levels on admission to the ED and 28-day mortality, organ failure, and level of care in a prospectively recruited observational study sample. Six hundred patients with sepsis admitted to the emergency in Malmö 2013-2015 were included in the analysis. Uni- and multivariable binary logistic regression was conducted to investigate the association between ACE2 and 28-day mortality, organ failure, and level of care. Plasma ACE2 levels were increased in patients with male sex, high age, and comorbidities, including diabetes, cardiovascular disease, and cancer. Plasma ACE2 levels associated with hospitalization and intermediate care unit stay in univariate but not multivariate analysis. Plasma ACE2 did neither associate with 28-day mortality, OR 1.19 (95% CI 0.86-1.65, p = 0.29), nor with organ failure, OR 1.08 (95% CI 0.73-1.56. p = 0.72). Future studies investigating the dynamics of circulating ACE2 levels in patients with sepsis longitudinally are warranted.

Mechanism of Action of Exercise in Regulating Spontaneous Hypertension through the Janus Kinase 2/Signal Transducer and Activator of Transcription 3 Signaling Pathway

ABSTRACT

Although blood pressure can be regulated to normal levels through drug intervention, the prognosis for patients remains bleak, and there is an urgent need to find a new way to prevent or reverse hypertension and its adverse consequences. Some studies have shown that hypertension can be effectively improved by exercise training, but the exact manner in which it works is not completely comprehended. Using spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats as models, an 8-week exercise intervention was adopted to detect the blood pressure, heart rate (HR), glucose tolerance, and insulin sensitivity. Histopathological changes in rat myocardium were observed using H and E staining and Masson staining. Different kits were used to detect the inflammation and oxidative stress in rats. Finally, the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway-related proteins were examined by Western blot. After exercise, SHR rats showed a decrease in blood pressure and HR level, and an increase in glucose tolerance and myocardial insulin sensitivity. Exercise reduced SHR cardiomyocyte cross-sectional area and collagen deposition index, improved cardiac function, and decreased inflammation and oxidative stress. In addition, exercise can modulate the JAK2/STAT3 pathway, and when combined with JAK2 kinase inhibitor, it has an even greater effect on SHR. In conclusion, exercise could reduce blood pressure, inflammation, and oxidative stress, improve glucose tolerance and insulin sensitivity in SHR rats through modulating the JAK2/STAT3 pathway.

Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology

Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.

Novel Potential Targets for Function-Promoting Therapies: Orphan Nuclear Receptors, Anti-inflammatory Drugs, Troponin Activators, Mas Receptor Agonists, and Urolithin A

In recent years, several new classes of therapies have been investigated with their potential for restoring or improving physical functioning in older adults. These have included Mas receptor agonists, regulators of mitophagy, skeletal muscle troponin activators, anti-inflammatory compounds, and targets of orphan nuclear receptors. The present article summarizes recent developments of the function-promoting effects of these exciting new compounds and shares relevant preclinical and clinical data related to their safety and efficacy. The development of novel compounds in this area is expanding and likely will need the advent of a new treatment paradigm for age-associated mobility loss and disability.

Improving the Identification of Frailty in Long-Term Care Residents: A Cross-Sectional Study

PURPOSE

To compare the capacity of blood myostatin concentration and physical, cognitive, and affective function tests to predict frailty among long-term care (LTC) residents.

METHODS

This cross-sectional analysis used baseline data from three randomized controlled trials involving 260 older adults in 14 LTC centers. Serum myostatin levels were analyzed by enzyme-linked immunosorbent assay. Frailty, physical fitness, cognitive and affective functions were assessed using validated tests and scales.

RESULTS

The Timed Up and Go, gait speed, 6-minute walk, and Berg Balance Scale had excellent capabilities in identifying frail individuals in accordance with Fried's Frailty Phenotype (FFP). The best tests for identifying frailty in accordance with the Clinical Frailty Scale (CFS) were Timed Up and Go and Berg Balance Scale. For the Tilburg Frailty Indicator (TFI), the best tests were Quality of Life in Alzheimer's Disease (QoL-AD) and Goldberg Anxiety. Myostatin, along with physical, cognitive, and affective function tests, improved the capability of the hand grip, arm-curl, Montreal Cognitive Assessment, Goldberg Anxiety, Goldberg Depression, and QoL-AD to identify frailty according to FFP, while myostatin improved CFS-defined frailty identification by the hand grip, arm-curl, 6-minute walk test, Berg Balance Scale, 30-second chair-stand, gait speed, Montreal Cognitive Assessment, Goldberg Anxiety, and De Jong-Gierveld Loneliness Scale.

CONCLUSION

Among LTC residents, serum myostatin was associated with being frail according to FFP and CFS. However, this measure was less discriminating of frailty than physical fitness tests (for FFP and CFS) and affective function parameters (for TFI). However, evaluated concurrently with physical, cognitive, and affective parameters, myostatin improved the capabilities of these measures to predict CFS-defined frailty.

Serum Sestrin-1 Concentration Is Higher in Frail than Non-Frail Older People Living in Nursing Homes

Given the increasing prevalence of frailty and its implications for public health, the identification of biomarkers to detect frailty is essential. Sestrin-1 is a protein with a protective role in muscle function. This study aimed to determine whether the serum sestrin-1 concentration differed between frail and non-frail populations and to investigate its association with frailty-related variables in 225 older women and men living in nursing homes (Gipuzkoa, Spain). Serum sestrin-1 concentration was measured by ELISA. Frailty, dependence, anthropometry, physical function, and physical activity were determined by validated tests and tools. The associations between sestrin-1 concentration and the other variables were determined using generalized linear models. The differences between frail and non-frail individuals were analyzed by the Mann–Whitney U-test, and receiver operating characteristic (ROC) curves were constructed to calculate the capability of sestrin-1 to detect frailty. Unexpectedly, frail individuals—according to the Fried Frailty Phenotype or the Clinical Frailty Scale—had higher serum sestrin-1 concentrations than non-frail individuals. Furthermore, the higher serum sestrin-1 concentration was associated with the increased frailty scores and dependence as well as the poorer physical function and the less physical activity. Given the contradictory results regarding serum sestrin-1 and frailty, further investigation is required to propose it as a molecular biomarker of frailty.