Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

Age-related changes in the immune system and challenges for the development of age-specific vaccines

BACKGROUND

A better understanding of how the immune system evolves with age and how vaccines work in older people has led to increasing focus on the development of vaccines aimed specifically at older age groups. We discuss strategies used to improve vaccine immunogenicity for older adults, focusing on licensed adjuvants.

FINDINGS

With age-related immune decline (immunosenescence), older adults face increased vulnerability to infections and severe complications. Immunosenescence affects T-cell and B-cell populations and innate immunity, leading to reduced chemotaxis, cytotoxicity, and altered cytokine production. This contributes to inflammaging-low-grade, chronic inflammation linked to aging. However, immune responses vary due to genetics and life-long exposures, making chronological age an imperfect indicator of immune health. Vaccination remains key to prevention, yet immune dysfunction complicates vaccine efficacy. Strategies to enhance responses in older adults include mRNA vaccines, high-antigen content vaccines, intradermal administration, and adjuvants. mRNA COVID-19 vaccines generated strong immune responses in older adults, though lower than in younger groups. High-antigen content influenza vaccines have shown superior efficacy compared to standard vaccination. Adjuvants offer a well-established approach to boosting vaccine responses by enhancing innate immunity.

CONCLUSIONS

Of various strategies used to improve immunogenicity of vaccines for older adults, adjuvants have been the most consistently effective and practical. More recently, mRNA vaccines have also shown great promise.

Enhanced influenza vaccination for older adults in Europe: a review of the current situation and expert recommendations for the future

INTRODUCTION

Influenza causes considerable morbidity and mortality in Europe, particularly among older adults due to comorbidities, as well as immunosenescence and inflammaging, which contribute to a diminished immune response. Vaccination remains the most effective way to prevent poor outcomes; however, uptake is suboptimal and many countries recommend standard vaccines despite evidence supporting better protection with enhanced (adjuvanted and high-dose) vaccines.

AREAS COVERED

A multidisciplinary group of experts reviewed the burden of influenza in Europe and evaluated data on enhanced vaccines, providing recommendations for their use in older adults. The group discussed barriers to vaccination and strategies to increase uptake.

EXPERT OPINION

Improving protection of older adults against influenza relies upon increasing vaccine uptake and ensuring access to vaccines that overcome age-related immunological decline. Achieving higher uptake requires national policies that facilitate equitable access and clear communication about vaccine eligibility. Based on available evidence, enhanced vaccines offer better protection than standard vaccines against hospitalization and complications in older adults. National recommendations should prioritize the use of enhanced influenza vaccines over standard vaccines in older adults. Limitations to interpretation of evidence include discrepancies in reporting of influenza-related medical encounters and underreporting of influenza-related complications.

Cardioprotective effect of senotherapy in chronically obese middle-aged female rats may be mediated by a MERCSs/Nrf2 interaction

Hypercaloric intake promotes the development of obesity, a risk factor for cardiovascular disease (CVD). In recent years, it has been suggested that senescent cells have negative implications for the outcome of these chronic pathologies, and senotherapy has emerged as a novel intervention to reduce damage to the organism. However, it is unclear whether the accumulation of senescent cells induces alterations at the cardiac level in rats fed a hypercaloric diet (HD) and if the use of senotherapeutics can reverse it. To address this question, we used middle-aged female rats fed HD from 21 days to 15 months of age. Under our experimental conditions, rats exhibited cardiac hypertrophy and fibrosis, accumulation of senescent cells, changes in mitochondrial morphology, and oxidative stress. Rats were treated for 2 months with senolytic (dasatinib + quercetin, DQ) or senomorphic (sulforaphane, SFN) agents. Interestingly, the HD rats showed cardiac improvement after the treatment. Our data suggest a possible link mechanism between Nrf2 activation and mitochondria-endoplasmic reticulum contact sites (MERCSs) preservation, activated by SFN rather than by the DQ combination, which allowed cardiac structure maintenance in HD rats decreasing the harmful effects of senescent cells.

Bidirectional relationship between diabetes and frailty in middle-aged and older adults: A systematic review and meta-analysis

BACKGROUND

Diabetes and frailty are prevalent and burdensome in middle-aged and older adults. However, current evidence on their association is inconsistent, and no quantitative meta-analysis exists. We conducted a systematic review and meta-analysis to examine whether diabetes increased the risk of frailty and vice versa.

METHODS

We systematically searched PubMed, Web of Science, Embase, and CINAHL databases from inception to 10 April 2025. Random-effects models were used to calculate pooled odds ratio (OR) and 95 % confidence interval (CI) for cross-sectional analysis and pooled relative risk (RR) for longitudinal analysis. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

From 8559 non-duplicated records, 31 articles were included. People with diabetes had increased risks of prevalent frailty (OR=2.21, 95 %CI: 1.60-3.06, I2=99.0 %, n = 15; GRADE=Low), prevalent pre-frailty (OR=2.23, 95 %CI: 2.19-2.28, I2=0.0 %, n = 2; GRADE=Very low), and incident frailty (RR=1.50, 95 %CI: 1.36-1.65, I2=0.0 %, n = 7; GRADE=Moderate). Those with pre-frailty (OR=1.95, 95 %CI: 1.61-2.36, I2=0.0 %; GRADE=Very low) but not with frailty (OR=2.28, 95 %CI:0.96-5.46, I2=92.3 %; GRADE=Very low) had increased odds of prevalent diabetes in two studies. In 15 studies, the pooled RRs for incident diabetes were 1.47 (95 %CI: 1.37-1.57, I2=91.0 %; GRADE=Moderate) in pre-frail participants and 1.96 (95 %CI: 1.73-2.23, I2=92.7 %; GRADE=Moderate) in frail participants.

CONCLUSION

Our findings support the bidirectional relationship between diabetes and frailty in middle-aged and older adults, with each condition contributing to the development of the other. This highlights the importance of early detection and integrated management strategies for diabetes and frailty.

A novel sex-specific association between insulin resistance and depressive symptoms in older adults: The potential mediating role of Vascular Endothelial Growth Factor

BACKGROUND

Insulin resistance (IR) and depression are increasingly recognized as interconnected conditions in aging, potentially linked through chronic low-grade inflammation ("inflammaging"). The triglyceride-glucose (TyG) index has emerged as a validated surrogate marker of IR, yet its relationship with inflammatory biomarkers and depressive symptoms in older adults remains underexplored.

OBJECTIVE

This study investigated the association between the TyG index, depressive symptoms, and circulating inflammatory molecules in cognitively healthy older adults, with emphasis on sex-specific differences and the potential mediating role of vascular endothelial growth factor (VEGF).

METHODS

In this retrospective study, 118 non-diabetic older adults (mean age 74.1 years; 52.5 % men) with preserved cognition (MMSE ≥27) were assessed. Depressive symptoms were measured using the Geriatric Depression Scale (GDS), while cytokines and growth factors were quantified via multiplex immunoassay. The TyG index was calculated from fasting glucose and triglyceride levels. Multiple linear regression models controlled for age, sex, BMI, and medication use.

RESULTS

Depressive symptoms (GDS ≥5) were present in 31.35 % of participants. Those with depression had lower levels of anti-inflammatory cytokines and elevated levels of VEGF and MCP-1. TyG index correlated with both GDS scores (r = 0.239, p = 0.017) and VEGF (r = 0.271, p = 0.005), with significant associations observed only in women. VEGF emerged as a key mediator in the TyG-depression link in women (R2 = 0.425).

CONCLUSIONS

These findings suggest a sex-specific metabolic-inflammatory signature in late-life depression. VEGF may serve as a mechanistic link between IR and depressive symptoms in older women, supporting sex-tailored interventions.

Ambient polycyclic aromatic hydrocarbons and cardiovascular disease in China

Polycyclic aromatic hydrocarbons (PAHs) are a prominent category of ambient air pollutants worldwide, but our understanding of their potential health effects at ambient concentrations is severely limited. Our goal was to investigate the relation between ambient PAHs and daily hospitalizations for cardiovascular disease and explore its potential mechanism. This research included both observational and experimental studies. For population-based study, we collected data on daily hospitalizations for cardiovascular events in 184 major Chinese cities, which cover a population of 280 million individuals, for period of 2014-2017. We utilized a time-series quasi-Poisson regression model to assess the city-specific relations between PAHs and hospitalizations, and then employed a random-effects meta-analysis to aggregate the effect estimates across the cities. We also employed meta-regression models and stratified analyses to explore possible effect modifiers. For animal study, mice were exposed to varying doses of PAHs via tracheal instillation to evaluate the cardiac damage induced by PAHs. Potential mechanisms were elucidated through transcriptomic and proteomic sequencing. On the national scale, each interquartile range (IQR) increase in PAHs concentrations at 0-7 days was related to a 5.18 % (3.27 %-7.12 %) increase in hospital admissions for cardiovascular disease, 5.72 % (3.83 %-7.65 %) for ischemic heart disease, and 6.08 % (3.37 %-8.87 %) for ischemic stroke. The cardiovascular impacts of PAHs remained even after controlling for PM2.5. The associations were more pronounced in cities with lower socioeconomic level, or higher temperatures and relative humidity, as well as in subpopulations with elder age (P < 0.05). We also found consistent associations between each of the seven individual PAHs and cardiovascular outcomes. In animal models, PAHs exposure induces cardiac injury via inflammation and oxidative stress, potentially linked to the PI3K/AKT and MAPK signaling pathways. This nationwide study indicated that ambient PAHs could represent a distinct risk factor for cardiovascular disease. They may contribute to cardiac damage through the regulation of inflammation and oxidative stress.

The potential therapeutic effects of Panax notoginseng in osteoporosis: A comprehensive review

BACKGROUND

Accumulating evidence shows that Panax notoginseng, a well-known medicinal herb, has an ideal effect on prevention and treatment of skeletal diseases. In this study, we reviewed clinical applications of clinical application as well as phytochemistry, pharmacokinetics, pharmacology in improving bone quality and toxicity of Panax notoginseng.

PURPOSE

Review the phytochemistry, pharmacokinetics, pharmacology involved in the improving bone metabolism and toxicity of Panax notoginseng and evaluate its potential as a traditional Chinese herbal medicine for osteoporosis.

METHODS

Several databases were consulted, including PubMed, China National Knowledge Infrastructure, National Science and Technology Library and Web of Science. The following words or phrases were used alone or in combinations in the titles and/or abstracts: "","Panax notoginseng", "Sanqi", "osteoporosis", "bone", "osteoblast", "osteoclast", "phytochemistry", "pharmacology" and "pharmacokinetics". Altogether 160 papers were cited.

RESULTS

8 clinical trials of Panax notoginseng alone for the treatment of osteoporosis were identified, most of which used traditional Chinese patent medicines to treat osteoporosis fractures. In these clinical trials, Panax notoginseng preparations have achieved relatively good therapeutic effects. However, more rigorous large-scale experiments are expected to prove their efficacy. Phytochemistry study showed that saponins, flavonoids, polysaccharides are the main active ingredients extracted from Panax notoginseng and the transformation of saponins during the processing explains the different effects of raw and cooked Panax notoginseng. The pharmacokinetics data reveals that protopanaxdiol-type (ppd-type) saponins possesses higher bioavailability than protopanaxtriol-type(ppt-type) saponins and ppd-type saponins such as ginsenoside Ra3, Rb1, and Rd can represent suitable pharmacokinetic markers for Panax notoginseng extracts. The data from animal experiments demonstrates that Panax notoginseng can improve bone quality in ovariectomized, diabetic, hyperlipidemia, radiation-induced, and arthritis rats through the regulation of anti-adipogenesis, anti-inflammation, anti-oxidation, angiogenesis and estrogenic effects. In vitro experiments, the activities of improving bone quality of Panax notoginseng and its ingredients may be attributed to the regulation of multiple signaling pathways, including Wnt/β-catenin, BMP/BMP-R, AMPK/mTOR, GPER/PI3K/AKT, etc. Acute and chronic toxicity as well as genotoxicity studies show that Panax notoginseng is well tolerated while long term use may lead to liver and kidney toxicity.

CONCLUSIONS

Panax notoginseng is a superior medicinal herb that contains multiple active ingredients and could play a potential role in the prevention and treatment of osteoporosis. Further studies should concentrate on developing Panax notoginseng products with higher curative effect and bioavailability.

Aging, frailty, and their effects on motor performance: evidence from kinematic analysis

INTRODUCTION

Aging is commonly linked to motor impairment. However, the relationship between motor performance across age groups and frailty remains unexplored through objective analysis.

OBJECTIVE

To kinematically evaluate motor performance in older and younger adults and investigate its potential connection to frailty.

METHODS

We included 65 healthy subjects (40 females, age range 46-83 years). We used kinematic techniques to study finger-tapping and measure several movement parameters, i.e., number of movements, movement rhythm, amplitude and velocity, as well as progressive reduction in amplitude and velocity during movement repetition (sequence effect). The frailty status was evaluated using a 40-item Frailty Index (FI). We also evaluated cognitive functions, using the Mini Mental State Examination (MMSE) and the Frontal Assessment Battery (FAB). We tested possible relationships between clinical and kinematic data using Spearman's correlation.

RESULTS

A key finding was a significant difference in movement velocity between younger and older adults, with the latter exhibiting lower values (P = 0.014). Accordingly, age significantly correlated with movement velocity (ρ = -0.335, P = 0.037). Among older adults, movement velocity was also found to correlate with frailty (ρr = -0.297, P = 0.033), thus indicating that greater frailty is associated with more impaired motor performance.

CONCLUSIONS

The relationship between the age-related slowed movement execution and frailty suggests that motor performance may serve as a sensitive indicator of physical vulnerability in aging populations.

Impact of coffee consumption on mortality in patients with cardiovascular and cerebrovascular diseases: A cohort study

BACKGROUND AND AIMS

Regarding the effects of coffee intake on the prognosis of the general population and people with cardiovascular and cerebrovascular diseases (CVD), previous studies have shown inconsistent conclusions in different populations. There is no study on the association between coffee intake and the prognosis of American adults and specific disease groups.

METHODS AND RESULTS

The influence of coffee intake on 5-year all-cause mortality was investigated by multivariate COX regression and Kaplan‒Meier curves. Subgroup analysis were used to verify whether the results were consistent across patients with different diseases. A competitive risk model was used to explore the correlation between coffee intake and CVD related death. After fully adjusting for confounders, the results suggested that coffee consumption was correlated with a 25 % lower risk of death compared with never drinking coffee (HR = 0.75, 95 % CI: 0.59-0.96, P = 0.022). Coffee intake was found to be protective against 5-year mortality (HR less than 1.0) regardless of whether participants had common chronic diseases. Drinking 1-3 cups of coffee per day was associated with a 35 % lower risk of CVD related death (HR = 0.65, 95 % CI: 0.43-0.98; P = 0.042).

CONCLUSION

The coffee consumption of 1-3 cups per day was correlated with a significantly reduced 5-year all-cause mortality and CVD related death in U.S. adults, especially those with combined hypertension, heart disease, and stroke. This study analyzed the beneficial effects of coffee on the general population and patients with CVD, and provided dietary recommendations.

Peripheral and central inflammation in depression: How large is the gap and can we bridge it with PET neuroimaging and neural-derived extracellular vesicles?

Major depressive disorder (MDD) presents as a multifaceted syndrome with complex pathophysiology and variable treatment responses, posing significant challenges in clinical management. Neuroinflammation is known to play pivotal mechanism in depression, linking immune responses with central nervous system (CNS) dysfunction. This review explores the interplay between peripheral and central inflammatory processes in MDD, emphasizing discrepancies in biomarker validity and specificity. While peripheral markers like cytokines have historically been investigated as proxies for neuroinflammation, their reliability remains contentious due to inconsistent findings, lack of correlation with neuroinflammatory markers, the influence of confounding variables, and the role of regulatory mechanism within the CNS. Additionally, the human brain shows a pattern of regionalized inflammation. Current methodologies for investigating neuroinflammation in humans in vivo, including neural-derived extracellular vesicles (EVs) and positron emission tomography (PET) neuroimaging using translocator protein, offer promising avenues while facing substantial limitations. We propose that future research in MDD may benefit from combined microglia-derived EV-TSPO PET neuroimaging analyses to leverage the strengths and mitigate the limitations of both individual methods.

Accelerated aging mediates the association between rheumatoid arthritis and depression severity

BACKGROUND

This study aimed to investigate the associations among phenotypic age acceleration (PAA), the prevalence of rheumatoid arthritis (RA), and depression severity and to examine the potential mediating role of PAA in the RA-depression relationship.

METHODS

A retrospective cohort analysis was conducted using data from adult participants in the National Health and Nutrition Examination Survey (2005-2010). Participants with RA were identified on the basis of self-report of RA in personal interviews. Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9). PAA was calculated with 9 clinical biomarkers and chronological age, with a relatively high RAA value indicating the acceleration of aging. Survey-weighted logistic regression models were used to explore the relationship between the prevalence of RA and PAA and the correlation between PAA and depression. Mediation analysis was employed to quantify the indirect effect of RA on depression through PAA.

RESULTS

A total of 9834 adults aged over 20 years were included. RA prevalence was positively associated with greater PAA (β = 1.60, 95 % confidence interval (CI): 0.86-2.35, P = 0.0002) and depression severity (β = 1.57, 95 % CI: 1.09-2.05, P < 0.0001). Additionally, PAA was correlated with depression severity (β = 0.04, 95 % CI: 0.02-0.06; P = 0.0001). Mediation analysis revealed that PAA significantly mediated the association between RA and depressive severity, explaining 2.26-5.57 % (all p < 0.001) of the total effect.

CONCLUSIONS

Individuals with RA exhibited accelerated biological aging, as represented by increased PAA, which partially mediated the relationship between RA and depression severity in this population.

Current strategies for senescence treatment: Focused on theranostic performance of nanomaterials

Age-related diseases imposed heavy burdens to the healthcare systems globally, while cell senescence served as one fundamental molecular/cellular basis for these diseases. How to tackle the senescence-relevant problems is a hotspot for biomedical research. In this review article, the hallmarks and molecular pathways of cell senescence were firstly discussed, followed by the introduction of the current anti-senescence strategies, including senolytics and senomorphics. With suitable physical or chemical properties, multiple types of nanomaterials were used successfully in senescence therapeutics, as well as senescence detection. Based on the accumulating knowledges for senescence, the rules of how to use these nanoplatforms more efficiently against senescence were also summarized, including but not limited to surface modification, material-cargo interactions, factor responsiveness etc. The comparison of these "senescence-selective" nanoplatforms to other treatment options (prodrugs, ADCs, PROTACs, CART etc.) was also given. Learning from the past, nanotechnology can add more choice for treating age-related diseases, and provide more (diagnostic) information to further our understanding of senescence process.

Association Between Sulfur Microbial Diet With All-Cause, Cardiovascular Disease, and Cancer Mortality: A Population-Based Cohort Study

This study aimed to determine the associations between sulfur microbial diet (SMD) and all-cause, cardiovascular disease, and cancer mortality. A total of 91 891 adults were included from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. To evaluate adherence to this dietary pattern, the SMD score was calculated with higher scores indicating greater compliance. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards regression. After a median follow-up of 15.0 years, 20 706 all-cause deaths were noted. The participants in the highest quartile of the SMD score had an enhanced risk of death from all causes (HR: 1.12, 95% CI: 1.07, 1.17) and cancer (HR: 1.15, 95% CI: 1.06, 1.24) than those in the lowest quartile. Dose-response analysis indicated a nonlinear association between the SMD score and both all-cause and cancer mortality. Subgroup analyses demonstrated a significant positive association between the SMD score and all-cause mortality in participants aged 65 years and older. Higher adherence to the SMD is linked to increased risks of all-cause and cancer mortality in the US population. These study findings suggest that intestinal sulfur-metabolizing bacteria may play a role in the association between diet and health outcomes.

Menopause and Body Composition: A Complex Field

Given that menopause affects about half of the world's midlife population, it is crucial to understand its impact beyond traditional menopausal symptomology. For instance, many women, while transitioning through menopause, experience profound changes in body composition. These changes may contribute to postmenopausal reductions in metabolic health. This narrative review explores the influence of menopause on skeletal muscle and adipose tissue, highlighting the decline in muscle mass and strength and the gain and redistribution of adipose tissue, particularly the increase in visceral adiposity. Although menopausal changes in body composition are seemingly extensively studied, the longitudinal studies are not that common, and the precise mechanisms driving body composition changes remain unclear, with uncertainties surrounding the roles of hormonal shifts compared with regular aging, energy balance, and lifestyle factors. Notably, it remains debated whether menopause or estrogen meaningfully influences resting energy expenditure. The review also considers the potential mitigating effects of menopausal hormone therapy and regular exercise. Understanding these changes is essential for developing effective strategies to support women's health during and after menopause.

Semisynthesis and biological evaluation of 17-hydroxybrevianamide N derivatives as anti-inflammatory agents by mediating NF-κB and MAPK signaling pathways

Chronic inflammation is a trigger for many diseases that affect approximately 10-20 % of the population around the world. Herein, (±)-17-hydroxybrevianamide N (1) was isolated from the fungus Aspergillus sp. (CHNSCLM-0151) and exhibited strong inhibitory activity against nitric oxide (NO) in lipopolysaccharide (LPS)-induced RAW264.7 cell. A series of new derivatives (±)-3-(±)-29 was semisynthesized by structural modification of the imide, phenolic hydroxyl, and carbonyl groups from the natural product (±)-1. The results of anti-inflammatory activity demonstrated that (±)-4, (±)-6, (±)-9, (±)-22, (±)-23, and (±)-24 exhibited obviously NO inhibitory (P < 0.0001) in LPS-stimulated RAW264.7 cells. To further investigate the relationship between chirality and activity, the enantiomers of the above six compounds were obtained by chiral resolution. As expected, the bioactivity results indicated stereoselectivity in the anti-inflammatory effect among the different isomers. In particular, compound (+)-4S-23 inhibited NO concentration with an IC50 value of 0.5 μM, demonstrating 3-fold greater potency compared to its (R)-enantiomer, and achieving 40-fold superior potency over the positive control NG-monomethyl-l-arginine (L-NMMA). This compound demonstrated suppression of TNF-α (25.7 ± 1.5 %), IL-6 (54.5 ± 3.9 %) and IL-1β (92.9 ± 4.1 %) production at 2 μM. More importantly, mechanistic investigations revealed that (+)-4S-23 (0.2 μM) modulates the MAPK signaling pathway, specifically downregulating phosphorylation of p38, ERK, and JNK. Furthermore, (+)-4S-23 also exhibited potent inhibitory activity against the NF-κB pathway by suppressing the phosphorylation of IκB-α and blocking nuclear translocation of phosphorylated p65. Notably, these findings position (+)-4S-23 as a promising candidate for development as a novel anti-inflammatory therapeutic targeting both MAPK and NF-κB signaling nodes.

Conserved biological processes in partial cellular reprogramming: Relevance to aging and rejuvenation

Partial or transient cellular reprogramming is defined by the limited induction of pluripotency factors without full dedifferentiation of cells to a pluripotent state. Comparing in vitro and in vivo mouse studies, and in vitro studies in humans, supported by visualizations of data interconnections, we show consistent patterns in how such reprogramming modulates key biological processes. Generally, partial reprogramming drives dynamic chromatin remodelling, involving histone modifications that regulate accessibility and facilitate pluripotency gene activation while silencing somatic identity. These changes are accompanied by modifications in stress response programs, such as inflammation, autophagy, and cellular senescence, as well as improved mitochondrial activity and dysregulation of extracellular matrix pathways. We also underscore the challenges in evaluating complex processes like aging and cellular senescence, given the variability in biomarkers used across studies. Overall, we highlight biological processes consistently influenced by reprogramming while noting that some effects are context-dependent, varying according to cell type, species, sex, recovery time, and the reprogramming method employed. These insights inform future research and potential therapeutic applications in aging and regenerative medicine.

Analysis of the association between long-term exposure to low-dose ionizing radiation and dyslipidemia and its components in medical radiologists: The mediating role of inflammatory markers

Introduction

Our study aimed to explore the association between long-term exposure to low-dose ionizing radiation (LDIR) and dyslipidemia and its components among medical radiologists, and to identify the mediating role of inflammatory markers.

Methods

This cross-sectional study was conducted on 3918 medical radiologists, with data collected through questionnaires and occupational external exposure dosimeters. The multifactorial logistic regression and restricted cubic spline model were used to analyze the association between long-term exposure to LDIR and dyslipidemia and its components among medical radiologists, and mediation analysis was used to identify potential mediation effects.

Results

Of 3918 medical radiologists, 995 (25.4 %) had dyslipidemia. The gender, age, body mass index (BMI), and smoking status were influential factors for dyslipidemia of medical radiologists. After adjusting for confounders, the OR and 95 % CI for the occurrence of dyslipidemia and high TG in the highest tertile group (Q3) were 1.32 (95 % CI: 1.04, 1.67) and 1.51 (95 % CI: 1.11, 2.07), respectively. Restricted cubic spline model showed that the cumulative effective dose was linearly associated with both dyslipidemia and high TG, and the risk of dyslipidemia and high TG increased with the cumulative effective dose. Mediation analysis suggested that the inflammatory marker SII significantly mediated the association between cumulative effective dose and TG levels.

Conclusion

Our study shows that medical radiologists have a high detection rate of dyslipidemia, and the risk of dyslipidemia and high TG increases with increasing cumulative effective dose. Inflammatory marker SII may play a mediating role in the association between cumulative effective dose and TG levels.

The connection between 91 inflammatory cytokines and frailty mediated by 1400 metabolites: An exploratory two-step Mendelian randomization analysis

BACKGROUND

Frailty, a common, multifaceted, and significant geriatric condition, involves crucial roles of inflammation and metabolic factors in its onset and progression. Nevertheless, the ambiguities and complexities in earlier observational studies make current research into their interactions somewhat insufficient. Our goals were to clarify the causal link between inflammatory cytokines and frailty and to explore the potential mediating effect of metabolites using Mendelian randomization (MR) analysis.

METHODS

Utilizing detailed summary-level data from genome-wide association studies, we conducted two-sample Mendelian randomization analyses to evaluate the potential causal connection between 91 inflammatory cytokines and the frailty index, along with the possible mediating pathways that involve 1400 metabolites. For our main analysis, we applied the inverse variance weighted method. To evaluate the potential mediating pathways of metabolites, a two-step MR analysis was utilized.

RESULTS

We identified 8 inflammatory cytokines that were genetically associated with the frailty index, we subsequently identified 2 mediated relationships, with 2 metabolites acting as potential mediators between 2 inflammatory cytokines and frailty index. The 8 inflammatory cytokines were fractalkine (CX3CL1), interleukin-33 (IL-33), leukemia inhibitory factor receptor (LIF-R), monocyte chemoattractant protein-1 (CCL8), CC motif chemokine 4 (CCL4), C-X-C motif chemokine 10 (CXCL10), fibroblast growth factor 5 (FGF-5), and TNF-beta (TNFB) levels.

CONCLUSIONS

The findings of this study demonstrate a direct connection between inflammatory cytokines and the frailty index, as well as two pathways mediated by metabolites. These biomarkers contribute valuable insights into the foundational mechanisms of frailty, presenting a novel research avenue for upcoming clinical studies.

C-reactive protein improves the ability to detect hypertension and insulin resistance in mild-to-moderate obstructive sleep apnea: Age effect

C-reactive protein (CRP) appears to improve the ability to detect cardiometabolic risk in young and middle-aged adults with mild-to-moderate obstructive sleep apnea (mmOSA). The aim of this study is to assess utility of CRP in identifying the risk of hypertension and insulin resistance across a wide age range including older patients with mmOSA. Adults (n = 216) of a wide age range (28-90 years old, mean age 52.64 ± 12.74) with mmOSA (5 ≤ AHI < 30) completed in-lab polysomnography or home sleep apnea testing, physical examination including blood pressure (BP) measures, structured medical history questionnaire, and blood draw for CRP and fasting glucose and insulin levels. In adults < 60 years, lnCRP but not the apnea-hypopnea index (AHI) was associated with greater odds for hypertension (odds ratio [OR] = 2.40, 95% CI = 1.20-4.84, p = 0.01; OR = 1.00, 95% CI = 0.92-1.08, p = 0.92, respectively) and with higher average systolic and diastolic BP. Also, in adults < 60 years lnCRP but not AHI, was associated with higher lnHOMA values. In contrast, in adults > 60 years neither lnCRP nor AHI were associated with greater odds for hypertension, average systolic and diastolic BP, and lnHOMA. Receiver-operating characteristics curves revealed that adding CRP to standard clinical factors (age, sex, and BMI) yielded moderately good risk models for hypertension in patients < 60 years (AUC = 0.721). In conclusion, CRP improves the ability to detect cardiometabolic risk in young and middle-aged, but not older adults with mmOSA, suggesting that inflammation may be a primary pathogenetic mechanism in younger patients with OSA.

The impact of a selective androgen receptor modulator (RAD140) on frailty and underlying mechanisms in older male and female C57Bl/6 mice

BACKGROUND

Androgen receptors (AR) are promising therapeutic targets for mechanisms of aging, including chronic inflammation, lean mass loss, and worsening bone health. We investigated the impact of RAD140, a selective AR modulator that activates ARs, on frailty and underlying mechanisms in older C57BL/6 mice.

METHODS

Mice (23.7-25.5 months; N = 21 males; 15 females) received RAD140 (5 mg/kg/day) or placebo (DMSO) daily for 6-weeks. Frailty (clinical and lab-based), body composition, circulating inflammatory markers, grip strength, and genes relating to function/hypertrophy in quadriceps femoris muscles were assessed.

RESULTS

Despite no differences in frailty between treatment and control, there were positive effects in male, but not female mice. RAD140 treated male mice had preserved lean mass (p = 0.024) and bone mineral density (p = 0.004) and lower serum interleukin-6 (p = 0.043) versus controls. In contrast, benefits to body composition and inflammatory markers were not seen in females. In either sex, grip strength, fat mass, and skeletal muscle genes were unaffected.

CONCLUSION

Six-weeks of RAD140 treatment did not affect frailty in older male or female mice. The beneficial effects in lean mass, bone mineral density, and systemic inflammation warrant longer treatments to explore any positive impact on frailty in males. RAD140 may not be ideal for achieving these in females.

Immunosenescence and immunotherapy in elderly patients with hepatocellular carcinoma

Liver cancer, more specifically hepatocellular carcinoma (HCC), is a global health issue and one of the dominant causes of cancer death around the world. In the past few decades, remarkable advances have been achieved in the systemic therapy of HCC. Immune checkpoint inhibitors (ICIs) have become a therapy mainstay for advanced HCC and have shown promise in the neoadjuvant therapy before resection. Despite these significant advancements, the compositions and functions of the immune system occur various alterations with age, called "immunosenescence", which may affect the antitumor effects and safety of ICIs, thus raising concerns that immunosenescence may impair elderly patients' response to ICIs. Therefore, it is important to learn more about the immunosenescence characteristics of elderly patients. However, the real-world elderly HCC patients may be not accurately represented by the elderly patients included in the clinical trials, affecting the generalizability of the efficacy and safety profiles from the clinical trials to the real-world elderly patients. This review summarizes the characteristics of immunosenescence and its influence on HCC progression and immunotherapy efficacy as well as provides the latest progress in ICIs available for HCC and discusses their treatment efficacy and safety on elderly patients. In the future, more studies are needed to clarify the mechanisms of immunosenescence in HCC, and to find sensitive screening tools or biomarkers to identify the patients who may benefit from ICIs.

Immunosenescence in skeletal muscle: The role-play in cancer cachexia chessboard

With the increase in life expectancy, age-related conditions and diseases have become a widespread and relevant social burden. Among these, immunosenescence and cancer cachexia play a significant often intertwined role. Immunosenescence is the progressive aging decline of both the innate and adaptive immune systems leading to increased infection susceptibility, poor vaccination efficacy, autoimmune disease, and malignancies. Cancer cachexia affects elderly patients with cancer causing severe weight loss, muscle wasting, inflammation, and reduced response to therapies. Whereas the connections between immunosenescence and cancer cachexia have been raising attention, the molecular mechanisms still need to be completely elucidated. This review aims at providing the current knowledge about the interplay between immunosenescence, skeletal muscle, and cancer cachexia, analyzing the molecular pathways known so far to be involved. Finally, we highlight potential therapeutic strategies suited for elderly population aimed to block immunosenescence and to preserve muscle mass in cachexia, also presenting the analysis of the current state-of-the-art of related clinical trials.

Dietary polyphenols as geroprotective compounds: From Blue Zones to hallmarks of ageing

Following the demographic shift towards an ageing population over the past century, particularly in developed countries, the concept of healthspan has gained increasing acceptance as a key framework for understanding the drivers of healthy ageing. Accordingly, long-lived individuals, such as nonagenarians and centenarians, who remain free from chronic diseases, provide a valuable model to investigate the complex interplay of biological, genetic, and environmental factors that contribute to exceptional longevity. Although there are other longevity hotspots worldwide, five regions, known as Blue Zones, are widely recognized for their exceptionally long-lived populations. Among the various determinants of healthy ageing, the eating patterns of long-lived individuals in Blue Zones include a variety of polyphenol-rich foods, which may contribute to their healthy phenotype. A significant body of evidence suggests that polyphenols, a large family of compounds ubiquitously found in plant-based foods, may exhibit geroprotective activity by influencing underlying biological mechanisms of ageing and promoting optimal longevity. While identifying several knowledge gaps that future investigations should address, the goal of this review is to provide an overview of how specific polyphenols found in foods commonly consumed by long-lived individuals residing in the Blue Zones may mitigate the risk of age-related diseases. Additionally, we discuss how these compounds, by acting on evolutionarily conserved mechanisms associated with ageing, have the potential to modulate the intricate network of the hallmarks of ageing.

The association between shorter disease course and sarcopenia in women with endometriosis: a retrospective analysis of NHANES 1999-2006

Endometriosis is a common gynecological disorder that is associated with chronic pelvic pain, infertility, and metabolic complications. Sarcopenia, characterized by progressive skeletal muscle loss, predominantly affects older adults. This study explored the incidence and risk factors for sarcopenia in endometriosis patients using the NHANES dataset, which included 373 participants. Endometriosis was confirmed through self-report questionnaire, and sarcopenia was diagnosed via dual-energy X-ray absorptiometry. Covariates encompassed age, race, marital status, education attainment, poverty income ratio, smoking habits, and comorbidities. Statistical analyses were conducted using SPSS version 26.0, incorporating four multivariate regression models. The average age was 40.3 and 40.0 years in endometriotic participants with and without sarcopenia, respectively. Minority ethnicity had higher odds for sarcopenia (OR 6.00, 95% CI 1.24-29.07). A disease duration of endometriosis less than five years was associated with higher sarcopenia risk (OR 4.83, 95% CI 2.57-9.09). Conversely, lower educational levels were linked to a reduced chance of developing sarcopenia (OR 0.42, 95% CI 0.21-0.86). These findings were consistent across all regression models, indicating that ethnic minority status, higher educational attainment, and shorter disease duration are significant risk factors for concurrent sarcopenia in endometriosis patients.

Alternative splicing in aging and aging-related diseases: From pathogenesis to therapy

Aging is a complex biological process associated with nearly all diseases. Alternative splicing is increasingly recognized as an important contributor to aging and a key research pathway for extending human lifespan. In this review, we highlight the findings of alternative splicing in the hallmarks of aging including key processes such as genomic instability, telomere length, protein stability, autophagy processes, etc., as well as antagonistic hallmarks of aging such as various metabolic signals, energy metabolism, clearance of senescent cells, stem cell self-renewal, cell communication and inflammatory process, etc. We also discuss the roles of alternative splicing in age-related diseases, including neurodegenerative diseases, cardiovascular diseases, skeletal muscle-related diseases, metabolic disorders, cancer, sensory degeneration, and chronic inflammation, etc. These studies suggest that new anti-aging therapies could be developed by regulating key splicing proteins or specific splicing events.

Effects of 28-day simvastatin administration on emotional processing, reward learning, working memory, and salivary cortisol in healthy participants at-risk for depression: OxSTEP, an online experimental medicine trial

BACKGROUND

Statins are among the most prescribed medications worldwide. Both beneficial (e.g. antidepressant and pro-cognitive) and adverse (e.g. depressogenic and cognitive-impairing) mental health outcomes have been described in clinical studies. The underlying neuropsychological mechanisms, whether positive or negative, are, however, not established. Clarifying such activities has implications for the safe prescribing and repurposing potential of these drugs, especially in people with depression.

METHODS

In this double-blind, randomized, placebo-controlled experimental medicine study, we investigated the effects of simvastatin on emotional processing, reward learning, working memory, and waking salivary cortisol (WSC) in 101 people at-risk for depression due to reported high loneliness scores (mean 7.3 ± 1.2 on the UCLA scale). This trial was largely conducted during periods of social distancing due to the COVID-19 pandemic (July 2021-February 2023), and we employed a fully remote design within a UK-wide sample.

RESULTS

High retention rates, minimal outlier data, and typical main effects of task condition (e.g. emotion) were seen in all cognitive tasks, indicating this approach was comparable to in-person testing. After 28 days, we found no statistically significant differences (F's < 3.0, p's > 0.20) for any of the measures of emotional processing, reward learning, working memory, and WSC.

CONCLUSIONS

Study results do not substantiate concerns regarding adverse neuropsychiatric events due to statins and support the safety of their prescribing in at-risk populations. Although other unmeasured cognitive processes may be involved, our null findings are also in line with more recent clinical evidence suggesting statins do not show antidepressant or pro-cognitive efficacy.

Gut-vitamin D interplay: key to mitigating immunosenescence and promoting healthy ageing

BACKGROUND

Immunosenescence is the loss and change of immunological organs, as well as innate and adaptive immune dysfunction with ageing, which can lead to increased sensitivity to infections, age-related diseases, and cancer. Emerging evidence highlights the role of gut-vitamin D axis in the regulation of immune ageing, influencing chronic inflammation and systemic health. This review aims to explore the interplay between the gut microbiota and vitamin D in mitigating immunosenescence and preventing against chronic inflammation and age-related diseases.

MAIN TEXT

Gut microbiota dysbiosis and vitamin D insufficiency accelerate immunosenescence and risk of chronic diseases. Literature data reveal that vitamin D modulates gut microbiota diversity and composition, enhances immune resilience, and reduce systemic inflammation. Conversely, gut microbiota influences vitamin D metabolism to promote the synthesis of active vitamin D metabolites with implications for immune health.

CONCLUSIONS

These findings underscore the potential of targeting gut-vitamin D axis to modulate immune responses, delay the immune ageing, and mitigate age-related diseases. Further research is needed to integrate vitamin D supplementation and microbiome modulation into strategies aimed at promoting healthy ageing.

Sex differences in middle-aged and old Wistar rats in response to long-term sulforaphane treatment for prevention of neuroinflammation, cognitive decline and brain senescence

The nervous system (NS) experiences morphological and functional changes during the aging process, where low-grade chronic inflammation, oxidative stress and senescence are key regulators. Sulforaphane (SFN) is an isothiocyanate that activates redox response and inhibits the inflammatory process, which could modify the pro-inflammatory components of senescent cells secretory phenotype (SASP). Here we aimed to determine if SFN long-term treatment was able to prevent age-associated damage in the NS of adult and old females and males Wistar rats. We evaluated cytokines and chemokines profile, senescent cells markers, and memory parameters of adult (15 m.o.) and old (21 m.o.) rats after three months of SFN treatment. Young rats (4 m.o.) were used as age controls. Differences between sexes were observed in the inflammatory profile. Our results showed that SFN-treatment diminished proinflammatory molecules, senescence markers and senescent cells number in brain cortex and hippocampus from males and females' adult rats, but no effects were observed in both sexes old groups compared with the same age control groups. SFN-dependent reduction in inflammatory and senescence parameters resulted in better scores in Barnes Maze Trial memory test when compared with same age non-treated group. Interestingly, adult females showed higher levels of proinflammatory cytokines and chemokines than adult males, which were prevented by SFN-treatment. No effects of SFN were observed in memory of old-treated groups.

Walking Football Programme for Elderly People: Study Protocol

This study aims to evaluate the effects of a Walking Football (WF) programme on physical fitness, body composition, health-related quality of life (QoL), and happiness in men and women over 60 years. WF is proposed as a safe and accessible activity to counteract physical inactivity and chronic conditions in ageing populations. A randomized controlled trial will be conducted with 120 participants (both sexes), assigned to either an experimental group (WF intervention) or a wait-list control group. The six-month intervention includes bi-weekly sessions with skills training, match simulations, and fitness exercises. Assessments will be performed at baseline, 3 months, and 6 months. Primary outcome measures will be: body composition (weight, BMI, fat and lean mass), muscular strength, aerobic endurance, agility, range of motion, and subjective well-being (QoL and happiness scales). Linear mixed-effects models and ANCOVA will be used to analyse the data. It is expected that WF will lead to improvements in physical and mental health, contributing to active ageing. This study may also support WF as a tool for social inclusion and well-being in older adults.

The intensity of exercise and inflammation markers in women with overweight & obesity: a systematic review and network meta-analysis

OBJECTIVES

The purpose of this network meta-analysis (NMA) of randomized controlled trials (RCT) was to examine the effects of different exercise intensities on inflammatory markers in women with overweight/obesity.

METHODS

A systematic search for RCTs that met the inclusion criteria for the period up to October 2024. random effects NMA was performed within a frequency-based framework.

RESULTS

A total of 75 RCTs were included (3989 participants). High-intensity exercise significantly modulated leptin and adiponectin levels, but had a nonsignificant effect on TNF-α, CRP, and IL-6 levels. Moderate-intensity exercise significantly modulated TNF-α, CRP, IL-6, leptin, and adiponectin levels. Surface under the cumulative ranking curve (SUCRA) probability ranking showed that moderate-intensity exercise was the most recommended exercise intensity for reducing TNF-α, CRP, IL-6, and leptin levels, and for modulating adiponectin levels, moderate-intensity exercise also had a SUCRA value of 65.4%, so we believe that moderate-intensity exercise may be the most robust type of exercise intensity in terms of the breadth of effects. Subgroup analysis showed that moderate-intensity aerobic exercise (MAE) significantly reduced TNF-α levels. Moderate-intensity resistance training (MRT) is the most recommended type for decreasing IL-6 and leptin levels. Moderate-intensity combined exercise (MCE) is the best type of exercise for managing CRP and adiponectin levels.

CONCLUSIONS

There were significant differences in the effects of different exercise intensities on specific inflammatory markers in women living with overweight and obesity. Moderate-intensity exercise may be the most robust type of exercise intensity. Future studies should consider the importance of exercise duration and volume (e.g., in MET* minutes/week) to better understand the relationship between exercise intensity and inflammatory markers. The effects of combining exercise and diet on inflammatory markers in women with overweight and obesity should also be explored in greater depth.

Ageing Trajectories: Exposome-Driven Pathobiological Mechanisms and Implications for Prevention from Blue Zones and Italian Longevity Hotspots Such as Cilento and Sicilian Mountain Villages

Ageing is influenced by a complex interplay of genetic, environmental, and lifestyle factors, with increasing evidence highlighting the exposome as a key determinant of healthspan. This review explores the impact of environmental exposures, focusing in particular on pollution, endocrine disruptors, and climate change on the development of age-related diseases such as cardiovascular diseases (CVDs), cancer, and metabolic disorders. Additionally, it examines protective factors that contribute to healthy ageing. A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on studies published between 2000 and 2025. Findings indicate that chronic exposure to pollutants accelerates cellular ageing through mechanisms such as oxidative stress, inflammation, and epigenetic dysregulation. In contrast, longevity hotspots-Blue Zones, Cilento and the mountain villages of Sicily (Sicani and Madonie Mountains)-illustrate how traditional dietary patterns, strong social structures, and reduced environmental toxicity contribute to exceptional health and longevity. Mechanistically, exposome-driven alterations in immune-inflammatory pathways and epigenetic regulation play a central role in modulating ageing trajectories. Understanding these interactions is essential for developing targeted strategies to mitigate harmful exposures and enhance protective factors. This review underscores the urgent need for integrative public health policies that address the environmental determinants of ageing, ultimately promoting a longer and healthier lifespan.

Fungal Bioactive Compounds as Emerging Therapeutic Options for Age-Related Neurodegenerative Disorders

Aging is a complex biological process characterized by progressive multiorgan deterioration that compromises the quality of life. Unhealthy aging often associates with cognitive decline and motor-neurological disorders including Alzheimer's disease, Parkinson's disease, and Huntington's disease. Genetic, environmental, and lifestyle factors, which include dietary habits, interact with aging and influence brain health, thus having an impact on the development of neurodegenerative disorders. In this context, fungal-derived bioactive compounds have emerged as promising neuroprotective agents due to their diverse biological properties that include antioxidative, anti-inflammatory, pro-autophagic, and neurotrophic effects. Key fungal metabolites, including polysaccharides, terpenoids, alkaloids, and phenolic compounds have been shown to modulate neuroinflammatory pathways, enhance neuronal survival, stimulate protective autophagy, and promote synaptic plasticity. Still, challenges related to their bioavailability, standardization, and clinical translation remain unresolved. Future deep research will be crucial to unlocking the full therapeutic potential of fungal-derived neuroprotective compounds. This review examines the potential therapeutic role of fungal metabolites, providing a comparative evaluation with a focus on their mechanisms of action in promoting brain health and longevity.

Boosting Immunity Through Nutrition and Gut Health: A Narrative Review on Managing Allergies and Multimorbidity

The increasing global burden of allergic diseases and multimorbidity underscores the urgent need for innovative strategies to strengthen immune health. This review explores the complex relationships among nutrition, gut microbiota, immune regulation, allergic diseases, and multimorbidity. It highlights how targeted nutritional and microbial interventions may influence disease outcomes. Dietary components and microbial metabolites dynamically modulated immune function, highlighting the critical role of the gut-immune-metabolism axis in disease pathogenesis and management. Personalized nutrition, guided by advances in diagnostics such as component-resolved diagnostics, basophil activation tests, and epigenetic biomarkers, allows for precise dietary interventions tailored to individual allergy phenotypes and multimorbidity profiles. The Mediterranean diet, breastfeeding, and microbiota-targeted therapies have emerged as effective strategies to enhance immune resilience, reduce inflammation, and manage allergic reactions. Technological advancements, including artificial intelligence-driven dietary assessments, wearable devices, and mobile applications, have further revolutionized personalized dietary management, enabling real-time, precise nutritional monitoring and intervention. Despite these advances, challenges in implementing personalized nutrition persist, including variability in dietary patterns, cultural and socioeconomic factors, and accessibility concerns. Future research should focus on long-term interventional and longitudinal studies to validate precision nutrition strategies and enhance clinical applicability. This integrative approach, combining nutrition, microbiome science, technology, and personalized healthcare, holds substantial promises for sustainable disease prevention and enhanced immune resilience across diverse populations.

Frailty Burden and Efficacy of Initial Invasive Strategy in Chronic Coronary Disease: The ISCHEMIA Trials

BACKGROUND

Frailty is common among patients with chronic coronary disease and is associated with worse outcomes.

METHODS

A pooled, post hoc analysis of the ISCHEMIA and ISCHEMIA-CKD trials was conducted. Baseline frailty was assessed using a Frailty Index (FI), and participants were categorized into data-derived tertiles. Multivariable Cox models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether baseline frailty status modified the treatment effect of the initial invasive (vs conservative) strategy on a composite outcome of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest and the secondary outcome of HRQoL (Seattle Angina Questionnaire [SAQ]).

RESULTS

Among 5322 participants (mean 64 years, 24% female), a high frailty burden (tertile 3 vs. tertile 1) was associated with lower baseline SAQ scores and increased risk of adverse clinical outcomes on follow-up. Baseline frailty burden did not significantly modify the effect of the initial invasive strategy on the primary composite outcome (Pinteractionfrailty × intervention arm = 0.30). However, frailty significantly modified the effect of the initial invasive strategy on HRQoL, with higher baseline frailty burden associated with greater improvement in SAQ scores at 1 year with initial invasive (vs. conservative) treatment (Pinteractionfrailty × intervention arm < 0.001). The treatment effect of an initial invasive vs. conservative strategy on 12-month SAQ score change was most pronounced in individuals with lower baseline SAQ scores in both higher and lower frailty burden groups.

CONCLUSION

Patients with chronic coronary disease with a higher frailty burden are more likely to experience greater improvements in HRQoL with initial invasive management without a higher risk of adverse clinical events. Lower baseline SAQ scores predicted greater improvement in HRQoL with initial invasive management, independent of frailty burden.

Role of inflammation in depressive and anxiety disorders, affect, and cognition: genetic and non-genetic findings in the lifelines cohort study

Inflammation is associated with a range of neuropsychiatric symptoms, but the issue of causality remains unclear. We used complementary non-genetic, genetic risk score (GRS), and Mendelian randomization (MR) analyses to examine whether inflammatory markers are associated with affect, depressive and anxiety disorders, and cognition. We tested in ≈55,098 (59% female) individuals from the Dutch Lifelines cohort the concurrent/prospective associations of C-reactive protein (CRP) with: depressive and anxiety disorders; positive/negative affect; and attention, psychomotor speed, episodic memory, and executive functioning at baseline and a follow-up assessment occurring 3.91 years later (SD = 1.21). Additionally, we examined the association between inflammatory GRSs (CRP, interleukin-6 [IL-6], IL-6 receptor [IL-6R and soluble IL-6R (sIL-6R)], glycoprotein acetyls [GlycA]) on these same outcomes (Nmin = 35,300; Nmax = 57,946), followed by MR analysis examining evidence of causality of CRP on outcomes (Nmin=22,154; Nmax = 23,268). In non-genetic analyses, higher CRP was associated with depressive disorder, lower positive/higher negative affect, and worse executive function, attention, and psychomotor speed after adjusting for potential confounders. In genetic analyses, CRPGRS was associated with any anxiety disorder (β = 0.002, p = 0.037) whereas GlycAGRS was associated with major depressive disorder (β = 0.001, p = 0.036). Both CRPGRS (β = 0.006, p = 0.035) and GlycAGRS (β = 0.006, p = 0.049) were associated with greater negative affect. Inflammatory GRSs were not associated with cognition, except sIL-6RGRS which was associated with poorer memory (β = -0.009, p = 0.018). There was a non-significant CRP-anxiety association using MR (β = 0.12; p = 0.054). Genetic and non-genetic analyses provide consistent evidence for an association between CRP and negative affect. These results suggest that inflammation may impact a broad range of trans-diagnostic affective symptoms.

Reduced abundance of Fusobacterium signifies cardiovascular benefits of sodium glucose cotransporter 2 inhibitor in type 2 diabetes: a single arm clinical trial

Background

The sodium glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin has been demonstrated cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM). However, the underlying mechanism remains poorly understood.

Methods

We conducted an 8-week, single-arm clinical trial, which enrolled 12 patients with inadequate glycemic control on metformin monotherapy. These patients were treated with SGLT2i dapagliflozin (10 mg/day). We assessed changes in clinical parameters pertinent to glucose metabolism and risk factors of cardiovascular disease (CVD), as well as alterations in the gut microbiota using macrogene sequencing.

Results

Improvements were observed in anthropometric parameters, glucose metabolism, blood lipid-related indices, inflammatory markers, and endothelial cell function-related parameters. Concurrently, SGLT2i led to changes in composition and functional pathways of the gut microbiota, manifested as increased abundance of probiotics and decreased abundance of harmful bacteria. Importantly, reduced abundance of Fusobacterium was correlated with improvements in various clinical indicators.

Conclusion

SGLT2i represents a superior initial therapeutic option for T2DM patients at risk of CVD. The cardiovascular benefits of SGLT2i may be attributed to shifts in the gut microbiota, particularly the reduced abundance of Fusobacterium.

Study on the comorbid mechanisms of sarcopenia and late-life depression

The increasing global aging population has brought greater focus to age-related diseases, particularly muscle-brain comorbidities such as sarcopenia and late-life depression. Sarcopenia, defined by the gradual loss of muscle mass and function, is notably prevalent among older individuals, while late-life depression profoundly affects their mental health and overall well-being. Epidemiological evidence suggests a high co-occurrence of these two conditions, although the precise biological mechanisms linking them remain inadequately understood. This review synthesizes the existing body of literature on sarcopenia and late-life depression, examining their definitions, prevalence, clinical presentations, and available treatments. The goal is to clarify the potential connections between these comorbidities and offer a theoretical framework for the development of future preventive and therapeutic strategies.

Associations of Markers of Inflammatory Status and Adiposity with Bone Phenotype at Age 60-64 Years: Findings from the MRC National Survey of Health and Development

This study investigated associations between markers of inflammatory status and adiposity (interleukin-6 [IL-6], adiponectin and leptin) and measures of bone phenotype and fractures. The Medical Research Council (MRC) National Survey of Health and Development (NSHD) is a British birth cohort study. Participants (born during the same week in 1946) with complete data on DXA and pQCT parameters, markers of inflammatory status and adiposity, and potential confounders (498 men and 474 women) were included in cross-sectional analyses. At age 60-64 years, bone phenotype was assessed by DXA and pQCT. Fractures were self-reported at ages 60-64 and 68-70 years. Multiple linear regression was used to determine associations of IL-6, adiponectin and leptin with bone phenotype (adjusted for fat and lean mass and lifestyle confounders). Standard deviation (SD) differences in outcomes per SD increases in exposures were estimated. Higher IL-6 levels were associated with lower total volumetric bone mineral density (vBMD) (- 0.10[- 0.19, 0.00]) in men, and higher areal BMD (aBMD) at the spine (0.12[0.03, 0.22]) and whole body (0.11[0.01, 0.20]) in women. Higher levels of adiponectin were associated with lower aBMD and trabecular vBMD. In women, higher leptin levels were associated with higher cortical vBMD (0.11[0.02, 0.20]). Higher adiponectin was associated with moderately increased odds of having a fragility fracture during adulthood in women (OR 1.16 [95% CI 0.94, 1.43, p = 0.18]). Our results highlight non-mechanical associations between markers of inflammatory status and adiposity with BMD and, in women, fractures. Ensuring inflammaging is minimised may be important in healthy bone ageing.

Association Between the Serum Creatinine to Cystatin C Ratio and Cardiovascular Disease in Middle-Aged and Older Adults in China: A Nationwide Cohort Study

BACKGROUND

The relationship between the serum creatinine to cystatin C ratio (sarcopenia index [SI]) and the risk of incident cardiovascular disease (CVD) remains unclear. Therefore, this study aims to explore the association between SI and the risk of incident CVD in middle-aged and older Chinese adults using nationally representative data.

METHODS AND RESULTS

We analyzed data from participants in CHARLS (China Health and Retirement Longitudinal Study) conducted in 2015 and 2018. The exposure variable was SI, calculated as the ratio of serum creatinine to cystatin C, multiplied by 100. The outcome variable was self-reported CVD (heart disease or stroke). A cross-sectional analysis was first performed using 2015 CHARLS data, which included 11 115 eligible participants (46.1% men; mean±SD age, 60.28±9.60 years). Logistic regression was used to estimate the association between SI and CVD. Longitudinal analysis was then conducted using the 2018 follow-up data, which included 8589 participants (46.4% men; mean±SD age, 59.57±9.42 years), with a median follow-up period of 3.0 years. Cox proportional hazard models were used to assess the relationship between SI and the risk of incident CVD, and a multivariate-adjusted restricted cubic spline model was used to explore the dose-response relationship. In the cross-sectional analysis, multivariate logistic regression revealed a significant negative association between SI and CVD. The longitudinal analysis identified 854 (9.94%) new CVD cases. Cox models showed that lower SI was significantly associated with an increased risk of incipient CVD. The multivariable adjusted hazard ratios for participants in the quartile 2 to quartile4 groups compared with those in the quartile 1 group were 0.94 (95% CI, 0.79-1.12), 0.63 (95% CI, 0.51-0.78), and 0.60 (95% CI, 0.47-0.75), respectively. Restricted cubic spline curves demonstrated a significant linear relationship between SI and CVD incidence (all P-nonlinear>0.05).

CONCLUSIONS

A lower SI was significantly associated with an increased risk of new-onset CVD in middle-aged and older Chinese adults. This suggests that SI has an important potential application as a serum marker of sarcopenia in predicting CVD.

Metabolomic Pathways of Inflammation and Mitochondrial Dysfunction Are Related to Worsening Healthy Aging Index and Mortality

BACKGROUND

Metabolic-inflammatory states are central to multiorgan mechanisms of aging, but precise functional biomarkers of physiological aging remain less clear.

METHODS

In the Health, Aging, and Body Composition study, we defined metabolomic profiles of the Healthy Aging Index (HAI), a composite of cardiovascular, lung, cognitive, metabolic, and renal function (0-10, with higher scores indicating poorer health) in a split set design from 2015 older participants (mean age 73.6 years; 50% women; 35% Black). We used standard regression to identify metabolomic correlates of Year 1 and Year 10 HAI, change in HAI over time, and mortality. A metabolite score of HAI was developed using LASSO regression.

RESULTS

We identified 42 metabolites consistently associated with Year 1 and Year 10 HAI, as well as change in HAI: 13 lipids, 4 amino acids, and 4 metabolites of other classes were associated with worse and worsening HAI while 20 lipids and 1 amino acid was associated with better and improving HAI. Most of these associations were no longer significant after additionally adjusting for inflammation biomarkers. A higher metabolite score of Year 1 HAI was associated with greater HAI deterioration over time (hold-out "test" set beta 0.40 [0.15-0.65]) and higher mortality (hold-out "test" set hazard ratio: 1.43 [1.23-1.67]).

CONCLUSIONS

A multiorgan healthy aging phenotype was linked to lipid metabolites, suggesting potential pathways related to mitochondrial function, oxidative stress, and inflammation. Metabolomics of HAI at older age were related to worsening health and mortality, suggesting potential links between metabolism and accelerated physiological aging.

Frailty Mediated the Associations of Fine Particulate Matter With Depression and Anxiety: Findings From the UK Biobank

BACKGROUND

The role of frailty in the associations of fine particulate matter (PM2.5) with depression and anxiety was unknown.

METHODS

This study is a longitudinal population-based cohort study. A total of 444 094 UK Biobank participants without depression or anxiety at baseline were included. PM2.5 concentrations and frailty phenotype were measured at baseline, while incident depression and anxiety were identified during a median follow-up of 7.8 y. A multivariable Cox regression model was utilized to evaluate the prospective relationships between PM2.5/frailty and the risk of depression and anxiety. Mediation analyses were performed to examine whether the associations were mediated by frailty.

RESULTS

Both frailty and PM2.5 exposure were associated with a higher risk of depression and anxiety. Each 10 μg/m3 increase in PM2.5 was associated with a 33% and 42% higher risk of depression (hazard ration [HR] 1.33, 95% CI: 1.17-1.49) and anxiety (HR 1.42, 95% CI: 1.24-1.67), respectively. Compared with individuals with nonfrailty, those with frailty was associated with a higher risk of depression (HR 3.14, 95% CI: 3.01-3.28) and anxiety (HR 2.39, 95% CI: 2.28-2.52), respectively. The estimate of the nature indirect effects of frailty was 1.07 (95% CI: 1.06-1.09) and 1.05 (95% CI: 1.05-1.06), which accounted for 64.6% and 22.4% of the associations between PM2.5 and depression/anxiety, respectively.

CONCLUSIONS

Our findings suggest that both exposure to PM2.5 and frailty are associated with higher risk of depression and anxiety. The adverse associations between PM2.5 and depression/anxiety are partially mediated through frailty. Targeting frailty management could be a critical strategy for reducing the PM2.5-related psychiatric health burden.

Obesity and inflammation in chronic and acute heart failure

Obesity and inflammation have been associated with an increased incidence of heart failure (HF) and death. However, until recent years, no therapy directed towards reducing inflammation and reducing obesity has been shown to reduce those adverse outcomes. Over the past few years, a few small studies have suggested that improving obesity-and in even smaller studies, reducing inflammation-may help improve HF severity, congestion, quality of life, and possibly outcomes. Larger studies that are being planned and executed, which will report their results within the next 2-3 years, should help further clarify the effects of weight and inflammation reduction in patients with HF.

Lithium in cardiovascular health and disease: Pharmacological and clinical implications

Lithium, a cornerstone therapy for bipolar disorder (BD), produces complex and dual effects on cardiovascular health. This review synthesizes current evidence on the direct and indirect cardiovascular effects of lithium. Direct effects include dose-dependent influences on cardiac development, hypertrophy, fibrosis, mitochondrial function, and arrhythmia. While therapeutic doses may confer cardioprotective benefits by inhibiting GSK-3β, which activates the Wnt/β-catenin signaling pathway and modulates anti-inflammatory pathways, supratherapeutic levels exacerbate oxidative stress, mitochondrial dysfunction, and arrhythmogenicity. Indirectly, lithium modulates cardiovascular outcomes caused by renal dysfunction, metabolic syndrome, and neuroendocrine-immune interactions. Clinical studies suggested that there is reduced cardiovascular mortality in lithium-treated BD patients, potentially offsetting its adverse metabolic effects. However, conflicting evidence persists, particularly regarding dose specificity and long-term outcomes. Future research should focus on high-quality clinical trials to clarify the balance between therapeutic benefits and adverse effects of lithium to ensure its safe and effective use in clinical practice.

Cellular senescence in age-related musculoskeletal diseases

Aging is typically associated with decreased musculoskeletal function, leading to reduced mobility and increased frailty. As a hallmark of aging, cellular senescence plays a crucial role in various age-related musculoskeletal diseases, including osteoporosis, osteoarthritis, intervertebral disc degeneration, and sarcopenia. The detrimental effects of senescence are primarily due to impaired regenerative capacity of stem cells and the pro-inflammatory environment created by accumulated senescent cells. The secreted senescence-associated secretory phenotype (SASP) can induce senescence in neighboring cells, further amplifying senescent signals. Although the removal of senescent cells and the suppression of SASP factors have shown promise in alleviating disease progression and restoring musculoskeletal health in mouse models, clinical trials have yet to demonstrate significant efficacy. This review summarizes the mechanisms of cellular senescence in age-related musculoskeletal diseases and discusses potential therapeutic strategies targeting cellular senescence.

Maternal dysbiosis produces long-lasting behavioral changes in offspring

Advanced maternal age (AMA) is defined as a pregnancy in a woman older than 35 years of age. AMA increases the risk for both maternal and neonatal complications, including miscarriage and stillbirth. AMA has also been linked to neurodevelopmental and neuropsychiatric disorders in the offspring. Recent studies have found that age-associated compositional shifts in the gut microbiota contribute to altered microbial metabolism and enhanced inflammation in the host. We investigated the specific contribution of the maternal microbiome on pregnancy outcomes and offspring behavior by recolonizing young female mice with aged female microbiome prior to pregnancy. We discovered that pre-pregnancy colonization of young dams with microbiome from aged female donors significantly increased fetal loss. There were significant differences in the composition of the gut microbiome in pups born from dams recolonized with aged female biome that persisted through middle age. Offspring born from dams colonized with aged microbiome also had significant changes in levels of neurotransmitters and metabolites in the blood and the brain. Adult offspring from dams colonized with an aged microbiome displayed persistent depressive- and anxiety-like phenotypes. Collectively, these results demonstrate that age-related changes in the composition of the maternal gut microbiome contribute to chronic alterations in the behavior and physiology of offspring. This work highlights the potential of microbiome-targeted approaches, even prior to birth, may reduce the risk of neuropsychiatric disorders.

Associations between the oral microbiome, number of teeth and frailty among American adults: A cross-sectional study from NHANES 2009-2012

BACKGROUND

The intricate interrelationship between oral health, the number of teeth, oral microbiota, and frailty remains largely unexplored in clinical research. This study aimed to investigate the interrelationship between oral microbiome, the number of teeth, and frailty.

METHODS

Data from 4518 participants in NHANES 2009-2012 were analyzed. Frailty was measured using the 48-item Frailty Index (FI). Multivariable logistic regression and restricted cubic spline (RCS) evaluated associations between alpha diversity and frailty. Mediation analysis was used to assess the role of number of teeth. The associations between oral microbiome diveristy and mortality were analyzed by Cox regression. Beta diversity was examined with PCoA and PERMANOVA.

RESULTS

The prevalence of frailty was 39.73 %. Univariate analysis showed that alpha diversity indices except for the Simpson index were significantly lower in frailty, and after adjusted for confounders, observed ASVs (adjusted OR: 0.80 [0.73, 0.87], p < 0.001), Faith's PD (adjusted OR: 0.81 [0.74, 0.88], p < 0.001) and Shannon-Weiner index (adjusted OR: 0.88 [0.81, 0.95], p = 0.002) were remained significantly associated with frailty. The reduced number of teeth partially mediated the relationship (for Faith's PD: βindirect = -0.001 [-0.003, 0.000], p = 0.036, proportion: 8.33 % [0.00 %, 37.50 %]; for Shannon-Weiner index, βindirect = -0.007 [-0.013, -0.002], p = 0.007, Proportion = 17.07 % [3.39 %, 65.00 %]). Univariable Cox proportional hazard regression showed that all alpha diversity indices were significantly associated with all-cause mortality in frail population, and in multivariable analysis, Shannon-Weiner index (HR: 0.72 [0.55, 0.94], p = 0.017) and Simpson index (HR: 0.71 [0.60, 0.83], p < 0.001) remained statistically significant. PCoA showed that beta diversity was also significantly associated with frailty.

CONCLUSION

Lower oral microbiome diversity is associated with higher frailty and mortality. The number of teeth partially mediates this link, emphasizing the importance of oral health in mitigating frailty and promoting healthy aging.

Metabolaging: a new geroscience perspective linking aging pathologies and metabolic dysfunction

With age, our metabolic systems undergo significant alterations, which can lead to a cascade of adverse effects that are implicated in both metabolic disorders, such as diabetes, and in the body's ability to respond to acute stress and trauma. To elucidate the metabolic imbalances arising from aging, we introduce the concept of "metabolaging." This framework encompasses the broad spectrum of metabolic disruptions associated with the hallmarks of aging, including the functional decline of key metabolically active organs, like the adipose tissue. By examining how these organs interact with essential nutrient-sensing pathways, "metabolaging" provides a more comprehensive view of the systemic metabolic imbalances that occur with age. This concept extends to understanding how age-related metabolic disturbances can influence the response to acute stressors, like burn injuries, highlighting the interplay between metabolic dysfunction and the ability to handle severe physiological challenges. Finally, we propose potential interventions that hold promise in mitigating the effects of metabolaging and its downstream consequences.

Social disadvantage accelerates aging

Social disadvantage, like advanced age, is a risk factor for a broad range of health conditions; however, whether it influences the aging process remains unclear. Here, using a multicohort approach, we investigated the associations of social disadvantage with age-related plasma proteins and age-related diseases. We found proteomic signatures of accelerated immune aging and 14 specific age-related proteins linked to social disadvantage during both early and later life. Individuals experiencing social disadvantage had an increased risk of 66 age-related diseases, with up to 39% of these associations mediated by the 14 age-related proteins (for example, DNAJB9, F2, HSPA1A, BGN). The main enriched pathway involved the upregulation of the pro-inflammatory regulator NF-κB24 and its downstream factor interleukin-8. Our findings support the hypothesis that social disadvantage throughout the life course may accelerate aging, a biological mechanism that could explain why social stratification plays such a fundamental role in determining human health.

Association of blood biomarkers with frailty-A mapping review

Frailty describes a geriatric syndrome characterized by an increased vulnerability. Although a variety of potential blood-based biomarkers have been discussed for its characterization, a reliable protocol considering blood-based biomarkers for this purpose is still missing. However, a comprehensive overview on these biomarkers is necessary to understand potential molecular pathways to frailty. We, therefore, performed a mapping review to identify those blood-based biomarkers most consistently associated with frailty in community-dwelling older adults as well as possible analytical gaps according to the available literature. A proposed weighted correlation index (CI) describing the direction and consistency of the association considering the number of available publications as well as the size of the study populations was calculated for each biomarker. Overall, 72 manuscripts were critically reviewed reporting on a total of 82 biomarkers. The most consistent positive association with at least 3 articles addressing the respective biomarker in unadjusted and fully adjusted models was shown for interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), neopterin, white blood cells count, glycated hemoglobin A1c (HbA1c) and sex hormone binding-globuline (SHBG) with a CI ≥ 0.7, while for negative association hemoglobin, 25-hydroxy vitamin D, free testosterone in men and albumin with a CI ≤ -0.7 were identified.

Immunological biomarkers of aging

The immune system has long been recognized for its critical role in the elimination of pathogens and the development of autoimmune diseases, but recent evidence demonstrates that it also contributes to noncommunicable diseases associated with biological aging processes, such as cancer, cardiovascular disease, neurodegeneration, and frailty. This review examines immunological biomarkers of aging, focusing on how the immune system evolves with age and its impact on health and disease. It discusses the historical development of immunological assessments, technological advancements, and the creation of novel biomarkers and models to study immune aging. We also explore the clinical implications of immune aging, such as increased susceptibility to infectious diseases, poor vaccine responses, and a higher incidence of noncommunicable diseases. In summary, we provide a comprehensive overview of current research, highlight the clinical relevance of immune aging, and identify gaps in knowledge that require further investigation.