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Maestri A, Garagnani P, Pedrelli M, Hagberg CE, Parini P, Ehrenborg E. Lipid droplets, autophagy, and ageing: A cell-specific tale. Ageing Res Rev 2024; 94:102194. [PMID: 38218464 DOI: 10.1016/j.arr.2024.102194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
Lipid droplets are the essential organelle for storing lipids in a cell. Within the variety of the human body, different cells store, utilize and release lipids in different ways, depending on their intrinsic function. However, these differences are not well characterized and, especially in the context of ageing, represent a key factor for cardiometabolic diseases. Whole body lipid homeostasis is a central interest in the field of cardiometabolic diseases. In this review we characterize lipid droplets and their utilization via autophagy and describe their diverse fate in three cells types central in cardiometabolic dysfunctions: adipocytes, hepatocytes, and macrophages.
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Affiliation(s)
- Alice Maestri
- Division of Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Garagnani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Pedrelli
- Cardio Metabolic Unit, Department of Laboratory Medicine, and Department of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden; Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Carolina E Hagberg
- Division of Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Parini
- Cardio Metabolic Unit, Department of Laboratory Medicine, and Department of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden; Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Ehrenborg
- Division of Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
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2
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De Simone P, Battistella S, Lai Q, Ducci J, D'Arcangelo F, Marchetti P, Russo FP, Burra P. Immunosuppression for older liver transplant recipients. Transplant Rev (Orlando) 2024; 38:100817. [PMID: 38128152 DOI: 10.1016/j.trre.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
Older liver transplant recipients have a lower risk of acute rejection than younger patients (9% for patients aged ≥65 years versus 23% for those aged 18-34 years) and are more vulnerable to immunosuppression-related complications. The number of liver transplant recipients ≥65 years has risen to 22% in Europe and the US, but limited information is available on the optimal immunosuppressive regimen for these patients. In this review, we discuss the appropriate management of immunosuppressive agents in older adults to minimize adverse events while avoiding acute rejection. The way the body processes drugs greatly depends on age. In the case of calcineurin inhibitor drugs, aging reduces hepatic metabolism, leading to changes in their pharmacokinetics. Corticosteroids also show decreased clearance as the patient ages. In severe cases of hypoalbuminemia, dose adjustment of mycophenolate acid derivatives may be necessary. However, the pharmacokinetic profiles of the mammalian target of rapamycin inhibitors, basiliximab, and rabbit anti-thymocyte globulin remain unaffected by age. Furthermore, age-related frailty may impact drug metabolism and require tailored interventions and closer follow-up. Although there is limited research, elderly liver transplant recipients require less immunosuppression with double or triple-agent regimens, lower exposure to calcineurin inhibitors, and a shorter course of corticosteroids. The usage of mammalian target of rapamycin inhibitors in older transplant populations has not been specifically investigated, and thus their usage should align with indications for younger patient groups.
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Affiliation(s)
- Paolo De Simone
- Liver Transplant Program, University of Pisa Medical School Hospital, Pisa, Italy; Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Italy.
| | - Sara Battistella
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, La Sapienza University of Rome, Italy
| | - Juri Ducci
- Liver Transplant Program, University of Pisa Medical School Hospital, Pisa, Italy
| | - Francesca D'Arcangelo
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Piero Marchetti
- Diabetology Unit, University of Pisa Medical School Hospital, Pisa, Italy
| | - Francesco Paolo Russo
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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3
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Bousquet A, Sanderson K, O’Shea TM, Fry RC. Accelerated Aging and the Life Course of Individuals Born Preterm. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1683. [PMID: 37892346 PMCID: PMC10605448 DOI: 10.3390/children10101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Individuals born preterm have shorter lifespans and elevated rates of chronic illness that contribute to mortality risk when compared to individuals born at term. Emerging evidence suggests that individuals born preterm or of low birthweight also exhibit physiologic and cellular biomarkers of accelerated aging. It is unclear whether, and to what extent, accelerated aging contributes to a higher risk of chronic illness and mortality among individuals born preterm. Here, we review accelerated aging phenotypes in adults born preterm and biological pathways that appear to contribute to accelerated aging. We highlight biomarkers of accelerated aging and various resiliency factors, including both pharmacologic and non-pharmacologic factors, that might buffer the propensity for accelerated aging among individuals born preterm.
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Affiliation(s)
- Audrey Bousquet
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (A.B.); (R.C.F.)
| | - Keia Sanderson
- Department of Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - T. Michael O’Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (A.B.); (R.C.F.)
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4
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Thompson LA, Chen H. Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update. Clin Geriatr Med 2023; 39:225-234. [PMID: 37045530 DOI: 10.1016/j.cger.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.
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Affiliation(s)
- Lisa A Thompson
- Geriatric Dental Fellowship, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Helen Chen
- Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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5
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Farrell B, Raman-Wilms L, Sadowski CA, Mallery L, Turner J, Gagnon C, Cole M, Grill A, Isenor JE, Mangin D, McCarthy LM, Schuster B, Sirois C, Sun W, Upshur R. A Proposed Curricular Framework for an Interprofessional Approach to Deprescribing. MEDICAL SCIENCE EDUCATOR 2023; 33:551-567. [PMID: 37261023 PMCID: PMC10226933 DOI: 10.1007/s40670-022-01704-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/02/2023]
Abstract
Deprescribing involves reducing or stopping medications that are causing more harm than good or are no longer needed. It is an important approach to managing polypharmacy, yet healthcare professionals identify many barriers. We present a proposed pre-licensure competency framework that describes essential knowledge, teaching strategies, and assessment protocols to promote interprofessional deprescribing skills. The framework considers how to involve patients and care partners in deprescribing decisions. An action plan and example curriculum mapping exercise are included to help educators assess their curricula, and select and implement these concepts and strategies within their programs to ensure learners graduate with competencies to manage increasingly complex medication regimens as people age. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01704-9.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8 Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON Canada
| | - Lalitha Raman-Wilms
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
- Centre On Aging, Winnipeg, MB Canada
| | - Cheryl A. Sadowski
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB Canada
| | - Laurie Mallery
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Justin Turner
- Faculty of Pharmacy, University of Montreal, Montreal, QC Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia
| | - Camille Gagnon
- Canadian Deprescribing Network, Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC Canada
| | - Mollie Cole
- Canadian Gerontological Nursing Association, Calgary, AB Canada
| | - Allan Grill
- Dept. of Family & Community Medicine, University of Toronto, Toronto, ON Canada
- Markham Family Health Team, Markham, ON Canada
- Ontario Renal Network, Toronto, Canada
| | - Jennifer E. Isenor
- College of Pharmacy, Faculty of Health and Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Dee Mangin
- David Braley & Nancy Gordon Chair in Family Medicine, Department of Family Medicine, McMaster University, Hamilton, ON Canada
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Lisa M. McCarthy
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8 Canada
- School of Pharmacy, University of Waterloo, Waterloo, ON Canada
- Institute for Better Health and Pharmacy Department, Trillium Health Partners, Mississauga, ON Canada
- Leslie Dan Faculty of Pharmacy & Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
- Women’s College Research Institute, Toronto, ON Canada
| | - Brenda Schuster
- College of Medicine (Regina Campus), University of Saskatchewan, Regina, Saskachewan Canada
| | - Caroline Sirois
- Centre d’excellence Sur Le Vieillissement de Québec & VITAM - Research Centre On Sustainable Health, Québec, Canada
- Faculty of Pharmacy, Université Laval, Québec, Canada
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Bridgepoint Collaboratory for Research and Innovation, Toronto, ON Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, ON Canada
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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6
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Soraci L, Cherubini A, Paoletti L, Filippelli G, Luciani F, Laganà P, Gambuzza ME, Filicetti E, Corsonello A, Lattanzio F. Safety and Tolerability of Antimicrobial Agents in the Older Patient. Drugs Aging 2023; 40:499-526. [PMID: 36976501 PMCID: PMC10043546 DOI: 10.1007/s40266-023-01019-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug-drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.
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Affiliation(s)
- Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA, 87100, Cosenza, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Luca Paoletti
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Filippo Luciani
- Infectious Diseases Unit of Annunziata Hospital, Cosenza, Italy
| | - Pasqualina Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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7
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Yang E, Lv Y, Wang Z, Wang D, Li Y, Sun Y, Zhang Y, Niu J, Chen Z, Liu W, Hu X. Coagulation status and determinants of possible aspirin resistance in patients with essential thrombocythemia. Front Med (Lausanne) 2022; 9:1092281. [PMID: 36606056 PMCID: PMC9808044 DOI: 10.3389/fmed.2022.1092281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives The currently recommended aspirin regimen appears inadequate for thromboprophylaxis in essential thrombocythemia (ET). This study aimed not only to evaluate the curative effect of aspirin but also to explore the coagulation status and determinants of aspirin resistance (AR) of ET patients. Methods A total of 80 ET patients who underwent coagulation tests, thromboelastography (TEG), and next-generation sequencing (NGS) were involved in the study. Patients were divided into the aspirin sensitivity (AS) group and AR group according to the arachidonic acid inhibition rate. Their clinical features and coagulation function were analyzed. Results The incidence of AR was 53.75% (43/80) in 80 ET patients. Fbg was significantly higher in coagulation tests in AR patients compared with AS patients (P < 0.05), while the differences in other variables (D-D, PT, PTA, INR, APTT, TT, FDP, and AT-III) were not statistically significant (P > 0.05). Compared with AS patients, the K values, α angles, MA values, and CI values of TEG in AR patients were statistically smaller (P < 0.05), but there was no significant difference in R value between them (P > 0.05). Univariate and multivariate logistic regression analysis showed that age, irregular use of aspirin, smoking, dyslipidemia, and hypertension increased the risk of AR (P < 0.05). In the routine NGS, the driver gene and non-driver gene had no effect on AR in ET patients. Conclusion Compared with AS patients, AR patients have enhanced platelet aggregation function, are in a relatively hypercoagulable state, and haveelevated fibrinogen function/levels, all of which cause a worse coagulation status. ET patients with increasing age, irregular use of aspirin, smoking, dyslipidemia, and hypertension are possibly at higher risk of AR. The routine NGS may not be helpful for the prediction of AR, therefore we recommend adding relevant drug-resistance genes to NGS.
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Affiliation(s)
- Erpeng Yang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Lv
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziqing Wang
- Xiyuan Clinical Medical College, Beijing University of Traditional Medicine, Beijing, China
| | - Dehao Wang
- Xiyuan Clinical Medical College, Beijing University of Traditional Medicine, Beijing, China
| | - Yumeng Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Sun
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyu Zhang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jicong Niu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhuo Chen
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiyi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,*Correspondence: Weiyi Liu,
| | - Xiaomei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Xiaomei Hu,
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8
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An Update on Usage of High-Risk Donors in Liver Transplantation. J Clin Med 2021; 11:jcm11010215. [PMID: 35011956 PMCID: PMC8746244 DOI: 10.3390/jcm11010215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/01/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
The ideal management for end stage liver disease, acute liver failure, and hepatocellular carcinoma (HCC), within specific criteria, is liver transplantation (LT). Over the years, there has been a steady increase in the candidates listed for LT, without a corresponding increase in the donor pool. Therefore, due to organ shortage, it has been substantially difficult to reduce waitlist mortality among patients awaiting LT. Thus, marginal donors such as elderly donors, steatotic donors, split liver, and donors after cardiac death (DCD), which were once not commonly used, are now considered. Furthermore, it is encouraging to see the passing of Acts, such as the HIV Organ Policy Equity (HOPE) Act, enabling further research and development in utilizing HIV grafts. Subsequently, the newer antivirals have aided in successful post-transplant period, especially for hepatitis C positive grafts. However, currently, there is no standardization, and protocols are center specific in the usage of marginal donors. Therefore, studies with longer follow ups are required to standardize its use.
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9
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Wang RR, Gu HQ, Wei YY, Yang JX, Hou YX, Liu HM, Yang ZY, Wang XB, Jiang YY. Development and Validation of a Prognostic Model for One-year Survival of Cirrhosis Patients with First-ever Spontaneous Bacterial Peritonitis. J Clin Transl Hepatol 2021; 9:647-654. [PMID: 34722179 PMCID: PMC8516845 DOI: 10.14218/jcth.2021.00031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Spontaneous bacterial peritonitis (SBP) is one of the leading causes of death in patients with liver cirrhosis. We aimed to establish a prognostic model to evaluate the 1-year survival of cirrhosis patients after the first episode of SBP. METHODS A prognostic model was developed based on a retrospective derivation cohort of 309 cirrhosis patients with first-ever SBP and was validated in a separate validation cohort of 141 patients. We used Uno's concordance, calibration curve, and decision curve (DCA) analysis to evaluate the discrimination, calibration, and clinical net benefit of the model. RESULTS A total of 59 (19.1%) patients in the derivation cohort and 42 (29.8%) patients in the validation cohort died over the course of 1 year. A prognostic model in nomogram form was developed with predictors including age [hazard ratio (HR): 1.25; 95% confidence interval (CI): 0.92-1.71], total serum bilirubin (HR: 1.66; 95% CI: 1.28-2.14), serum sodium (HR: 0.94; 95% CI: 0.90-0.98), history of hypertension (HR: 2.52; 95% CI: 1.44-4.41) and hepatic encephalopathy (HR: 2.06; 95% CI: 1.13-3.73). The nomogram had a higher concordance (0.79) compared with the model end-stage liver disease (0.67) or Child-Turcotte-Pugh (0.71) score. The nomogram also showed acceptable calibration (calibration slope, 1.12; Bier score, 0.15±0.21) and optimal clinical net benefit in the validation cohort. CONCLUSIONS This prediction model developed based on characteristics of first-ever SBP patients may benefit the prediction of patients' 1-year survival.
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Affiliation(s)
- Rui-Rui Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Ying Wei
- The first Clinical School, Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Xiang Yang
- Department of Gastroenterology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Yi-Xin Hou
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hui-Min Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Yun Yang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xian-Bo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yu-Yong Jiang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Correspondence to: Yu-Yong Jiang, Beijing Diantan Hospital, Capital Medical University, Beijing 100015, China. ORCID: https://orcid.org/0000-0002-6082-1180. Tel: +86-13552175162, E-mail:
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10
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Wáng YXJ. Gender-specific liver aging and magnetic resonance imaging. Quant Imaging Med Surg 2021; 11:2893-2904. [PMID: 34249621 DOI: 10.21037/qims-21-227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 12/14/2022]
Abstract
The number of imaging studies performed on elderly individuals will increase in the next several decades. It is important to understand normal age-related changes in the structural and functional imaging appearance of the liver. This article highlights a number of liver aging aspects which are particularly relevant to magnetic resonance imaging (MRI). Physiology of aging liver is associated with a reduction in size, in perfusion, and in function. Pulsed echo-Doppler showed substantial reduction of portal flow in elderly subjects, particularly those after the age of 75 years old. An MRI biomarker diffusion derived vessel density (DDVD) demonstrated that liver microperfusion volume in healthy females starts to decrease even before menopause age. Liver fat content and iron content increase with aging, and the change is more substantial in women after menopause. Adult men have higher liver fat and iron contents than women from the start and change less during aging. Nonalcoholic fatty liver disease (NAFLD) is very common among assumed healthy subjects. There is a male predominance of NAFLD from the paediatric population up to fifth decade of life in adults. After the age of 60 years, women overtake their male counterparts in prevalence of NAFLD. Higher liver fat leads to decreased apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM)-Dslow measures. Higher liver iron content shortens T2* measure, lower ADC and IVIM-Dslow measures, increases imaging noises and decreases liver visibility. Young women have high liver T1rho value and then decrease substantially, while liver T1rho in men remains relatively unchanged with aging. In positron emission tomography (PET) studies, aging is associated with an increase of both liver fluorine-18-fluorodeoxyglucose maximum standard uptake and mean standard uptake values.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
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11
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Wáng YXJ. Mutual constraining of slow component and fast component measures: some observations in liver IVIM imaging. Quant Imaging Med Surg 2021; 11:2879-2887. [PMID: 34079748 DOI: 10.21037/qims-21-187] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Cheungpasitporn W, Lentine KL, Tan JC, Kaufmann M, Caliskan Y, Bunnapradist S, Lam NN, Schnitzler M, Axelrod DA. Immunosuppression Considerations for Older Kidney Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2021; 8:100-110. [PMID: 34211822 PMCID: PMC8244945 DOI: 10.1007/s40472-021-00321-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW While kidney transplantation improves the long-term survival of the majority of patients with end-stage kidney disease (ESKD), age-related immune dysfunction and associated comorbidities make older transplant recipients more susceptible to complications related to immunosuppression. In this review, we discuss appropriate management of immunosuppressive agents in older adults to minimize adverse events, avoid acute rejection, and maximize patient and graft survival. RECENT FINDINGS Physiological changes associated with senescence can impact drug metabolism and increase the risk of posttransplant infection and malignancy. Clinical trials assessing the safety and efficacy of immunosuppressive agents in older adults are lacking. Recent findings from U.S. transplant registry-based studies suggest that risk-adjusted death-censored graft failure is higher among older patients who received antimetabolite avoidance, mammalian target of rapamycin inhibitor (mTORi)-based, and cyclosporine-based regimens. Observational data suggest that risk-adjusted mortality may be increased in older patients who receive mTORi-based and cyclosporine-based regimens but lower in those managed with T-cell induction and maintenance steroid avoidance/withdrawal. SUMMARY Tailored immunosuppression management to improve patient and graft survival in older transplant recipients is an important goal of personalized medicine. Lower intensity immunosuppression, such as steroid-sparing regimens, appear beneficial whereas mTORi- and cyclosporine-based maintenance are associated with greater potential for adverse effects. Prospective clinical trials to assess the safety and efficacy of immunosuppression agents in older recipients are urgently needed.
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Huang H, Zheng CJ, Wang LF, Che-Nordin N, Wáng YXJ. Age and gender dependence of liver diffusion parameters and the possibility that intravoxel incoherent motion modeling of the perfusion component is constrained by the diffusion component. NMR IN BIOMEDICINE 2021; 34:e4449. [PMID: 33354829 DOI: 10.1002/nbm.4449] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
The aim of this study was to establish reference values for middle-aged subjects and to investigate the age and gender dependence of liver diffusion MRI parameters. The IVIM type of liver diffusion scan was based on a single-shot spin-echo-type echo-planar sequence using a 1.5 T magnet with 16 b-values. Diffusion-derived vessel density (DDVD)(b0b2) or DDVD(b0b10) was the signal difference between b = 0 and b = 2 (or b = 10) s/mm2 images after removing visible vessels. IVIM analysis was performed with full fitting and segmented fitting, and with a threshold b-value of 60 or 200 s/mm2 , and fitting started from b = 2 s/mm2 . Thirty-one men (age range: 25-71 years) and 26 men (age: 22-69 years) had DDVD and IVIM analysis, respectively, while 37 women (age: 20-71 years) and 36 women (age: 20-71 years) had DDVD and IVIM analysis, respectively. DDVD results showed a significant age-related reduction for women. IVIM results for full fitting showed excellent agreement with those for segmented fitting using a threshold b of 60 s/mm2 , but this was less good for results with a threshold b of 200 s/mm2 . As age increased, female subjects' Dslow measure showed a significant reduction, while their PF and Dfast measures showed a significant increase. For the age group of 40-55 years, DDVD(b0b2), DDVD(b0b10), Dslow , PF and Dfast were 12.26 ± 3.90 au/pixel, 16.95 ± 5.45 au/pixel, 1.072 ± 0.067 (10-3 mm2 /s), 0.141 ± 0.025 and 61.0 ± 14.0 (10-3 mm2 /s) for men, and 13.35 ± 3.6 au/pixel, 17.20 ± 3.62 au/pixel, 1.069 ± 0.074 (10-3 mm2 /s), 0.119 ± 0.014 and 57.1 ± 13.2 (10-3 mm2 /s) for women, respectively. DDVD measure of this study suggest that aging is associated with a reduction in liver perfusion. There is a possibility that a lower Dslow measure is associated with artificially higher PF and Dfast measures, and that IVIM modeling of the perfusion component is constrained by the diffusion component.
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Affiliation(s)
- Hua Huang
- Department of Radiology, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, Guangdong Province, China
| | - Cun-Jing Zheng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Li-Fei Wang
- Department of Radiology, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, Guangdong Province, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Thompson LA, Chen H. Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update. Dent Clin North Am 2021; 65:275-284. [PMID: 33641753 DOI: 10.1016/j.cden.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.
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Affiliation(s)
- Lisa A Thompson
- Geriatric Dental Fellowship, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Helen Chen
- Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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15
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Li D, Song Y, Wang Y, Guo Y, Zhang Z, Yang G, Wang G, Xu C. Nos2 deficiency enhances carbon tetrachloride-induced liver injury in aged mice. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 23:600-605. [PMID: 32742597 PMCID: PMC7374991 DOI: 10.22038/ijbms.2020.39528.9380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective(s): As a multifunctional molecule, NO has different effects on liver injury. The present work aimed to investigate the effects of Nos2 knockout (KO) on acute liver injury in aged mice treated with carbon tetrachloride (CCl4). Materials and Methods: The acute liver injury model was produced by CCl4 at 10 ml/kg body weight in 24-month-old Nos2 KO mice and wild type (WT) mice groups. The histological changes, transaminase and glutathione (GSH) contents, and the expressions of liver function genes superoxide dismutase (SOD2) and butyrylcholinesterase (BCHE), as well as apoptosis- and inflammation-associated genes were detected at 0, 6, 16, 20, 28, and 48 hr, respectively. Results: Compared with WT aged mice, there are more fat droplets in liver tissues of Nos2 KO aged mice, and the serum levels of ALT and AST were elevated in the KO group; in addition, there was a decrease in the expression of SOD2 and BCHE and GSH content at multiple time-points. Furthermore, the expression of apoptosis protein CASPASE-3 was elevated from 20 to 48 hr, the same as CASPASE-9 at 28 and 48 hr and pro-apoptotic protein BAX at 6 and 28 hr, while the expression of apoptosis inhibitory protein BCL2 declined at 6 and 28 hr; at the same time the mRNA expressions of genes related to inflammation were increased at different extents in liver extracts of Nos2 KO aged mice. Conclusion: Nos2 KO exacerbated liver injury probably by elevated oxidative stress, apoptosis and inflammation response in CCl4-induced aged mice liver intoxication model.
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Affiliation(s)
- Deming Li
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Yaping Song
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Yahao Wang
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Yuedong Guo
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Zhaoke Zhang
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Ganggang Yang
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Gaiping Wang
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
| | - Cunshuan Xu
- State Key Laboratory Cell Differentiation and Regulation, Xinxiang, Henan, China.,Henan International Joint Laboratory of Pulmonary Fibrosis.,Henan center for outstanding overseas scientists of pulmonary fibrosis, Xinxiang, Henan, China.,College of Life Science, Xinxiang, Henan, China.,Institute of Biomedical Science, Xinxiang, Henan, China.,Overseas Expertise Introduction Center for Discipline Innovation of Pulmonary Fibrosis (111 Project), Henan Normal University, Xinxiang, Henan, China
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Dickson KM, Martins PN. Implications of liver donor age on ischemia reperfusion injury and clinical outcomes. Transplant Rev (Orlando) 2020; 34:100549. [PMID: 32498978 DOI: 10.1016/j.trre.2020.100549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
The aging process causes detrimental changes in a variety of organ systems. These changes include: lesser ability to cope with stress, impaired repair mechanisms and decreased cellular functional reserve capacity. Not surprisingly, aging has been associated with increased susceptibility of donor heart and kidneys grafts to ischemia reperfusion injury (IRI). In the context of liver transplantation, however, the effect of donor age seems to be less influential in predisposing the graft to IRI. In fact, a widely comprehensive understanding of IRI in the aged liver has yet to be agreed upon in the literature. Nevertheless, there have been many reported implications of increased liver donor age with poor clinical outcomes besides IRI. These other poor outcomes include: earlier HCV recurrence, increased rates of acute rejection and greater resistance to tolerance induction. While these other correlations have been identified, it is important to re-emphasize the fact that a unified consensus in regard to liver donor age and IRI has not yet been reached among researchers in this field. Many researchers have even demonstrated that the extent of IRI in aged livers can be ameliorated by careful donor selection, strict allocation or novel therapeutic modalities to decrease IRI. Thus, the goals of this review paper are twofold: 1) To delineate and summarize the conflicting data in regard to liver donor age and IRI. 2) Suggest that careful donor selection, appropriate allocation and strategic effort to minimize IRI can reduce the frequency of a variety of poor outcomes with aged liver donations.
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Affiliation(s)
- Kevin M Dickson
- Department of Surgery, Division of Transplantation, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01605, USA.
| | - Paulo N Martins
- Department of Surgery, Division of Transplantation, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01605, USA.
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17
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Abstract
Elderly patients are the main users of drugs and they differ from younger patients. They are a heterogeneous population that cannot be defined only by age but should rather be stratified based on their frailty. The elderly have distinctive pharmacokinetic and pharmacodynamic characteristics, are frequently polymorbid, and are therefore treated with multiple drugs. They may experience adverse reactions that are difficult to recognize, since some of them present non-specific symptoms easily mistaken for geriatric conditions. Paradoxically, the elderly are underrepresented in clinical trials, especially the frail individuals whose pharmacological response and expected treatment outcome can be different from those of non-frail patients. This means that the benefit-risk balance of drugs used in frail elderly patients is frequently unknown. We present some proposals to overcome the barriers preventing the enrollment of frail elderly patients in clinical trials, and strategies for monitoring their therapy to minimize the risk of adverse reactions. Automated alerts for drug and drug-disease interactions could help appropriate prescribing but should flag only clinically relevant interactions. Pharmaceutical forms should be designed to allow easy dose adjustment and, together with packaging and labeling, should account for the physical and cognitive limitations of frail elderly patients. Aggregate pharmacovigilance reports should summarize the safety profile in the elderly, but rather than presenting the results by age they should focus on patients' frailty, perhaps using the number of comorbidities as a proxy when information on frailty is not available.
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18
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D'Errico A, Riefolo M, Serenari M, De Pace V, Santandrea G, Monica M, de Cillia C, Ravaioli M, Cescon M, Vasuri F. The histological assessment of liver fibrosis in grafts from extended criteria donors predicts the outcome after liver transplantation: A retrospective study. Dig Liver Dis 2020; 52:185-189. [PMID: 31155489 DOI: 10.1016/j.dld.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/07/2019] [Accepted: 05/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of extended criteria donors (ECD) in liver transplantation is increasing due to the organ shortage. Histological evaluation of the liver graft in the context of procurement is an important tool for extending the donor pool without affecting the quality of the transplanted organs. Macrovesicular steatosis is widely accepted as predictor of early allograft dysfunction (EAD), while other features, such as portal fibrosis, are poorly studied. AIM To identify morphological features, other than macrovesicular steatosis, that may affect recipients' outcome. METHODS Between 2014 and 2016, 132 donors with extended criteria underwent pre-transplant liver biopsy during procurement. Histological variables of the graft, donors'/recipients' clinical data, EAD and patient/graft survival were registered. RESULTS The recipients who received a graft with histological-proven portal fibrosis had a significant lower patient and graft survival in comparison to patients without fibrosis (P = 0.044 and P = 0.039, respectively). Donors' dyslipidemia was significantly associated with the occurrence of EAD (P = 0.021). When dyslipidemia was combined with histological liver fibrosis a 54.5% incidence of EAD was observed (P = 0.012). CONCLUSIONS The histological assessment of liver fibrosis in pre-transplant biopsy of ECD grafts, together with donor's clinical data, provides important information on recipients' outcome.
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Affiliation(s)
- Antonia D'Errico
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Mattia Riefolo
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Serenari
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Vanessa De Pace
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Melissa Monica
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Carlo de Cillia
- Regional Transplant Center, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Ravaioli
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Cescon
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
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19
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Senescence and the Impact on Biodistribution of Different Nanosystems: the Discrepancy on Tissue Deposition of Graphene Quantum Dots, Polycaprolactone Nanoparticle and Magnetic Mesoporous Silica Nanoparticles in Young and Elder Animals. Pharm Res 2020; 37:40. [PMID: 31970499 DOI: 10.1007/s11095-019-2754-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022]
Abstract
PURPOSES Senescence is an inevitable and irreversible process, which may lead to loss in muscle and bone density, decline in brain volume and loss in renal clearance. Although aging is a well-known process, few studies on the consumption of nanodrugs by elderly people were performed. METHODS We evaluated three different nanosystems: i) carbon based nanosystem (Graphene Quantum Dots, GQD), ii) polymeric nanoparticles and mesoporous silica (magnetic core mesoporous silica, MMSN). In previous studies, our group has already characterized GQD and MMSN nanoparticles by dynamic light scattering analysis, atomic force microscopy, transmission electron microscopy, X-ray diffraction, Raman analysis, fluorescence and absorbance. The polymeric nanoparticle has been characterized by AFM and DLS. All the nanosystems were radiolabeled with 99 m-Tc by. The in vivo biodistribution/tissue deposition analysis evaluation was done using elder (PN270) and young (PN90) mice injected with radioactive nanosystems. RESULTS The nanosystems used in this study were well-formed as the radiolabeling processes were stable. Biodistribution analysis showed that there is a decrease in the uptake of the nanoparticles in elder mice when compared to young mice, showing that is necessary to increase the initial dose in elder people to achieve the same concentration when compared to young animals. CONCLUSION The discrepancy on tissue distribution of nanosystems between young and elder individuals must be monitored, as the therapeutic effect will be different in the groups. Noteworthy, this data is an alarm that some specific conditions must be evaluated before commercialization of nano-drugs. Graphical Abstract Changes between younger and elderly individuals are undoubtedly, especially in drug tissue deposition, biodistribution and pharmacokinetics. The same thought should be applied to nanoparticles. A comprehensive analysis on how age discrepancy change the biological behavior of nanoparticles has been performed.
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20
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Magidson PD, Thoburn AK, Hogan TM. Emergency Orthogeriatrics: Concepts and Therapeutic Considerations for the Geriatric Patient. Emerg Med Clin North Am 2019; 38:15-29. [PMID: 31757248 DOI: 10.1016/j.emc.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Appropriate recognition of the physiologic, psychological, and clinical differences among geriatric patients, with respect to orthopedic injury and disease, is paramount for all emergency medicine providers to ensure they are providing high-value care for this vulnerable population.
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Affiliation(s)
- Phillip D Magidson
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A1 East Suite 150, Baltimore, MD 21224, USA.
| | - Allison K Thoburn
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA
| | - Teresita M Hogan
- Department of Medicine, Division of Emergency Medicine, University of Chicago School of Medicine, 5841 South Maryland Avenue, MC 6098, Chicago, IL 60637, USA
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21
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Lazzeri C, Bonizzoli M, Ghinolfi D, De Simone P, Pezzati D, Rreka E, Bombardi M, Migliaccio ML, Peris A. Comorbidities and Age in Brain-Dead Donors and Liver Transplantation: A 15-Year Retrospective Investigation. EXP CLIN TRANSPLANT 2019; 18:60-64. [PMID: 31724921 DOI: 10.6002/ect.2019.0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Although livers from older donors (> 70 y) have been shown to be increasingly more efficiently used for transplant, donor comorbidities are considered additional risk factors. This is quite intriguing as comorbidities are known to increase with advancing age in the donor population. MATERIALS AND METHODS We assessed whether age and donor comorbidities influenced liver procurement over a 15-year period in a cohort of 1702 brain-dead donors in Tuscany, Italy. RESULTS Over the study period, age of potential donors significantly increased (P = .02) as well as the proportion of patients who were > 55 years old. The incidence of hypertension, diabetes mellitus, and previously known coronary artery disease also significantly increased. We observed a progressive increase in the number of transplanted livers from donors with advancing age despite an increase in comorbidities. The highest incidences of traumatic brain injury and anoxic brain injury were observed in the youngest donors. Transaminase levels and use of vasoactive drugs were lower in donors who were ≥ 72 years old. CONCLUSIONS According to our results, criteria for liver donors have already changed. Although age does not seem to be a limiting factor, older donors deserve a more accurate donor selection due to the higher incidence of risk factors (primarily diabetes mellitus).
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Affiliation(s)
- Chiara Lazzeri
- From the Intensive Care Unit and Regional ECMO Referral Centre, Azienda OspedalieroUniversitaria Careggi, Florence, Italy
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22
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Abstract
An aging worldwide population demands that anesthesiologists consider geriatrics a unique subset of patients requiring customization of practice. This article reviews the current literature investigating physiologic changes of the elderly that affect pharmacokinetics and pharmacodynamics. Changes in drug absorption, distribution, metabolism, and excretion are discussed as well as the ultimate effects of medications. Implications for practice regarding specific anesthetic and analgesic drugs are addressed. Despite the immense body of research that contributes to understanding of geriatric pharmacology, elderly patients often are excluded from rigorous research trials, and further scientific investigation to inform best practices for this group of patients is needed.
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Affiliation(s)
- Tate M Andres
- Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN, USA.
| | - Tracy McGrane
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232, USA
| | - Matthew D McEvoy
- Perioperative Consult Service, Division of Multispecialty Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232, USA
| | - Brian F S Allen
- Regional and Acute Pain Medicine Fellowship, Regional and Acute Pain Medicine Service, Division of Multispecialty Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232, USA
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23
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Gao F, Zhang Q, Liu Y, Gong G, Mao D, Gong Z, Li J, Luo X, Li X, Chen G, Li Y, Zhao W, Wan G, Li H, Sun K, Wang X. Nomogram prediction of individual prognosis of patients with acute-on-chronic hepatitis B liver failure. Dig Liver Dis 2019; 51:425-433. [PMID: 30241795 DOI: 10.1016/j.dld.2018.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/07/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The current definitions and etiologies of acute-on-chronic liver failure (ACLF) are clearly very different between East and West. AIMS This study aimed to develop an effective prognostic nomogram for acute-on-chronic hepatitis B liver failure (ACHBLF) as defined by the Asia Pacific Association for the Study of the Liver (APASL). METHODS The nomogram was based on a retrospective study of 573 patients with ACHBLF, defined according to the APASL, at the Beijing Ditan Hospital. The results were validated using a bootstrapped approach to correct for bias in two external cohorts, including an APASL ACHBLF cohort (10 hospitals, N = 329) and an EASL-CLIF ACHBLF cohort (Renji Hospital, N = 300). RESULTS Multivariate analysis of the derivation cohort for survival analysis helped identify the independent factors as age, total bilirubin, albumin, international normalized ratio, and hepatic encephalopathy, which were included in the nomogram. The predictive value of nomogram was the strongest compared with CLIF-C ACLF, MELD and MELD-Na and similar to COSSH-ACLF in both the derivation and prospective validation cohorts with APASL ACHBLF, but the CLIF-C ACLF was better in the EASL-CLIF ACHBLF cohort. CONCLUSIONS The proposed nomogram could accurately estimate individualized risk for the short-term mortality of patients with ACHBLF as defined by APASL.
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Affiliation(s)
- Fangyuan Gao
- Center of Integrative Medicine, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Qianqian Zhang
- Department of Hepatology, The First Hospital Affiliated to Hunan University of Chinese Medicine, Changsha, China
| | - Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Guozhong Gong
- Department of Infectious Diseases, The Second Xiangya Hospital of Center South University, Changsha, China
| | - Dewen Mao
- Department of Hepatology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Zuojiong Gong
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Li
- Center of Integrative Medicine, 302 Military Hospital of China, Beijing, China
| | - Xinla Luo
- Department of Hepatology, Hubei Provincial Hospital of TCM, Wuhuan, China
| | - Xiaoliang Li
- Department of Traditional Chinese Medicine, The Third People Hospital of Shenzhen, Shenzhen, China
| | - Guoliang Chen
- Department of Hepatology, Xiamen Hospital of TCM, Xiamen, China
| | - Yong Li
- Department of Hepatology, Shandong Provincial Hospital of TCM, Jinan, China
| | - Wenxia Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Henan University of TCM, Zhengzhou, China
| | - Gang Wan
- Statistics Room, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Hai Li
- Department of Gastroenterology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Kewei Sun
- Department of Hepatology, The First Hospital Affiliated to Hunan University of Chinese Medicine, Changsha, China.
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital Capital Medical University, Beijing, China.
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24
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Gao F, Li X, Wan G, Li Y, Zhang Q, Liu Y, Liu H, Li H, Wang X. Development and external validation of a prognostic nomogram for acute decompensation of chronic hepatitis B cirrhosis. BMC Gastroenterol 2018; 18:179. [PMID: 30509201 PMCID: PMC6276255 DOI: 10.1186/s12876-018-0911-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute decompensation (AD) has been shown to be associated with a high mortality rate for cirrhosis patients. This study aimed to develop a prognostic nomogram to evaluating the individual prognosis for AD of cirrhosis in chronic hepatitis B (CHB). METHODS The nomogram was developed using data from a retrospective study on 509 patients hospitalized for AD of CHB cirrhosis from October 2008 to February 2014 at the Beijing Ditan Hospital, Capital Medical University. The predictive accuracy, discriminative ability, and clinical net benefit were evaluated by concordance index (C-index), calibration curves, and decision curve analysis (DCA). The results were validated on 620 patients consecutively enrolled from January 2005 to December 2010 at the Renji Hospital, Shanghai Jiao Tong University,. RESULTS On multivariate analysis of the derivation cohort, independent factors included in the nomogram were age, previous decompensation, bacterial infection, hepatic encephalopathy, and total bilirubin. The calibration curve for the probability of survival showed good agreement between the nomogram and actual observation. The nomogram had a C-index of 0.897, which was statistically higher than the C-index values of CTP (0.793), MELD (0.821), SOFA (0.868), or the Chronic Liver Failure Consortium AD (CLIF-C AD) (0.716) scores (p < 0.001 for all). Using DCA, the nomogram also demonstrated superior net benefits over other score models. The results were confirmed in the validation cohort. CONCLUSIONS The proposed nomogram enables more-accurate individualized prediction of survival than MELD, CTP, SOFA, or CLIF-C AD scores for AD of CHB cirrhosis patients.
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Affiliation(s)
- Fangyuan Gao
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoshu Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Statistics Room, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huimin Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hai Li
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
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Stahl EC, Haschak MJ, Popovic B, Brown BN. Macrophages in the Aging Liver and Age-Related Liver Disease. Front Immunol 2018; 9:2795. [PMID: 30555477 PMCID: PMC6284020 DOI: 10.3389/fimmu.2018.02795] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022] Open
Abstract
The number of individuals aged 65 or older is projected to increase globally from 524 million in 2010 to nearly 1. 5 billion in 2050. Aged individuals are particularly at risk for developing chronic illness, while being less able to regenerate healthy tissue and tolerate whole organ transplantation procedures. In the liver, these age-related diseases include non-alcoholic fatty liver disease, alcoholic liver disease, hepatitis, fibrosis, and cirrhosis. Hepatic macrophages, a population comprised of both Kupffer cells and infiltrating monocyte derived macrophages, are implicated in several chronic liver diseases and also play important roles in the homeostatic functions of the liver. The effects of aging on hepatic macrophage population dynamics, polarization, and function are not well understood. Studies performed on macrophages derived from other aged sources, such as the bone marrow, peritoneal cavity, lungs, and brain, demonstrate general reductions in autophagy and phagocytosis, dysfunction in cytokine signaling, and altered morphology and distribution, likely mediated by epigenetic changes and mitochondrial defects, that may be applicable to hepatic macrophages. This review highlights recent findings in macrophage developmental biology and function, particularly in the liver, and discusses the role of macrophages in various age-related liver diseases. A better understanding of the biology of aging that influences hepatic macrophages and thus the progression of chronic liver disease will be crucial in order to develop new interventions and treatments for liver disease in aging populations.
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Affiliation(s)
- Elizabeth C Stahl
- Department of Bioengineering, Pittsburgh Liver Research Center, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Martin J Haschak
- Department of Bioengineering, Pittsburgh Liver Research Center, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Branimir Popovic
- Department of Bioengineering, Pittsburgh Liver Research Center, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bryan N Brown
- Department of Bioengineering, Pittsburgh Liver Research Center, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Khan MS, Roberts MS. Challenges and innovations of drug delivery in older age. Adv Drug Deliv Rev 2018; 135:3-38. [PMID: 30217519 DOI: 10.1016/j.addr.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.
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Romano P, Agena F, de Almeida Rezende Ebner P, Massakazu Sumita N, Kamada Triboni AH, Ramos F, dos Santos Garcia M, Coelho Duarte NJ, Brambate Carvalhinho Lemos F, Zocoler Galante N, David-Neto E. Longitudinal Pharmacokinetics of Mycophenolic Acid in Elderly Renal Transplant Recipients Compared to a Younger Control Group: Data from the nEverOld Trial. Eur J Drug Metab Pharmacokinet 2018; 44:189-199. [DOI: 10.1007/s13318-018-0506-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ni Y, Wu T, Yang L, Xu Y, Ota T, Fu Z. Protective effects of astaxanthin on a combination of D-galactose and jet lag-induced aging model in mice. Endocr J 2018. [PMID: 29526991 DOI: 10.1507/endocrj.ej17-0500] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oxidative stress caused free radical and mitochondrial damage plays a critical role in the progression of aging and age-related damage at the cellular and tissue levels. Antioxidant supplementation has received growing attention and the effects of antioxidant on aging are increasingly assessed in both animal and human studies. However, additional and more promising treatments that contribute to the expansion of anti-aging therapies are needed. Astaxanthin, a super antioxidant carotenoid and free radical scavenger, inhibits lipid peroxidation more potently than vitamin E. In the present study, we investigated the preventative effects of astaxanthin on aging using an accelerated aging model: mice chronically treated with a combination of D-galactose and jet lag. After 6 weeks of treatment, astaxanthin administration tended to protect the liver weight loss in aged mice. It is probably by upregulating the mRNA expression of galactose-1-phosphate uridyltransferase, which contribute to the enhancement of D-galactose metabolism. Astaxanthin supplementation also improved muscle endurance of aged mice in a swimming test. These results were associated with reduced oxidative stress in serum and increased anti-oxidative enzymes activities and mRNA expression in vivo. Moreover, astaxanthin reversed the dysregulation of aging-related gene expression caused by the combination of D-galactose and jet lag in the liver and kidney of mice. In conclusion, astaxanthin prevents liver weight loss, ameliorates locomotive muscular function, exerts significant anti-aging effects by reducing oxidative stress and improving the expression of age-related genes in D-galactose and jet lag-induced aging model.
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Affiliation(s)
- Yinhua Ni
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, China
| | - Tao Wu
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, China
| | - Luna Yang
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, China
| | - Yang Xu
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, China
| | - Tsuguhito Ota
- Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Asahikawa 078-8802, Japan
| | - Zhengwei Fu
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310014, China
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Abstract
As the HIV population continues to live longer as a result of antiretroviral therapy, liver-related mortality has become one of the leading causes of non-AIDS related death in this patient population. The liver possesses a remarkable regenerative capacity but undergoes complex biological changes in response to aging and inflammation that result in decreased cellular regeneration and a tipping of the scales towards fibrogenesis. Patients with HIV infection have serological evidence of ongoing inflammation, with elevations in some biomarkers persisting despite adequate virologic control. In addition, HIV-co-infected patients have markers of advanced age on liver biopsy and increased prevalence of fibrosis as compared to an age-matched HCV mono-infected cohort. In this review, we will discuss the biology of aging, age-related changes in the liver, and the relevant mechanisms by which HIV causes inflammation in the context of accelerated aging, fibrosis of the liver, and other viral co-infection.
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Affiliation(s)
- Austin W Chan
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, 315 Trent Dr, PO Box 102359, Durham, NC, 27710, USA.
| | - Yuval A Patel
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Steve Choi
- Division of Gastroenterology, Durham VA Medical Center, Duke University School of Medicine, Durham, NC, USA
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Angamo MT, Curtain CM, Chalmers L, Yilma D, Bereznicki L. Predictors of adverse drug reaction-related hospitalisation in Southwest Ethiopia: A prospective cross-sectional study. PLoS One 2017; 12:e0186631. [PMID: 29036230 PMCID: PMC5643118 DOI: 10.1371/journal.pone.0186631] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are important causes of morbidity and mortality in the healthcare system; however, there are no studies reporting on the magnitude and risk factors associated with ADR-related hospitalisation in Ethiopia. OBJECTIVES To characterise the reaction types and the drugs implicated in admission to Jimma University Specialized Hospital, Southwest Ethiopia, and to identify risk factors associated with ADR-related hospitalisation. METHODS A prospective cross-sectional study was conducted from May 2015 to August 2016 among consenting patients aged ≥18 years consecutively admitted to medical wards taking at least one medication prior to admission. ADR-related hospitalisations were determined through expert review of medical records, laboratory tests, patient interviews and physical observation. ADR causality was assessed by the Naranjo algorithm followed by consensus review with internal medicine specialist. ADR preventability was assessed using Schumock and Thornton's criteria. Only definite and probable ADRs that provoked hospitalisation were considered. Binary logistic regression was used to identify independent predictors of ADR-related hospitalisation. RESULTS Of 1,001 patients, 103 (10.3%) had ADR-related admissions. Common ADRs responsible for hospitalisation were hepatotoxicity (35, 29.4%) and acute kidney injury (27, 22.7%). The drug classes most frequently implicated were antitubercular agents (45, 25.0%) followed by antivirals (22, 12.2%) and diuretics (19, 10.6%). Independent predictors of ADR-related hospitalisation were body mass index (BMI) <18.5 kg/m2 (adjusted odd ratio [AOR] = 1.69; 95% confidence interval [CI] = 1.10-2.62; p = 0.047), pre-existing renal disease (AOR = 2.84; 95%CI = 1.38-5.85, p = 0.004), pre-existing liver disease (AOR = 2.61; 95%CI = 1.38-4.96; p = 0.003), number of comorbidities ≥4 (AOR = 2.09; 95%CI = 1.27-3.44; p = 0.004), number of drugs ≥6 (AOR = 2.02; 95%CI = 1.26-3.25; p = 0.004) and history of previous ADRs (AOR = 24.27; 95%CI = 11.29-52.17; p<0.001). Most ADRs (106, 89.1%) were preventable. CONCLUSIONS ADRs were a common cause of hospitalisation. The majority of ADRs were preventable, highlighting the need for monitoring and review of patients with lower BMI, ADR history, renal and liver diseases, multiple comorbidities and medications. ADR predictors should be integrated into clinical pathways and pharmacovigilance systems.
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Affiliation(s)
- Mulugeta Tarekegn Angamo
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- * E-mail:
| | - Colin Michael Curtain
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leanne Chalmers
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Daniel Yilma
- Department of Internal Medicine, School of Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Luke Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Longitudinal Pharmacokinetics of Tacrolimus in Elderly Compared With Younger Recipients in the First 6 Months After Renal Transplantation. Transplantation 2017; 101:1365-1372. [PMID: 27482958 DOI: 10.1097/tp.0000000000001369] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Elderly (Eld) (≥60 years) recipients are receiving renal transplants more frequently. The pharmacokinetics (PK) studies of immunosuppressive drugs in healthy volunteers, rarely, include old patients. METHODS We studied 208 12-hour tacrolimus (TAC) PK (0, 20, 40, 60, 90, 120, 180, 240, 360, 480, 600, 720 min) in 44 Eld (65 ± 3 years) and compared the results with 31 younger controls (Ctrl) (35 ± 6 years) recipients, taking oral TAC/mycophenolate sodium (MPS)/prednisone, at 4 different timepoints: PK1 (8 ± 2 days; n = 72), PK2 (31 ± 4 days; n = 61), PK3 (63 ± 6 days; n = 44), and PK4 (185 ± 10 days; n = 31). Tacrolimus PK was measured by ultraperformance liquid chromatography coupled to a mass spectrometer repetition and noncompartmental PKs were analyzed using Phoenix WinNonlin. RESULTS Mean TAC dose was lower in the Eld group than in Ctrl ones throughout timepoints either by total daily dose or adjusted (Adj) per body weight. Mean TAC trough level (Cmin), used to adjust daily dose, was not different between the 2 groups in all timepoints. AdjCmax and AdjTAC-area under the curve at dosing interval were both higher in the Eld compared to the Ctrl group in PKs1, 3, and 4. Estimated total body clearance normalized by dose and weight was lower in the Eld group compared with the Ctrl in all PKs and statistically lower at PKs 1 and 3. Similar to younger recipients TAC trough level has also a high correlation (R = 0.76) with area under the curve at dosing interval. CONCLUSIONS These data indicate that Eld recipients have a lower TAC clearance and therefore need a lower TAC dose than younger recipients.
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Gao F, Sun L, Ye X, Liu Y, Liu H, Geng M, Li X, Yang X, Li Y, Wang R, Chen J, Wan G, Jiang Y, Wang X. Development and validation of a prognostic model for acute-on-chronic hepatitis B liver failure. Eur J Gastroenterol Hepatol 2017; 29:669-678. [PMID: 28195876 DOI: 10.1097/meg.0000000000000854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM The CANONIC study proposed the Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C ACLF) prognostic model at the European Association for the Study of the Liver-CLIF diagnosis. This study aimed to develop and validate a prognostic model for predicting the short-term mortality of hepatitis B virus (HBV) ACLF as defined by the Asia-Pacific Association for the Study of the Liver. PATIENTS AND METHODS A retrospective cohort of 381 HBV ACLF patients and a prospective cohort of 192 patients were included in this study. Independent predictors of disease progression were determined using univariate and multivariate Cox proportional hazard regression analysis, and a regression model for predicting prognosis was established. Patient survival was estimated by Kaplan-Meier analysis and subsequently compared by log-rank tests. The area under the receiver operating characteristic curve was used to compare the performance of various current prognostic models. RESULTS Our model was constructed with five independent risk factors: hepatic encephalopathy, international normalized ratio, neutrophil-lymphocyte ratio, age, and total bilirubin, termed as the HINAT ACLF model, which showed the strongest predictive values compared with CLIF-C ACLF, CLIF-C Organ Failure, Sequential Organ Failure Assessment, CLIF-Sequential Organ Failure Assessment, Model for End-stage Liver Disease, Model for End-stage Liver Disease-sodium, and Child-Turcotte-Pugh scores; this model reduced the corresponding prediction error rates at 28 and 90 days by 16.4-54.5% after ACLF diagnosis in both the derivation cohort and the validation cohorts. CONCLUSION The HINAT ACLF model can accurately predict the short-term mortality of patients with HBV ACLF as defined by Asia-Pacific Association for the Study of the Liver.
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Affiliation(s)
- Fangyuan Gao
- aCenter of Integrative Medicine bStatistics Room, Beijing Ditan Hospital, Capital Medical University cDepartment of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Abstract
Mortality rates on the liver transplant waiting list are increasing. The shortage of organs has resulted in higher utilization of extended criteria donors (ECDs), with centers pushing the limits of what is acceptable for transplantation. Donor quality is more appropriately represented as a continuum of risk, and careful selection and matching of ECD grafts with recipients may lead to excellent outcomes. Although there is no precise definition for what constitutes an ECD liver, this review focuses on frequently cited characteristics, including donor age, steatosis, donation after cardiac death, and donors with increased risk of disease transmission.
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Affiliation(s)
- Irine Vodkin
- Division of Gastroenterology and Hepatology, University of California, San Diego, 200 West Arbor Drive M/C 8413, San Diego, CA, USA.
| | - Alexander Kuo
- Division of Gastroenterology and Hepatology, University of California, San Diego, 200 West Arbor Drive M/C 8413, San Diego, CA, USA
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Tanabe Y, Shimizu C, Hamada A, Hashimoto K, Ikeda K, Nishizawa D, Hasegawa J, Shimomura A, Ozaki Y, Tamura N, Yamamoto H, Yunokawa M, Yonemori K, Takano T, Kawabata H, Tamura K, Fujiwara Y. Paclitaxel-induced sensory peripheral neuropathy is associated with an ABCB1 single nucleotide polymorphism and older age in Japanese. Cancer Chemother Pharmacol 2017; 79:1179-1186. [DOI: 10.1007/s00280-017-3314-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/18/2017] [Indexed: 11/29/2022]
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35
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Li D, Li J, Wang G, Qin Y, Niu Z, Li Z, Xu C. Delayed Liver Regeneration after Partial Hepatectomy in Aged Nos2 Knockout Mice. CELL JOURNAL 2017; 19:218-230. [PMID: 28670514 PMCID: PMC5412780 DOI: 10.22074/cellj.2016.4878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 07/25/2016] [Indexed: 01/13/2023]
Abstract
Objective Patients over 60 years of age have higher mortality and morbidity after major
liver resections. Nitric oxide (NO) derived from the catalytic activity of Nos2 plays a beneficial role in liver regeneration (LR) after partial hepatectomy (PH). In this experiment, we
evaluated the effect of Nos2 knockout (KO) on LR in aged mice after PH.
Materials and Methods In this experimental study, 52 two-year-old Nos2 KO and 46 the
same age wild-type (WT) C57BL/6J mice were subjected to 2/3 PH. Liver tissues were
collected at 11 time points after PH. Mice survival ratio and liver coefficient (liver-weight/
body-weight) was calculated. Transcript and protein levels were estimated by reverse
transcriptase-quantitative polymerase chain reaction (RT-qPCR) and Western blot, respectively.
Results The aged Nos2 KO mice had lower survival ratio (P=0.039) and liver coefficient
(P=0.002) at the termination phase. Nos2 transcript level was obviously increased after
PH in WT mice and undetected in the Nos2 KO mice. During LR, the expression at the
transcript level of Cyclin D1, Cyclin A2 and Cyclin B1 and protein expression level of
proliferation marker Ki67 and proliferation-associated transcription factors JNK1, NF-kB
and STAT3 were decreased or delayed. The expression of pro-apoptotic proteins, CASPASE3, CASPASE9 and BAX, was increased in the Nos2 KO mice.
Conclusion Decreased survival ratio and impaired LR in aged Nos2 KO mice is probably
due to decreased liver cell proliferation and increased liver cell apoptosis.
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Affiliation(s)
- Deming Li
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
| | - Jun Li
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
| | - Gaiping Wang
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
| | - Yanli Qin
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
| | - Zhipeng Niu
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
| | - Ziwei Li
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
| | - Cunshuan Xu
- Key Laboratory for Cell Differentiation Regulation, Xinxiang, China.,College of Life Science, Henan Normal University, Xinxiang, China
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Abstract
In the older patient population, rates of Type 2 Diabetes (T2D) and obesity are reaching epidemic proportions. In fact, older patients will soon constitute the majority of patients with T2D in most developed countries. The higher prevalence of T2D in older individuals is seen in both men and women and across racial and ethnic groups. However, certain ethnic groups are disproportionately affected and successful strategies must account for these fundamental differences. T2D in old age is associated with traditional diabetes-associated complications including micro- and macro vascular disease, but is also closely related to numerous other comorbidities including cognitive impairment, urinary incontinence, sarcopenia, and increased fall risk. An overall state of chronic inflammation and dysregulated immune system may underlie these increased risks; yet our understanding of immunometabolism during the aging process remains incomplete. In addition, optimal recognition and treatment of diabetes in the elderly is hampered by a lack of relevant, high-quality studies, as the majority of clinical trial data establishing risk profiles, glycemic targets, and therapeutic interventions for T2D are not applicable for large segments of the older patient population. Simply acknowledging this gap is inadequate. We need strong evidence-based data upon which to successfully identify diabetic patients and then intervene in ways that are targeted to specific individuals within a heterogeneous group of elderly patients with T2D.
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Affiliation(s)
- David Bradley
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
| | - Willa Hsueh
- Department of Internal Medicine, Wexner Medical Center, The Ohio State University, USA
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Antibiothérapie du sujet âgé : On peut toujours mieux faire. Can J Aging 2016; 35:385-92. [DOI: 10.1017/s0714980816000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACTAntimicrobials are among the most prescribed drugs and their prescription increases with age, due to frailty and accrued risk factors for acquiring infections. Antimicrobial prescription in elderly patients must not only account for the risk of toxicity due to drug overexposure, but also of treatment failure or promotion of antimicrobial resistance due to under-dosage. This paper reviews the main antimicrobial, pharmacokinetic and pharmacodynamic variations induced by aging, comorbidities and polypharmacy, and how to take them into account to optimize antimicrobial prescription in elders.
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Nemes B, Gámán G, Polak WG, Gelley F, Hara T, Ono S, Baimakhanov Z, Piros L, Eguchi S. Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors. Expert Rev Gastroenterol Hepatol 2016; 10:827-39. [PMID: 26838962 DOI: 10.1586/17474124.2016.1149061] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The definition and factors of extended criteria donors have already been set; however, details of the various opinions still differ in many respects. In this review, we summarize the impact of these factors and their clinical relevance. Elderly livers must not be allocated for hepatitis C virus (HCV) positives, or patients with acute liver failure. In cases of markedly increased serum transaminases, donor hemodynamics is an essential consideration. A prolonged hypotension of the donor does not always lead to an increase in post-transplantation graft loss if post-OLT care is proper. Hypernatremia of less than 160 mEq/L is not an absolute contraindication to accept a liver graft per se. The presence of steatosis is an independent and determinant risk factor for the outcome. The gold standard of the diagnosis is the biopsy. This is recommended in all doubtful cases. The use of HCV+ grafts for HCV+ recipients is comparable in outcome. The leading risk factor for HCV recurrence is the actual RNA positivity of the donor. The presence of a proper anti-HBs level seems to protect from de novo HBV infection. A favourable outcome can be expected if a donation after cardiac death liver is transplanted in a favourable condition, meaning, a warm ischemia time < 30 minutes, cold ischemia time < 8-10 hours, and donor age 50-60 years. The pathway of organ quality assessment is to obtain the most relevant information (e.g. biopsy), consider the co-existing donor risk factors and the reserve capacity of the recipient, and avoid further technical issues.
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Affiliation(s)
- Balázs Nemes
- a Department of Organ Transplantation, Faculty of Medicine , Institute of Surgery, University of Debrecen , Debrecen , Hungary
| | - György Gámán
- b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Wojciech G Polak
- c Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC , University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fanni Gelley
- d Department of Internal medicine and Gastroenterology , Polyclinic of Hospitallers Brothers of St. John of God , Budapest , Hungary
| | - Takanobu Hara
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Shinichiro Ono
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Zhassulan Baimakhanov
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Laszlo Piros
- b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Susumu Eguchi
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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Yang W, Burkhardt B, Fischer L, Beirow M, Bork N, Wönne EC, Wagner C, Husen B, Zeilinger K, Liu L, Nussler AK. Age-dependent changes of the antioxidant system in rat livers are accompanied by altered MAPK activation and a decline in motor signaling. EXCLI JOURNAL 2015; 14:1273-90. [PMID: 27004051 PMCID: PMC4800781 DOI: 10.17179/excli2015-734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 12/15/2022]
Abstract
Aging is characterized by a progressive decrease of cellular functions, because cells gradually lose their capacity to respond to injury. Increased oxidative stress is considered to be one of the major contributors to age-related changes in all organs including the liver. Our study has focused on elucidating whether important antioxidative enzymes, the mTOR pathway, and MAPKs exhibit age-dependent changes in the liver of rats during aging. We found an age-dependent increase of GSH in the cytosol and mitochondria. The aged liver showed an increased SOD enzyme activity, while the CAT enzyme activity decreased. HO-1 and NOS-2 gene expression was lower in adult rats, but up-regulated in aged rats. Western blot analysis revealed that SOD1, SOD2, GPx, GR, γ-GCL, and GSS were age-dependent up-regulated, while CAT remained constant. We also demonstrated that the phosphorylation of Akt, JNK, p38, and TSC2(Ser1254) decreased while ERK1/2 and TSC2(Thr1462) increased age-dependently. Furthermore, our data show that the mTOR pathway seems to be activated in livers of aged rats, and hence stimulating cell proliferation/regeneration, as confirmed by an age-dependent increase of PCNA and p-eIF4E(Ser209) protein expression. Our data may help to explain the fact that liver cells only proliferate in cases of necessity, like injury and damage. In summary, we have demonstrated that, age-dependent changes of the antioxidant system and stress-related signaling pathways occur in the livers of rats, which may help to better understand organ aging.
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Affiliation(s)
- Wei Yang
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, PR China
| | - Britta Burkhardt
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
| | - Luise Fischer
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
| | - Maja Beirow
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
| | - Nadja Bork
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
| | - Eva C. Wönne
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Campus-Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Cornelia Wagner
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
| | - Bettina Husen
- Pharmacelsus GmbH, Science Park 2, 66123 Saarbrücken, Germany
| | - Katrin Zeilinger
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Campus-Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, PR China
| | - Andreas K. Nussler
- Eberhard Karls University Tübingen, Dept. of Traumatology, Schnarrenbergstr. 95, 72076 Tübingen, Germany
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Gan L, Langenickel T, Petruck J, Kode K, Rajman I, Chandra P, Zhou W, Rebello S, Sunkara G. Effects of age and sex on the pharmacokinetics of LCZ696, an angiotensin receptor neprilysin inhibitor. J Clin Pharmacol 2015; 56:78-86. [DOI: 10.1002/jcph.571] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Lu Gan
- Novartis Institutes for BioMedical Research; Cambridge MA USA
| | | | - Jesika Petruck
- Novartis Institutes for BioMedical Research; Cambridge MA USA
| | - Kiran Kode
- Novartis Healthcare Pvt Ltd; Hyderabad Telangana India
| | - Iris Rajman
- Novartis Institutes for BioMedical Research; Basel Switzerland
| | - Priya Chandra
- Novartis Institutes for BioMedical Research; East Hanover NJ USA
| | - Wei Zhou
- Novartis Institutes for BioMedical Research; East Hanover NJ USA
| | - Sam Rebello
- Novartis Institutes for BioMedical Research; East Hanover NJ USA
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Shi YY, Hesselink DA, van Gelder T. Pharmacokinetics and pharmacodynamics of immunosuppressive drugs in elderly kidney transplant recipients. Transplant Rev (Orlando) 2015; 29:224-30. [PMID: 26048322 DOI: 10.1016/j.trre.2015.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 02/05/2023]
Abstract
Elderly patients are a fast growing population among transplant recipients over the past decades. Both the innate and adaptive immune reactivity decrease with age, which is believed to contribute to the decreased incidence of acute rejection and increased infectious death rate in elderly transplant recipients. In contrast to recipient age, donor age is associated with a higher incidence of acute rejection. Pharmacokinetic studies in renal transplant recipients show that CNI troughs are >5% higher in elderly compared to younger patients given the same dose normalized by body weight. This may impact the starting dose of tacrolimus and cyclosporine. Possibly in elderly patients the intracellular (in lymphocyte) concentrations are relatively high in relation to the whole blood concentration, resulting in a stronger pharmacodynamic effect at the same whole blood trough concentration. For cyclosporine this has been shown, but it is not clear if the same is true for other immunosuppressive drugs. Pharmacodynamic studies have compared the inhibition of target enzymes, or more downstream effects of immunosuppressive drugs, in younger and older patients. Measurement of nuclear factor of activated T-cell (NFAT)-regulated gene expression (RGE), a pharmacodynamic read-out of CNI, is a promising biomarker of immunosuppression. Low levels of NFAT RGE are associated with increased risk of infection and non-melanoma skin cancer in elderly patients. Clinical trials to evaluate the safety and efficacy of immunosuppression regimens in this specific patient population, which is underrepresented in published trials, are lacking. More studies in elderly patients are needed to investigate the impact of age on the pharmacokinetics or pharmacodynamics of immunosuppressive drugs, and to decide on the optimal regimen and target levels for elderly transplant recipients.
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Affiliation(s)
- Yun-Ying Shi
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Dennis A Hesselink
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Teun van Gelder
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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42
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Mangus RS, Fridell JA, Kubal CA, Davis JP, Joseph Tector A. Elevated alanine aminotransferase (ALT) in the deceased donor: impact on early post-transplant liver allograft function. Liver Int 2015; 35:524-31. [PMID: 25756162 DOI: 10.1111/liv.12508] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Serum alanine aminotransferase (ALT) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1-year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. METHODS The on-site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001–2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0–499 μ/L; moderate elevation, 500–999 μ/L (>10× upper limit of normal) and severe elevation, ≥1000 μ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1-year graft and patient survival. RESULTS Distribution of subjects included: normal/mild, 1259 (93%); moderate, 34 (3%) and severe, 55 (4%). Risk of 30-day graft loss for the three study groups was: 72 (6%), 3 (9%) and 3 (6%) (P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87%), 1048 (88%); moderate, 31 (91%), 31 (91%) and severe, 43 (88%), 44 (90%) (P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end-stage liver disease score (MELD) demonstrates no statistically significant difference among the three study groups. CONCLUSIONS This study demonstrates clinical equivalence in early graft function and 1-year graft and patient survival for donor livers with varying peak levels of serum ALT. These donor allografts may, therefore, be utilized successfully.
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Affiliation(s)
- Richard S Mangus
- Transplant Division; Indiana University School of Medicine; Indianapolis Indiana USA
| | - Jonathan A Fridell
- Transplant Division; Indiana University School of Medicine; Indianapolis Indiana USA
| | | | - Jason P Davis
- Transplant Division; Indiana University School of Medicine; Indianapolis Indiana USA
| | - A. Joseph Tector
- Transplant Division; Indiana University School of Medicine; Indianapolis Indiana USA
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43
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Wang K, Jiang WT, Deng YL, Pan C, Shen ZY. Effect of donor age on graft function and long-term survival of recipients undergoing living donor liver transplantation. Hepatobiliary Pancreat Dis Int 2015; 14:50-5. [PMID: 25655290 DOI: 10.1016/s1499-3872(15)60334-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation (LDLT) has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient survival. METHODS All LDLT cases (n=159) were divided into the older (donor age≥50 years, n=10) and younger (donor age<50 years, n=149) donor groups. Donor graft and recipient condition pre-, intra- and post-operation were compared between the two groups. In particular, graft functions and recipient survivals were analyzed. RESULTS The median donor age was 58.5 (52.5-60.0) years in the older donor group and 25.0 (23.0-32.0) in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups (P>0.05). However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group (1900 vs 1200 mL, P=0.023). The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively (P=0.459). The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively (P=0.811). CONCLUSION It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients' survival.
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Affiliation(s)
- Kai Wang
- Department of Transplant Surgery, Tianjin First Center Hospital, Key Laboratory of Organ Transplantation of Tianjin, Tianjin 300192, China.
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Reeve E, Wiese MD, Mangoni AA. Alterations in drug disposition in older adults. Expert Opin Drug Metab Toxicol 2015; 11:491-508. [DOI: 10.1517/17425255.2015.1004310] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tangiisuran B, Scutt G, Stevenson J, Wright J, Onder G, Petrovic M, van der Cammen TJ, Rajkumar C, Davies G. Development and validation of a risk model for predicting adverse drug reactions in older people during hospital stay: Brighton Adverse Drug Reactions Risk (BADRI) model. PLoS One 2014; 9:e111254. [PMID: 25356898 PMCID: PMC4214735 DOI: 10.1371/journal.pone.0111254] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/29/2014] [Indexed: 11/23/2022] Open
Abstract
Background Older patients are at an increased risk of developing adverse drug reactions (ADR). Of particular concern are the oldest old, which constitute an increasingly growing population. Having a validated clinical tool to identify those older patients at risk of developing an ADR during hospital stay would enable healthcare staff to put measures in place to reduce the risk of such an event developing. The current study aimed to (1) develop and (2) validate an ADR risk prediction model. Methods We used a combination of univariate analysis and multivariate binary logistic regression to identify clinical risk factors for developing an ADR in a population of older people from a UK teaching hospital. The final ADR risk model was then validated in a European population (European dataset). Results Six-hundred-ninety patients (median age 85 years) were enrolled in the development stage of the study. Ninety-five reports of ADR were confirmed by independent review in these patients. Five clinical variables were identified through multivariate analysis and included in our final model; each variable was attributed a score of 1. Internal validation produced an AUROC of 0.74, a sensitivity of 80%, and specificity of 55%. During the external validation stage the AUROC was 0.73, with sensitivity and specificity values of 84% and 43% respectively. Conclusions We have developed and successfully validated a simple model to use ADR risk score in a population of patients with a median age of 85, i.e. the oldest old. The model is based on 5 clinical variables (≥8 drugs, hyperlipidaemia, raised white cell count, use of anti-diabetic agents, length of stay ≥12 days), some of which have not been previously reported.
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Affiliation(s)
- Balamurugan Tangiisuran
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains, Malaysia, Pulau Pinang, Malaysia
| | - Greg Scutt
- Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
- * E-mail:
| | - Jennifer Stevenson
- Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
| | - Juliet Wright
- Department of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - G. Onder
- Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - M. Petrovic
- Department of Geriatrics and Gerontology, Ghent University Hospital, Ghent, Belgium
| | - T. J. van der Cammen
- Department of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
- Department of Internal Medicine, Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Chakravarthi Rajkumar
- Department of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Graham Davies
- Institute of Pharmaceutical Science, King’s College London, London, United Kingdom
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Abrams AP, Thompson LA. Physiology of aging of older adults: systemic and oral health considerations. Dent Clin North Am 2014; 58:729-738. [PMID: 25201538 DOI: 10.1016/j.cden.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article reviews the concepts of physiologic reserve, the principles of the normative aging process as exemplified by the cardiovascular, neurologic, and musculoskeletal systems. How these principles apply to oral health, and age-related changes in the oral cavity itself, is reviewed and suggests how they may affect disease management by oral health care providers. It does not focus on diseases related to aging, but rather aims to explore the normal physiologic changes associated with aging dentition and systemic changes related to age, thus enabling clinicians to obtain a better understanding of the presentation of older adults and how it may change their approach to diagnosis and treatment.
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Affiliation(s)
- Alan P Abrams
- Geriatric Medical Fellowship Program, Division of Gerontology, Beth Israel Deaconess Medical Center, 110 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA.
| | - Lisa A Thompson
- Fellowship in Geriatric Dentistry, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
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Patzak M, Porzner M, Oeztuerk S, Mason RA, Wilhelm M, Graeter T, Kratzer W, Haenle MM, Akinli AS. Assessment of liver size by ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:399-404. [PMID: 24638913 DOI: 10.1002/jcu.22151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 11/08/2013] [Accepted: 02/20/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND To determine liver span sonographically in a randomly selected population sample and identify factors that affect liver size. METHODS A total of 1,789 subjects (963 females, 826 males; mean age 41.8 ± 12.8 years) underwent sonographic examination of the liver in the midclavicular line to determine liver span. Subjects underwent physical examination and blood tests and completed a standardized interview questionnaire. RESULTS The average liver span in the midclavicular line for the overall collective was 15.0 ± 1.5 cm; the average for females was 14.9 ± 1.6 cm and 15.1 ± 1.5 cm for males. Liver span exceeded 16 cm in 24.3% of subjects. Results of the multivariate analysis showed that, of the factors potentially influencing liver span, gender, age, body mass index, body height, fatty liver (p < 0.0001), waist-to-hip ratio (p = 0.015), and metabolic syndrome (p = 0.032) are significant. By contrast, diabetes mellitus, alcohol consumption, tobacco consumption, physical activity, and laboratory findings showed no influence. CONCLUSIONS Sonographic measurement of liver span in the midclavicular line is a simple method for routine clinical use. Gender, age, body mass index, waist-to-hip ratio, body height, hepatic steatosis, and metabolic syndrome are factors associated with liver span.
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Affiliation(s)
- Monika Patzak
- Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Javier de Andrés A, Juan Pablo Acuña B, Alicia Olivares S. Dolor en el paciente de la tercera edad. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70089-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gohlke S, Mishto M, Textoris-Taube K, Keller C, Giannini C, Vasuri F, Capizzi E, D’Errico-Grigioni A, Kloetzel PM, Dahlmann B. Molecular alterations in proteasomes of rat liver during aging result in altered proteolytic activities. AGE (DORDRECHT, NETHERLANDS) 2014; 36:57-72. [PMID: 23690132 PMCID: PMC3889881 DOI: 10.1007/s11357-013-9543-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
Aging induces alterations of tissue protein homoeostasis. To investigate one of the major systems catalysing intracellular protein degradation we have purified 20S proteasomes from rat liver of young (2 months) and aged (23 months) animals and separated them into three subpopulations containing different types of intermediate proteasomes with standard- and immuno-subunits. The smallest subpopulation ΙΙΙ and the major subpopulation Ι comprised proteasomes containing immuno-subunits β1i and β5i beside small amounts of standard-subunits, whereas proteasomes of subpopulation ΙΙ contained only β5i beside standard-subunits. In favour of a relative increase of the major subpopulation Ι, subpopulation ΙΙ and ΙΙΙ were reduced for about 55 % and 80 %, respectively, in aged rats. Furthermore, in all three 20S proteasome subpopulations from aged animals standard-active site subunits were replaced by immuno-subunits. Overall, this transformation resulted in a relative increase of immuno-subunit-containing proteasomes, paralleled by reduced activity towards short fluorogenic peptide substrates. However, depending on the substrate their hydrolysing activity of long polypeptide substrates was significantly higher or unchanged. Furthermore, our data revealed an altered MHC class I antigen-processing efficiency of 20S proteasomes from liver of aged rats. We therefore suggest that the age-related intramolecular alteration of hepatic proteasomes modifies its cleavage preferences without a general decrease of its activity. Such modifications could have implications on protein homeostasis as well as on MHC class I antigen presentation as part of the immunosenescence process.
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Affiliation(s)
- Sabrina Gohlke
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
| | - Michele Mishto
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
- />Centro Interdipartimentale di Ricerca sul Cancro “Giorgio Prodi”, University of Bologna, Bologna, Italy
| | - Kathrin Textoris-Taube
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
| | - Christin Keller
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
| | - Carolin Giannini
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
| | - Francesco Vasuri
- />“F. Addarii” Institute of Oncology and Transplant Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Capizzi
- />“F. Addarii” Institute of Oncology and Transplant Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonia D’Errico-Grigioni
- />“F. Addarii” Institute of Oncology and Transplant Pathology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Peter-Michael Kloetzel
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
| | - Burkhardt Dahlmann
- />Institute of Biochemistry, Charité-Universitätsmedizin Berlin, CCM, CharitéCrossOver, Charitéplatz 1, 10117 Berlin, Germany
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Grizzi F, Di Caro G, Laghi L, Hermonat P, Mazzola P, Nguyen DD, Radhi S, Figueroa JA, Cobos E, Annoni G, Chiriva-Internati M. Mast cells and the liver aging process. IMMUNITY & AGEING 2013; 10:9. [PMID: 23496863 PMCID: PMC3599827 DOI: 10.1186/1742-4933-10-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
It has now ascertained that the clinical manifestations of liver disease in the elderly population reflect both the cumulative effects of longevity on the liver and the generalized senescence of the organism ability to adjust to metabolic, infectious, and immunologic insults. Although liver tests are not significantly affected by age, the presentation of liver diseases such as viral hepatitis may be subtler in the elderly population than that of younger patients. Human immunosenescence is a situation in which the immune system, particularly T lymphocyte function, deteriorates with age, while innate immunity is negligibly affected and in some cases almost up-regulated. We here briefly review the relationships between the liver aging process and mast cells, the key effectors in a more complex range of innate immune responses than originally though.
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Affiliation(s)
- Fabio Grizzi
- Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giuseppe Di Caro
- Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Luigi Laghi
- Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Paul Hermonat
- Department of Internal medicine and Gene Therapy Program, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paolo Mazzola
- Department of Health Sciences, University of Milano-Bicocca, Milan, and Geriatric Clinic, San Gerardo Hospital, Monza, Italy
| | - Diane D Nguyen
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Saba Radhi
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jose A Figueroa
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Everardo Cobos
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,The Laura W. Bush Institute for Women's Health and Center for Women's Health and Gender-Based Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Giorgio Annoni
- Department of Health Sciences, University of Milano-Bicocca, Milan, and Geriatric Clinic, San Gerardo Hospital, Monza, Italy
| | - Maurizio Chiriva-Internati
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,The Laura W. Bush Institute for Women's Health and Center for Women's Health and Gender-Based Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA.,Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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