Understanding cognitive frailty in aging adults: prevalence, risk factors, pathogenesis and non-pharmacological interventions.

The worldwide increase in the aged population raises health concerns for elderly individuals. Cognitive frailty of the elderly (apart from those suffering from Alzheimer´s disease or other type of dementia) is a complex construct associated with aging, which is composed of physical and cognitive components, while physical frailty and cognitive impairment mutually affect each other. Although the prevalence of cognitive frailty in community-dwelling older adults without neurodegenerative disease is low, it can rise dramatically in clinical settings. Early identification of this condition can contribute to delaying the adverse outcomes that lead to higher mortality rates. This review aims to define cognitive frailty, its prevalence, risk factors, and pathogenesis, while highlighting the need for further research on identification, prevention, and non-pharmacological management of cognitive frailty in older adults in view of promoting healthy aging and secondary prevention strategies for dementia (Fig. 1, Ref. 93). Keywords: cognitive frailty, older adults, risk factors, nutrition, exercise.

Donor non-specific MICA antibodies in renal transplant recipients.

Despite recent advances in solid organ transplantations, an antibody mediated rejection caused by donor specific antibodies is still a major problem in kidney graft survival. Besides HLA-induced humoral response, antibodies against MICA antigens have recently attracted attention because of their possible role in graft rejection. The aim of our study was to establish whether renal recipients produce antibodies against MICA molecules due to the transplantation and if they are specific for MICA antigens of the donors. MICA antibody screening was performed in 124 kidney recipient sera. 22 sera, that were found to be MICA antibody positive, were further examined for MICA antibody profiles and compared with donor MICA alleles. The analysis of MICA antibody positive sera showed mostly more complex reactivity patterns. A significant fraction of patient sera (59%) reacted not only with the donor MICA antigens, but also with other MICA patterns. A match between antibody specificities and MICA antigens was observed in 41% of renal recipients only. On the other hand, as much as in 36% of recipient sera were detected antibodies against their own MICA molecules. We did not prove a complete correlation between the recipient MICA antibody specificities and MICA antigens of the donor. We assume that MICA antibody induction occurs not only due to the allogeneic stimulation itself but also due to other factors that need to be elucidated.

Circulating TGF-ß1, glycation, and oxidation in children with diabetes mellitus type 1.

The present study investigates the relationship between diabetes metabolic control represented by levels of HbA1c, early glycation products-(fructosamine (FAM)), serum-advanced glycation end products (s-AGEs), lipoperoxidation products (LPO), advanced oxidation protein products (AOPP) and circulating TGF-ß in young patients with DM1. The study group consisted of 79 patients with DM1 (8-18 years). 31 healthy children were used as control (1-16 years). Baseline characteristics of patients were compared by Student's t-test and nonparametric Mann-Whitney test (Statdirect), respectively. The correlations between the measured parameters were examined using Pearson correlation coefficient r and Spearman's rank test, respectively. A P value < 0.05 was considered as statistically significant. HbA1c was measured by LPLC, s-AGEs spectrofluorimetrically, LPO and AOPP spectrophotometrically and TGF-ß by ELISA. Our results showed that parameters of glycation and oxidation are significantly higher in patients with DM1 than in healthy control. The level of serum TGF-ß was significantly higher in diabetics in comparison with control: 7.1(3.6; 12.6) versus 1.6(0.8; 3.9) ng/mL. TGF-ß significantly correlated with age and duration of DM1. There was not found any significant relation between TGF-ß and parameres of glycation and oxidation. However, these results do not exclude the association between TGF-ß and the onset of diabetic complications.

Glycation and lipid peroxidation in children and adolescents with type 1 diabetes mellitus with and without diabetic complications.

Glycation and oxidative stress lead to formation of compounds that have several biological effects and contribute to the development of the complications of diabetes mellitus. All steps of glycoxidation generate oxygen free radicals, some of them in common with lipid peroxidation pathways. Some oxidation or lipid peroxidation products may bind to proteins and amplify glycoxidation-generated lesions. The aim of this study was to measure glycation and lipid peroxidation parameters and examine the relationship between them in patients with type 1 diabetes mellitus (DM1) with (+DC) and without (-DC) diabetic complications. Fifty patients with DM1 aged from 7-19 years and with duration of DM1 (DD) at least 5 years were included. Twenty-four patients were -DC and 26 were +DC. Twelve healthy children formed a control group. There were significantly higher values of fructosamine (FAM), HbA(1c), serum advanced glycation endproducts (s-AGEs) and lipid peroxides (LPO) in the +DC group compared with -DC, and significantly higher values of HbA(1c), FAM and LPO in both diabetic groups than in controls. The s-AGEs level in the -DC group was similar to that in controls. In the total diabetic group, regardless of DC, there was a significant negative correlation between LPO and HDL-C (r = -0.379; p <0.05), and a positive correlation between LPO and triacylglycerol (TAG) (r = 0.852; p <<0.05), FAM (r = 0.414; p <0.05) and s-AGEs (r = 0.454; p <0.05). In the +DC group LPO correlated negatively with HDL-C (r = -0.392, p <0.05) and positively with TAG (r = 0.848; p <<0.05), FAM (r = 0.457; p = 0.02), and s-AGEs (r = 0.516, p = 0.02), whereas in the -DC group LPO correlated only with HDL-C (r = -0.441; p = 0.03) and TAG (r = 0.769; p <<0.05). We demonstrated a linkage between enhanced formation of AGEs and lipid peroxidation products and the presence of diabetic complications. Thus, the overproduction of glycation and lipid peroxidation products may take part in DC development as early as in childhood and adolescence.

HbA1c and serum levels of advanced glycation and oxidation protein products in poorly and well controlled children and adolescents with type 1 diabetes mellitus.

Diabetes mellitus is associated with hyperglycemia and with accelerated non-enzymatic glycation, increased oxidative stress and free radical production. The aim of the present study was to evaluate the levels of proteins glycation and oxidation parameters, compare them between poorly and well controlled children with type 1 diabetes mellitus, and determine the impact of glycemic control on these parameters. Blood and serum were obtained from 81 patients with type 1 diabetes mellitus (DM1) (20 patients had long-term good glycemic control [GGC], 61 patients had long-term poor glycemic control [PGC]). Thirty-one healthy children were used as controls. Fructosamine (FAM) was determined by a spectrophotometric method, HbA1c was measured by LPLC, serum advanced glycation end-products (s-AGEs) were determined fluorimetrically, and advanced oxidation protein products (AOPP) were measured spectrophotometrically. We observed significantly higher FAM, HbA1c, s-AGEs and AOPP levels in the patients with DM1 compared with controls, and significantly higher FAM, HbA1c and sAGEs levels in the PGC group compared with the GGC group. AOPP was higher in the PGC group than in the GGC group, but not significantly. In the PGC group we observed significant correlations between HbA1c and HDL-C (r = -0.306, p = 0.01), HbA1c and s-AGEs (r = 0.486, p < 0.001), and HbA1c and AOPP (r = 0.447, p < 0.01). s-AGEs significantly correlated with triacylglycerols (TAG) (r = 0.537, p < 0.001) and AOPP with HDL-C (r = -0.336, p < 0.05), TAG (r = 0.739, p < 0.001) and s-AGEs (r = 0.577, p < 0.001). In conclusion, our results showed both glycative and oxidative stress are increased in the PGC diabetic group compared with controls, they are linked with glycemic control, and probably contribute to the development of diabetic complications. We suggest that the measurement of not only HbA1c but also s-AGEs and AOPP may be useful to predict the risk of development of diabetic complications.

Rapid and simple method for determination of Nepsilon-(carboxymethyl)lysine and Nepsilon-(carboxyethyl)lysine in urine using gas chromatography/mass spectrometry.

A new procedure was developed to determine in urine the concentrations of N(epsilon)-(carboxymethyl)lysine (CML) and N(epsilon)-(carboxyethyl)lysine (CEL), the major products of oxidative modification of glycated proteins, to assess levels of oxidative stress in physiological systems. The urine samples were acetonitrile-deproteinized, then derivatized by ethylchloroformate, and N(O,S)-ethoxycarbonyl ethyl esters of amino acids were analysed by isotope dilution gas chromatography/mass spectrometry. Recovery averaged 89%. Linearity was excellent (r = 0.998-0.999) in the 0.5-25 micromol/L range for CML and CEL. The limit of detection of this assay was 0.1 micromol/L (corresponding to 0.20 pmol of CML or CEL on column). Intra-day and inter-day precisions were likewise excellent, with relative standard deviations <4.63 and <6.15%, respectively. Accuracy of CML and CEL determination (15 micromol/L) was 2.9 and 5.9% of the estimated theoretical value. The time from obtaining the urine sample to determination of the concentration from the chromatographic peak was 80 min or less. This method is sensitive, reproducible, accurate, relatively cheap and very simple. It can be useful for laboratories involved in the diagnosis and monitoring of age-related chronic diseases.