Rapid antigen test during a COVID-19 outbreak in a private hospital in Hong Kong.

INTRODUCTION: In response to two nosocomial clusters of coronavirus disease 2019 (COVID-19) in our hospital, we adopted a series of strict infection control measures, including regular rapid antigen test (RAT) screening for high-risk patients, visitors, and healthcare workers. We evaluated the diagnostic performance of a locally developed RAT, the INDICAID COVID-19 Rapid Antigen Test (Phase Scientific, Hong Kong), using respiratory samples from both symptomatic and asymptomatic individuals. METHODS: Real-time reverse-transcription polymerase chain reaction (rRT-PCR)-confirmed deep throat saliva (DTS) and pooled nasopharyngeal swab and throat swab (NPS/TS) samples collected from 1 November to 30 November 2020 were tested by INDICAID. Screening RATs were performed on asymptomatic healthcare workers during a 16-week period (1 December 2020 to 22 March 2021). RESULTS: In total, 20 rRT-PCR-confirmed samples (16 DTS, four pooled NPS/TS) were available for RAT. Using the original sample, RAT results were positive in 17/20 samples, indicating 85% sensitivity (95% confidence interval [CI]=62.11%-96.79%). Negative RAT results were associated with higher cycle threshold (Ct) values. For samples with Ct values <25, the sensitivity was 100%. Of the 49 801 RATs collected from healthcare workers, 33 false positives and one rRT-PCR-confirmed case were detected. The overall specificity was 99.93% (95% CI=99.91%-99.95%). The positive and negative predictive values were 2.94% (95% CI=2.11%-4.09%) and 100%, respectively. CONCLUSION: The INDICAID COVID-19 RAT demonstrated good sensitivity for specimens with high viral loads and satisfactory specificity for low-risk, asymptomatic healthcare workers.

Recent advances in calorie restriction research on aging.

The extension of both median and maximum lifespan and the suppression of age-related diseases in laboratory animals by reduced food intake, i.e., calorie restriction (CR) are regarded as hallmarks of CR's anti-aging action. The diverse efficacy of CR to counteract aging effects and its experimental reproducibility has made it the gold standard of many aging intervention studies of recent years. Although CR originally was used as a tool to perturb the aging process of laboratory animals as to uncover clues of underlying mechanisms of aging processes, current CR research interests have shifted to the retardation of aging-related functional decline and the prevention of age-related diseases. Advances in CR research on non-human primates and recent endeavors using human subjects offer a promising outlook for CR's beneficial effects in healthy human aging. In this review, several major issues related to CR's anti-aging mechanisms are discussed by highlighting the importance of modulating deleterious chronic inflammation at molecular levels and the impact of epigenetic chromatin and histone modifications by CR at the ultimate control sites of gene expression. The recent research on rapamycin as a CR mimetic is summarized and a brief description of intermittent feeding patterns is reviewed in comparison to the CR effect.

Molecular inflammation as an underlying mechanism of the aging process and age-related diseases.

Aging is a biological process characterized by time-dependent functional declines that are influenced by changes in redox status and by oxidative stress-induced inflammatory reactions. An organism's pro-inflammatory status may underlie the aging process and age-related diseases. In this review, we explore the molecular basis of low-grade, unresolved, subclinical inflammation as a major risk factor for exacerbating the aging process and age-related diseases. We focus on the redox-sensitive transcription factors, NF-κB and FOXO, which play essential roles in the expression of pro-inflammatory mediators and anti-oxidant enzymes, respectively. Major players in molecular inflammation are discussed with respect to the age-related up-regulation of pro-inflammatory cytokines and adhesion molecules, cyclo-oxygenase-2, lipoxygenase, and inducible nitric oxide synthase. The molecular inflammation hypothesis proposed by our laboratory is briefly described to give further molecular insights into the intricate interplay among redox balance, pro-inflammatory gene activation, and chronic age-related inflammatory diseases. The final section discusses calorie restriction as an aging-retarding intervention that also exhibits extraordinarily effective anti-inflammatory activity by modulating GSH redox, NF-κB, SIRT1, PPARs, and FOXOs.

Induction of endothelial iNOS by 4-hydroxyhexenal through NF-kappaB activation.

Lipid peroxidation and its end-product, 4-hydroxyhexenal (HHE), are known to affect redox balance during aging, which causes various degenerative processes including vascular alterations from endothelial cell deterioration. To better understand the molecular action of HHE in the development of vascular abnormalities during the aging process, we investigated whether the upregulation of inducible endothelial nitric oxide synthase (iNOS) by HHE is mediated through nuclear factor kappaB (NF-kappaB) activation. Results indicate that HHE stimulates iNOS by the transcriptional regulation of NF-kappaB activation through cytosolic kappaB degradation inhibitors (IkappaB). Pretreatment with NF-kappaB inhibitors Bay 11-7082 and N-acetyl cysteine (NAC) suppressed the upregulation of iNOS by blunting IkappaB degradation and NF-kappaB binding activity. Because inflammatory stimuli induce iNOS to generate large amounts of nitric oxide (NO), intracellular NO levels in the presence of Bay 11-7082, NAC, and caffeic acid methyl ester were estimated. These inhibitors significantly suppressed the HHE-induced NO levels to a basal level. These findings strongly suggest that in endothelial cells, HHE induces iNOS gene expression through NF-kappaB activation, which can lead to vascular dysfunction by the activation of various proinflammatory genes.

Oxidative stress and vascular aging.

In attempt to meet tissue demands for proper blood flow, the vasculature alters its structure, simultaneously responding to both physical and chemical stresses. Substantial information has emerged in this field of study, particularly concerning the roles of the endothelium and smooth muscle cells in relation to signaling pathways for mechanotransduction. As a first line of defense upon exposure to various stressors, the endothelium and smooth muscle cells respond with adaptive cellular modifications. One prime example of these modifications is the cellular response to oxidative stress as evidenced by accumulated data. A recent proposal of the inflammatory hypothesis of vascular aging emphasized that stress-induced vascular aging may be the primary event that underlies the general aging phenomenon of systemic dysfunction.

Age-related increase of brain cyclooxygenase activity and dietary modulation of oxidative status.

Several studies have demonstrated that inhibitors of cyclooxygenase (COX) attenuate various neuronal injuries and age-dependent demented conditions. From these findings, we proposed to test the effect of age on COX activity and its possible suppression by the antiaging action of dietary restriction in the rat brain. The status of reactive oxygen species (ROS) was also assessed to correlate with COX activity to delineate the underlying mechanism of the altered COX activity during aging. These results showed that COX activity significantly increased in 24-month-old rats compared with 6-month-old rats in an ad libitum group. Interestingly, mRNA and protein levels of COX-2 showed little corresponding age-related change. The formation of ROS was found to increase gradually with age in ad libitum fed rats. However, dietary restriction suppressed the increase at the age of 24 months. To substantiate the relationship between ROS and COX activity when the rats were 24 months of age, we conducted in vitro experiments with a C6 glioma cell line. Together, it is concluded that increased COX activity with age is due to the activation of COX catalytic reaction by ROS without increased gene expression of COX-2 and that it is related to the increased pro-oxidant status in aged rats.

Gene expression of cyclooxygenase in the aging heart.

Cyclooxygenase (COX) is the key rate-limiting enzyme in the prostaglandin synthetic pathway. Two isoforms of COX have been identified: a constitutive COX-1 and an inducible COX-2, which is activated in response to various stimuli. We investigated the changes of COX-1 and COX-2 in rat heart during aging. We measured the age-related changes in the mRNA and protein levels of COX by using reverse-transcription polymerase chain reaction and Western blotting, respectively. COX-2 mRNA and protein levels increased with age, whereas those of COX-1 showed no change. The COX activity determined by prostaglandin E(2) production increased with age. Because the COX-catalyzed arachidonate cascade is an important source of reactive oxygen species (ROS) generation, changes in ROS generation and lipid peroxidation were also assessed. The amount of ROS generated by the COX pathway increased with age, as did the total ROS generation and lipid peroxidation. These results show that COX-2 activity increases with age, partially because of elevated transcriptional expression and protein content, and they suggest that increased COX-2 can play a role in oxidative alterations in the aged heart.

Effect of dietary restriction on age-related increase of liver susceptibility to peroxidation in rats.

Dietary restriction (DR) increases life span and decreases age-related diseases in experimental animals. It has received a great deal of attention in connection with the relationship between aging, nutrition, and oxidative stress because oxidative injury in several organ systems is a prominent feature in aging. We investigated the possibility that DR can protect vulnerable liver lipids against age-related increases of peroxidation. Male Fischer 344 rats fed ad libitum (AL) or dietarily restricted (maintained on 60% of AL food intake) were killed by decapitation at 4 (young) or 12 mon (adult) of age. Phosphatidylcholine hydroperoxide (PCOOH) concentration of liver was determined using a chemiluminescent high-performance liquid chromatographic method. Liver PCOOH increased with age in adult rats, but less of an increase of PCOOH was seen in DR rats, which is consistent with results on production of thiobarbituric acid-reactive substances and oxygen-derived free radicals. No significant differences were found in liver superoxide dismutase and catalase activity between AL and DR groups of young and adult rats. Liver triglyceride and cholesterol contents were lower in DR than AL rats at 12 mon. Fatty acid compositions of phosphatidylcholine and phosphatidylethanolamine indicated that the ratio of (20:3n-6 + 20:4n-6)/18:2n-6, an index of linoleic acid (18:2n-6) desaturation, was lower in DR than in AL rats. We concluded that DR suppresses age-related oxidative damage in liver by modulating the amount of lipid as well as fatty acid composition.

Effects of berberine on intracellular free calcium in smooth muscle cells of Guinea pig colon.

AIM: To investigate the effects and mechanism of berberine (Ber) on the intracellular free calcium concentration ([Ca(2+)](i)) in the smooth muscle cells of guinea pig colon. METHODS: The changes of [Ca(2+)](i) were assayed by the biwavelength spectrophotometry with Fura 2-AM in the cell suspension of the smooth muscle cells, which were freshly isolated from guinea pig colon. RESULTS: In the resting state, [Ca(2+)](i) in the HEPES-Ringer solution (CaCl(2) 1.5 mmol.l(-1)) was (108 +/- 9.4) nmol.l(-1) (n = 7). Ber had no significant effects on the resting [Ca(2+)](i), but markedly inhibited the increase in [Ca(2+)](i )induced by 60 mmol.l(-1) KCl in a concentration-dependent manner. The value of IC(50 )was 34.09 micromol.l(-1). 30 and 100 micromol.l(-1) Ber also inhibited the elevation of [Ca(2+)](i) evoked by 10 micromol.l(-1) Ach in a dose-dependent fashion in the presence or absence of extracellular Ca(2+). In addition, Ber inhibited the elevation of [Ca(2+)](i) stimulated by cyclopiazonic acid (CPA) in a dose-dependent manner. This effect was more potent in the HEPES-Ringer solution (IC(50) = 37.79 micromol.l(-1)) than Ca(2+)-free medium (IC(50) = 49.70 micromol.l(-1)). CONCLUSIONS: Ber possessed an inhibitory effect on the influx of extracellular Ca(2+) and Ca(2+)-release from intracellular stores in the smooth muscle cells of colon. That is to say Ber may be a blocker of Ca(2+) channels.

The inflammation hypothesis of aging: molecular modulation by calorie restriction.

Current evidence strongly indicates that reactive oxygen species (ROS) and reactive nitrogen species (RNS) are widely implicated in the inflammatory process. However, mechanistic information is not readily available on the extent to which ROS/RNS contributes to the proinflammatory states of the aging process. The involvement of the underlying inflammation during the aging process and the molecular delineation of anti-inflammatory action of calorie restriction (CR) is described. Age-related upregulations of NF-kappaB, IL-beta, IL-6, TNFalpha, cyclooxygenase-2, and inducible NO synthase are all attenuated by CR. The suppression of the NF-kappaB activation was accomplished by blocking the dissociation of inhibitory IkappaBalpha and IkappaBbeta by CR. These findings provide underlying molecular insights into the anti-inflammatory action of CR in relation to the aging process. Based on these and other available data, it is suggested that the "Inflammation Hypothesis of Aging" supports the molecular basis of the inflammatory process as a plausible cause of the aging process.

Stress resistance by caloric restriction for longevity.

Hardly an aspect of aging is more important than an organism's ability to withstand stress or to resist both internally and externally imposed insults. We know that as organisms loose their ability to resist these insults, aged organisms suffer more than the young. Therefore, a prime strategy for an organism's survival has been the evolutionarily adapted defense systems that guard against insult. For better survivability, an organism's defense system must be maximized to its full effect through well-coordinated networks of diverse biologically responsive elements. Although terms like stress, resistance, and adaptability have long been used in biology, they remain mechanistically and quantitatively poorly defined. In a gerontological context, stress resistance or susceptibility are often discussed in association with an organism's vulnerability to disease and age-related damage. However, to date, there is no clear molecular delineation of cellular and molecular mechanisms for such complex biological phenomena. The life-prolonging action of caloric restriction (CR) seems to offer an excellent opportunity for investigating the interrelationship between stress and the aging process. As an omnipotent intervention, CR provides a unique opportunity to probe the organism's ability to withstand age-related stress as a survival strategy. In this context, the antiaging action of CR can be viewed as "nutritional stress," because the organism's reduced caloric intake seems to be a stimulatory metabolic response for survivability. Recent gerontologic research has provided sufficient experimental data supporting this antiaging property of CR, of which several pertinent, key examples are discussed below.

The effect of age on cyclooxygenase-2 gene expression: NF-kappaB activation and IkappaBalpha degradation.

Increased oxidative stress resulting in the activation of NF-kappaB is thought to play a crucial role in the expression of the cyclooxygenase-2 (COX-2), which is the key enzyme in proinflammatory prostanoid synthesis. In the current study, we investigated whether the aging process affects the status of the redox-sensitive NF-kappaB in rat kidney, and how this age-related modulation is related to COX-2 gene expression and COX-derived reactive oxygen species (ROS). We found that the aging process strongly enhanced the activation of NF-kappaB and its DNA-binding activity with an increased ROS status. Accompanied with the change in the NF-kappaB activity was a decreased IkappaBalpha as confirmed by the increased nuclear p65 protein. Thus, these data strongly indicated that the aging process increases NF-kappaB activity by downregulating IkappaBalpha. A closer examination further revealed that age-related oxidative status correlated with the increased COX-derived prostanoid biosynthetic process is mediated by the increased NF-kappaB-regulated COX activity. This increase in NF-kappaB activity was accompanied by the increased COX-2 mRNA and protein levels. Based on these data, we concluded that the age-related increase in redox-sensitive NF-kappaB translocation and binding activities are associated with increased ROS, and further that this transactivation was modulated by the age-related decrease of IkappaBalpha.

Isolation and identification of a phenolic antioxidant from Aloe barbadensis.

A potent antioxidative compound has been isolated from a methanolic extract of Aloe barbadensis Miller using a combination of column and thin-layer chromatography. The antioxidant activity of this substance was similar to that of alpha-tocopherol as assessed in vitro using rat brain homogenates. On the basis of electrospray ionization and electron-impact ionization mass spectra in combination with reversed-phase, high-performance liquid chromatographic behavior, this compound has been identified as 8-C-beta-D-[2-O-(E)-coumaroyl]glucopyranosyl-2-[2-hydroxy]-propyl-7-methoxy-5-methylchromone.

[Effects of berberine on intracellular calcium concentration in smooth muscle cells of guinea pig colon].

The purpose of the present investigation is to study how berberine (Ber) affect the intracellular free calcium concentration ( Ca(2+) (i)) of the smooth muscle cells of guinea pig colon by means of biwavelength spectrophotometry with Fura 2 AM in a cell suspension specimen. In the resting state, Ca(2+) (i) in HEPES Ringer solution (CaCl2 1.5 mmol/L) was 108 9.4 nmol/L (n=7), which was not significantly affected by Ber. On the other hand, Ber inhibited the increased Ca(2+) (i) induced by 60 mmol/L KCl in a dose dependent manner, with a value of IC(50) being 34.09 micromol/L. 30, 100 micromol/L Ber also inhibited 10 micromol/L ACh evoked Ca(2+) (i) elevation in a dose dependent manner either in the presence or absence of extracellular Ca(2+). In addition, Ber inhibited cyclopiazonic acid (CPA) stimulated Ca(2+) (i) elevation dose dependently. This effect was more potent in HEPES Ringer solution (IC(50)=37.79 micromol/L) than in Ca(2+) free medium (IC(50)=49.70 micromol/L). The above results suggest that Ber exerts an inhibitory effect on the extracellular Ca(2+) influx and the Ca(2+) release from intracellular stores.

Dietary restriction and life-span extension.

The popularity of the dietary restriction (DR) paradigm (often used interchangeably with calorie restriction) among gerontologists is primarily based on the research finding of the last two decades. Originally discovered by McCay's group in the 1930s, this paradigm showed that animals placed on the DR regimen, meaning reduced nutrition without malnutrition, had robust life extensions (1). This scientific breakthrough showed that nutritional status can bring about distinctive metabolic adjustments.

Significance of hepatic xanthine oxidase and uric acid in aged and dietary restricted rats.

Xanthine oxidase (XOD), one of the major intracellular sources of superoxide production, is well characterized as a causative factor in ischemia/reperfusion related damage. In the present study, we investigated age-effect on the status of XOD, an enzyme interconvertible with xanthine dehydrogenase (XDH) under oxidative stress. We also examined the modulation of the enzyme using the anti-oxidative action of dietary restriction (DR). We obtained evidence showing XOD activity to be significantly increased by DR, peaking at 24 months, although no progressive, age-related changes were noticed. On the other hand, while XDH activity decreased in ad libitum fed rats with age, DR maintained higher activity levels at 18 and 24 months of age. During aging, the conversion of XDH to XOD was slightly increased, as indicated by the XOD/XDH ratio. One novel finding of the present study is DR's ability to elevate the uric acid level, which likely augments the anti-oxidative defense system, thereby buffering against oxidatively stressed conditions during aging. Based on what is known about the antioxidative abilities of DR and uric acid, we propose that the high uric acid levels we observed in DR rats may well serve as part of a defense strategy to protect redox balance.

The antioxidative effect of ganhuangenin against lipid peroxidation.

The antioxidative effect of ganhuangenin (GHG), isolated from Scutellaria baicalensis Georgi, was examined by measuring its ability to suppress the formation of phospatidylcholine hydroperoxide (PCOOH). The results show that a pretreatment with GHG effectively suppressed PCOOH formation, which was initiated by the peroxyl-generating oxidant, AAPH (2,2'-azobis-2-aminopropane hydrochloride). The protective action of GHG against the formation of the PCOOH was observed in liver, lung, and kidney. When compared with other known antioxidants, we found the antioxidative potency of GHG to be greater than that of alpha-tocopherol. Our data strongly indicate that GHG is a powerful antioxidant against lipid peroxidation and is, therefore, responsible for this prophylactic effect.

Regional difference of ROS generation, lipid peroxidation, and antioxidant enzyme activity in rat brain and their dietary modulation.

One of the potential causes of age-related neuronal damage can be reactive oxygen species (ROS), as the brain is particularly sensitive to oxidative damage. In the present study, we investigated the effects of aging and dietary restriction (DR) on ROS generation, lipid peroxidation, and antioxidant enzymes in cerebrum, hippocampus, and cerebellum of 6-, 12-, 18-, and 24-month-old rats. ROS generation significantly increased with age in cerebrum of ad libitum (AL) rats. However, no significant age-difference was observed in hippocampus and cerebellum. DR significantly decreased ROS generation in cerebrum and cerebellum at 24-months. On the other hand, the increased lipid peroxidation of AL rats during aging was significantly reduced by DR in all regions. Our results further showed that catalase activity decreased with age in cerebellum of AL rats, which was reversed by DR, although SOD activity had little change by aging and DR in all regions. In a similar way, glutathione (GSH) peroxidase activity increased with age in cerebrum of AL rats, while DR suppressed it at 24-months. These data further support the evidence that the vulnerability to oxidative stress in the brain is region-specific.

Downregulation of telomerase in rat during the aging process.

Telomerase is an RNA-dependent DNA polymerase that maintains the tandem arrays of telomeric repeats at the eukaryotic chromosome ends. Because of its ability to replenish lost telomeric sequences, telomerase is thought to be required for cell proliferation. At present, very little information on the role of telomerase in aging is available. In the present study, we tested the telomerase activity of Fischer 344 rat testis and liver at 6, 12, 18 and 24 months of age. As the testis is an androgen-dependent tissue, we also investigated the changes of testosterone and mRNA levels of androgen receptor in this tissue. Our results show that the telomerase activity of Fischer 344 rat testis significantly reduced at 24 months of age compared to 6 months of age, and that the mRNA level of telomerase protein component 1 (TLP-1) show a corresponding decrease with the telomerase activity. Interestingly, this down-regulation was not observed in the liver. The testosterone level in testis increased until 18 months of age, but reduced by 50% at 24 months of age. Our conclusions are that the telomerase activity is age-dependent and its change is a tissue-specific phenomenon.

Modulation of cardiac mitochondrial membrane fluidity by age and calorie intake.

The aim of the present study was to determine the effects of dietary restriction (DR) on the age-related changes in membrane fluidity, fatty acid composition and free radical damage of mitochondrial membranes obtained from the rat left ventricle. Mitochondrial membrane preparations were obtained from the left ventricles of 6- and 24-month-old, male, Fischer 344 rats that were allowed to eat throughout their life either ad lib (Group A) or only 60% of the amount consumed by the ad lib fed group (Group B). Our results show that the membrane fluidity of the 24 month Group A hearts was less than that of the 6 month group A hearts. No differences in membrane fluidity were observed between the 6 and 24 month DR groups. The fatty acid composition of the mitochondrial membranes of the two ad lib fed groups differed: the long-chain polyunsaturated 22:4 fatty acid was higher in the older group, although linoleic acid (18:2) was lower. DR eliminated the differences. No statistically significant difference in the overall polyunsaturated fatty acid content was noted. However, the peroxidizability index was higher in the membranes of the 24 month Group A hearts but not in the 24 month Group B hearts. Finally, the degree of lipid damage, as assessed in vitro by the induced production of reactive oxygen species, was elevated in the 24 month Group A hearts. No difference was observed between the young and old DR groups. Considered together, these results suggest that DR maintains the integrity of the cardiac mitochondrial membrane fluidity by minimizing membrane damage through modulation of membrane fatty acid profile.