Evaluation of off-label rapamycin use to promote healthspan in 333 adults

Rapamycin (sirolimus) is an FDA-approved drug with immune-modulating and growth-inhibitory properties. Preclinical studies have shown that rapamycin extends lifespan and healthspan metrics in yeast, invertebrates, and rodents. Several physicians are now prescribing rapamycin off-label as a preventative therapy to maintain healthspan. Thus far, however, there is limited data available on side effects or efficacy associated with use of rapamycin in this context. To begin to address this gap in knowledge, we collected data from 333 adults with a history of off-label use of rapamycin by survey. Similar data were also collected from 172 adults who had never used rapamycin. Here, we describe the general characteristics of a patient cohort using off-label rapamycin and present initial evidence that rapamycin can be used safely in adults of normal health status.

Incidence of atrial and ventricular arrhythmias in patients with CIEDs and COVID-19

Background

It remains unclear whether COVID-19 infection is associated with increased arrhythmia burden in patients with cardiac implantable electronic devices (CIEDs).

Methods

We identified 46 patients tested positive for COVID-19 between 01/03/2020 and 31/05/2021 in our cohort of 1209 patients with CIED (3.8%). Data on arrhythmia burden during a 9 week period (a 4 week “pre-infection” period: P1, the week before the positive Covid-19 test: P2, and the 4 weeks afterwards: P3) was accessible in 35 patients.

Results

83% of patients were not hospitalised. Five patients (14.3%) (all non-hospitalised) had high rate atrial (HRA) events, 4 of which exclusively during P1 and/or P2. Thirty-two non-sustained VT (NSVT) episodes were recorded in 8 patients, one degenerating in VF requiring ICD shock (occurring in P2). One patient had frequent NSVT each week. After exclusion of this outlier, a numerical 4-fold increase in weekly NSVT episodes was observed between P1 and P3 (Patients with NSVT: 0.07±0.12 vs. 0.29±0.17 episodes/week, p=0.057; entire cohort: 0.015±0.060 vs. 0.059±0.138 episodes/week, p=0.16) (Figure 1). In P3, hospitalised patients had a trend towards higher NSVT burden vs. non-hospitalised patients (2/6 (33.3%) vs. 4/29 (13.8%), p=0.27) which was not apparent before the positive Covid-19 test.

Conclusion

Our single-centre experience suggests that COVID-19 infection may result in an increase in VA but not atrial arrhythmia burden in patients with CIED.

Funding Acknowledgement

Type of funding sources: None.

Domestic cats convert [2H8]-β-carotene to [2H4]-retinol following a single oral dose

Many animals convert β-carotene to retinol to meet their vitamin A (VA) requirement. However, this pathway is inefficient in many carnivores. This study quantified the plasma response to a single oral dose of [(2) H(8)]-β-carotene in adult domestic cats, including measurement of [(2) H(4)]-retinol derived from the dose. Cats were fed with either a control diet containing adequate VA (n = 5) or a VA-devoid diet (n = 5) for 28 days. An oral dose of either 5 mg/kg body weight (BW) (n = 4) or 10 mg/kg BW (n = 6) of [(2) H(8) ]-β-carotene was administered on day 28. Plasma samples were collected prior to dosing and at 6, 12, 24, 32, 48, 72, 120, 168 and 216 h post-dose. Plasma retinoids and β-carotene were measured using HPLC and [(2) H(4)]-retinol by GC-ECNCI-MS (gas chromatography/electron capture negative chemical ionization/mass spectrometry). β-carotene was undetectable in plasma prior to dosing. Post-dose, mean peak plasma β-carotene was 0.37 ± 0.06 nmol/ml at 9.0 ± 1.8 h following the dose, while [(2) H(4) ]-retinol peaked at 3.71 ± 0.69 pmol/ml at 55.2 ± 16.3 h. The ratio per cent of total area under the curve for [(2) H(4)]-retinol compared with the β-carotene response was 4.6 ± 2.6%. There was little effect of diet or dose on the β-carotene or [(2) H(4)]-retinol responses. The appearance of [(2) H(4)]-retinol in plasma indicates that cats are capable of converting β-carotene to active VA. Conversion efficiency was not calculated in this study, but it is likely inadequate to meet cats' VA requirement without the inclusion of preformed VA in the diet.

Perspectives on inhibiting mTOR as a future treatment strategy for hematological malignancies

Mammalian target of rapamycin (mTOR) is a protein kinase implicated in the regulation of various cellular processes, including those required for tumor development, such as the initiation of mRNA translation, cell-cycle progression and cellular proliferation. In a wide range of hematological malignancies, the mTORC1 signaling pathway has been found to be deregulated and has been designed as a major target for tumor therapy. Given that pre-clinical studies have clearly established the therapeutic value of mTORC1 inhibition, numerous clinical trials of rapamycin and its derivates (rapalogs) are ongoing for treatment of these diseases. At this time, although disease stabilization and tumor regression have been observed, objective responses in some tumor types have been modest. Nevertheless, some of the mechanisms underlying cancer-cell resistance to rapamycin have now been described, thereby leading to the development of new strategy to efficiently target mTOR signaling in these diseases. In this review, we discuss the rationale for using mTOR inhibitors as novel therapies for a variety of hematological, malignancies with a focus on promising new perspectives for these approaches.

Modelling of peak-flow wall shear stress in major airways of the lung

Some respiratory diseases result in the inflammation of the lung airway epithelium. An associated chronic cough, as found in many cases of asthma and in long-term smokers, can exacerbate damage to the epithelial layer. It has been proposed that wall shear stresses, created by peak expiratory flow-rates during a coughing episode, are responsible. The work here uses a computational fluid dynamics technique to model peak expiratory flow in the trachea and major lung bronchi. Calculated wall shear stress values are compared to a limited set of published measurements taken from a physical model. The measurements are discussed in the context of a flow study of a complex bronchial network. A more complete picture is achieved by the calculation method, indicating, in some cases, higher maximum wall shear stresses than measured, confirming the original findings of the experimental work. Recommendations are made as to where further work would be beneficial to medical applications.

Spin-exchange-induced circularly polarized molecular fluorescence

We have measured the circular polarization of light emitted from both atomic H and molecular H2 after bombarding H2 with longitudinally polarized electrons. For both atomic and molecular fluorescence near threshold we observe a circular polarization as great as 10% of the electron polarization. This represents the first direct observation of spin transfer in electron-molecule collisions.

The design and development of a triaxial wear-testing joint simulator

Most of the existing wear testers created to wear test total hip replacements, specifically the acetabular component, are designed to exert only an axial force and provide rotation in a close approximation of the actual femoral movement. The Rocky Mountain Joint Simulator was designed to exert three orthogonal forces and provide rotations about the X-, Y- and Z-axes to more closely simulate the physiological forces and motions found in the human gait cycle. The RMJS was also designed with adaptability for other joints, such as knees or canine hips, through the use of hydraulics and a computer-programmable control system. Such adaptability and functionality allows the researcher to more closely model a gait cycle, thereby obtaining wear patterns that resemble those found in retrieved implants more closely than existing simulators. Research is ongoing into the tuning and evaluation of the machine and preliminary acetabular component wear test results will be presented at the conference.

Developmental stage-specific life-cycle bioassay for assessment of sediment-associated toxicant effects on benthic copepod production

In chronic bioassays of sediment organic compounds, toxicant exposures often decline through time, such that the beginning of a test yields disproportionately higher exposures than the end. Thus, those life stages initiating a test often are exposed to the highest concentrations, and for rapidly maturing test fauna, this may lead to varying conclusions regarding compound toxicities depending on the initial life stage chosen. This problem can be addressed by comparative full life-cycle tests initiated with different test-organism life stages. Thus, a full life stage-to-life stage toxicity test was developed for the rapidly maturing meiobenthic copepod Amphiascus tenuiremis to assess the importance of developmental stage at the onset of sediment toxicant exposure relative to reproduction, net population growth, and sex and age structure. Tests were conducted with a model spiked-sediment insecticide, chlorpyrifos, for each of the major life stages (P1) of A. tenuiremis (nauplius, copepodite, and adult). Each P1 stage was allowed to mature and reproduce in low chlorpyrifos concentrations (6-33% of stage-specific 96-h LC50s; 4-22 ng chlorpyrifos/g dry sediment) for 26 d. Test endpoints were numbers of surviving adult females, males, eggs per female (clutch), first generation (F1) nauplii, F1 copepodites, F1 total production, and realized F1 production per surviving female. Only the copepodite P1 test showed a significant decline in survival of an adult age class: females declined by 28% at 22 ng/g. Reductions in total production ranged from 33-96% of controls from nauplius to adult. The P1 naupliar stage was most sensitive, with F1 production being 33-47% of that in controls. However, on a realized production per female basis, both the copepodite and naupliar P1 yielded significantly reduced F1s of 23 and 40% of controls at 11 and 22 ng/g.

Life-table evaluation of sediment-associated chlorpyrifos chronic toxicity to the benthic copepod, Amphiascus tenuiremis

A partial life-cycle experiment was conducted to assess chronic effects of sediment-associated chlorpyrifos, an organophosphate pesticide, on a marine, benthic copepod population. The static-renewal experiment was initiated with 4 treatments including control, 13 replicates per treatment with one female (bearing first clutch of eggs) per replicate. No males were added because one fertilization is sufficient for several clutches. Once weekly, all replicate chamber contents (10-ml culture tubes with 1.5 ml of sediment and 5 ml of seawater) were sieved and enumerated to determine survival and fecundity. Surviving adult females were placed back into chambers with newly spiked sediments. This process was repeated for 7 weeks until all initial females were dead or reproduction had ceased for at least two weeks. Survival and fecundity data were then used to determine population dynamic parameters such as r (intrinsic rate of natural increase) for each treatment. Results revealed a chronic toxicity response with significant population effects (p<0.05) in all pesticide treatments versus the control; concentrations that represent 7-32% of the 96-hr LC50. The control treatment had an r value 26-52% higher than the pesticide treatments. This translated into a control population rate increase of up to twice that of pesticide treatments. In addition, significant reductions in weekly and total fecundity were found in all chlorpyrifos treatments. Based on these results, usage of population parameters with benthic copepods allows for an integrative measurement of population effects from chronic exposure to sediment-associated contaminants.

A bizarre case of vehicular suicide

The upper torso of a man was discovered under a highway sign next to tire tread marks leading from the highway and continuing beyond the sign. The victim's lower torso and automobile were also found along the same path 31 m (101 ft) and 41 m (133 ft) beyond the sign, respectively. The decedent was initially thought to be a disposed, homicide victim who had been dismembered by his assailant(s). Accident reconstruction revealed that the victim was the driver of the automobile and was transected by the highway sign stanchion as he protruded through the passenger side window of his moving vehicle. Based on the scene findings, autopsy, and psychological autopsy, the manner of death was classified as suicidal. The criteria used by medical examiners for vehicular suicide are also discussed.

Instructed heart rate control in a high heart rate population

Forty college students were selected from a large number of introductory psychology students on the basis of high heart rate during an initial screening session. Subjects were then contacted and participated in two additional sessions during which heart rate, respiration rate, and skin conductance measures were obtained. Each session consisted of a baseline period followed by five trial periods during which subjects attempted to control their heart rate or performed a visual tracking task. Subjects were randomly assigned to one of four groups. One group served as a control and monitored a visual feedback display driven by their own heart rate but received no instructions to decrease their heart rate. In contrast, the three heart rate control groups were instructed to decrease heart rate during the trial periods by utilizing a relaxation procedure, proportional biofeedback, or proportional biofeedback plus criterion information. No group differences were present during the baseline periods. During feedback trials, however, all the training groups differed from the control in heart rate but did not differ from each other. It is suggested that feedback displays may not facilitate heart rate reduction beyond the level achieved by instructing subjects to use a general relaxation procedure.

The Effects of Civilization Upon Our Eyes

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The Value of a Röntgen Examination in some Diseased Conditions of Bone

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