Resistance Exercise Program in Cognitively Normal Older Adults: CERT-Based Exercise Protocol of the AGUEDA Randomized Controlled Trial

OBJECTIVES

To provide a comprehensive CERT (Consensus on Exercise Reporting Template)-based description of the resistance exercise program implemented in the AGUEDA (Active Gains in brain Using Exercise During Aging) study, a randomized controlled trial investigating the effects of a 24-week supervised resistance exercise program on executive function and related brain structure and function in cognitively normal older adults.

DESIGN AND PARTICIPANTS

90 cognitively normal older adults aged 65 to 80 were randomized (1:1) to a: 1) resistance exercise group; or a 2) wait-list control group. Participants in the exercise group (n = 46) performed 180 min/week of resistance exercise (3 supervised sessions per week, 60 min/session) for 24 weeks.

INTERVENTION

The exercise program consisted of a combination of upper and lower limb exercises using elastic bands and the participant's own body weight as the main resistance. The load and intensity were based on the resistance of the elastic bands (7 resistances), number of repetitions (individualized), motor complexity of exercises (3 levels), sets and rest (3 sets/60 sec rest), execution time (40-60 sec) and velocity (as fast as possible).

SETTINGS

The maximum prescribed-target intensity was 70-80% of the participants' maximum rate of perceived exertion (7-8 RPE). Heart rate, sleep quality and feeling scale were recorded during all exercise sessions. Those in the wait-list control group (n = 44) were asked to maintain their usual lifestyle. The feasibility of AGUEDA project was evaluated by retention, adherence, adverse events and cost estimation on the exercise program.

RESULTS AND CONCLUSIONS

This study details the exercise program of the AGUEDA trial, including well-described multi-language manuals and videos, which can be used by public health professionals, or general public who wish to implement a feasible and low-cost resistance exercise program. The AGUEDA exercise program seems to be feasible by the high retention (95.6%) and attendance rate (85.7%), very low serious adverse event (1%) and low economic cost (144.23 € /participant/24 weeks). We predict that a 24-week resistance exercise program will have positive effects on brain health in cognitively normal older adults.

AB0020 COMPARATIVE DESCRIPTION OF CYTOKINES AND MATRIX METALLOPROTEINASES IN A GROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHROSIS UNDER A STRICT FOLLOW-UP COMPARED WITH COVID-19 PATIENTS

Background

COVID-19, rheumatoid arthritis (RA) and osteoarthrosis (OA) are diseases characterized by the secretion of cytokines related to the stimulation of the inflammatory response.

Objectives

To identify the differences in the cytokine and matrix metalloproteinases (MMP) profile within one acute infectious disease and two chronic inflammatory rheumatic diseases.

Methods

Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months), OA patients without strict clinical follow-up, evaluated once or twice a year, and Severe (mortality) COVID-19 patients were included. Eleven proteins (cytokines, MMPs and its tissue inhibitors) were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes were performed. Approval of Ethics Committee and informed consent were obtained.

Results

A total of 108 patients with RA and OA were compared with 20 severe COVID-19 patients. There were no significant differences through the method of Kruskall–Wallis, between RA and OA patients. IL1-B and MMP-2 were significantly lower in COVID-19 patients. Levels of IL-10, IL-1RA, IL-6, MMP-1, MMP-9, and TIMP-1 were significantly higher in COVID-19 patients. There were no differences in TNF-A, TIMP-2 and INF-G. (Table 1)

Table 1.

Significant correlations between cytokines related to Covid-19, RA and OR.

Cytokine (pg/ml) Median valuesRA (%)OACOVID-19P-valueIL-1054.9254.49116.38<0.0001aIl1-RA62.1951.82110.08<0.0001aIL1-B67.0955.3046.170.045IL-656.0951.3484.98<0.0001b 0.003cTNF-A17.514.616.3NSMMP-1d57.8454.8490.81<0.0001b 0.045cMMP-2 d70.3870.5948.560.040MMP-9 d66.2558.1686.40.007 bTIMP-1 d51.5960.99111.67<0.0001aTIMP-2 d45.247.749.6NSINF-G5.755.323.07NS

a Between RA and Covid-19 and OA and Covid-19, without differences between RA and OA. b Between OA and Covid-19.

C Between RA and Covid-19. d ng/ml.

Conclusion

Compared with RA and OA patients, severe COVID-19 patients have a great impact on the cytokines and MMPs addressed in this study, proving that COVID-19 patients suffer from a cytokine storm [1] when severely infected.

References

[1]R. Mulchandani, T. Lyngdoh, and A. K. Kakkar, “Deciphering the COVID-19 cytokine storm: Systematic review and meta-analysis,” Eur. J. Clin. Invest., vol. 51, no. 1, pp. 1–21, 2021, doi: 10.1111/eci.13429.

Disclosure of Interests

None declared

AB0250 DESCRIPTION OF ARTERIAL STIFFNESS, INFLAMMAGING AND VASCULAR AGE IN A GROUP OF PATIENTS WITH RHEUMATOID ARTHRITIS UNDER A STRICT FOLLOW-UP COMPARED WITH UNCONTROLLED OSTEOARTHRITIS PATIENTS

Background

The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than in individuals in the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level, called vascular aging reflected by arterial stiffness and endothelial dysfunction

Objectives

The aim of the study was to compare vascular age and arterial stiffness (PWV-Pulse Wave Velocity) in two groups of patients with RA and with osteoarthritis (OA) and to assess the influence of inflammaging (persistent low-grade inflammation that develops with age) and metabolic markers in these outcomes.

Methods

Analytical cross-sectional study. RA patients under a strict follow-up program (T2T evaluated every two months) and OA patients without strict clinical follow-up, evaluated once or twice a year, were included. Patients with history of uncontrolled hypertension, CVD and/or current smoking were excluded. Waist-hip ratio, body mass index (BMI), DAS28 (RA), C-Reactive protein (CRP), Erythrocyte sedimentation rate (ESR), glycemia and lipid profile were measured. PWV and vascular age (in years) were evaluated through oscillometric method, arteriograph-TensioMed. Eleven proteins components of the inflammaging (cytokines, Matrix metalloproteinases - MMPs and its tissue inhibitors), were quantified through Luminex multiplex assay in serum samples. Univariate and bivariate analyzes (Chi-square and non-parametric correlations) were performed. Approval of Ethics Committee and informed consent were obtained.

Results

A total of 106 patients (74% women) were included (52/RA and 54/OA). Mean age was 57±5.6 years without differences between groups. There were significant differences in CRP and ESR (higher in RA) and in BMI, waist circumference and weight (higher in OA). RA patients had low disease activity level (DAS28: Median 2.6, IQR 1.3). There were no differences in PWV, vascular age or inflammaging (except for MMP-1, higher in RA), between the groups. PWV had a positive correlation with LDL (Rho Coef. 0.218 p=0.025). Patients who performed physical activity had a lower vascular age than those who did not [43 Interquartile range (IQR)23 vs 60 IQR 17, p=0.032). Vascular age was higher in RA patients who did not receive methotrexate 60 (IQR 19.3) compared with patients under methotrexate treatment 44.5 (IQR 23) (p = 0.017). Also, vascular age was lower in OA patients under prescribed physical activity (43 IQR 24.8 vs 56.5 IQR 20, p=0.03). MMP-9 in RA patients (Rho 0.283, p=0.042) and IL-10 in OA patients (Rho 0.290, p= 0.036) correlated with diastolic pressure. The components of inflammaging did not correlate with vascular age. The Framingham Risk Score was strongly associated with vascular age.

Table 1.

Significant correlations with vascular age

VariableSpearman’s Rhop-valueLDL levels0.2000.040Systolic blood pressure0.3000.002Mean arterial blood pressure0.2100.031Daily coffee cups intake-0.2120. 045Framingham Risk Score0.340<0.0001MDHAQ score in RA patients0.4170.002

LDL: low density lipoprotein; MDHAQ: multidimensional health assessment questionnaire.

Conclusion

In RA strictly controlled patients, there are no differences in endothelial dysfunction, vascular age or inflammaging, when comparing with uncontrolled overweight OA patients. Physical activity, LDL levels and coffee consumption corelate with vascular age in OA and RA patients. OA patients under physiatrists follow-up and RA patients under methotrexate treatment or with low MDHAQ levels have lower vascular age levels.

References

[1]Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis. Santos-Moreno P, Burgos-Angulo G, Martinez-Ceballos MA, et al Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis. RMD Open. 2021 Jan;7(1):e001470

Disclosure of Interests

None declared

Pathophysiology of deep vein thrombosis

Deep venous thrombosis is a frequent, multifactorial disease and a leading cause of morbidity and mortality. Most of the time deep venous thrombosis is triggered by the interaction between acquired risk factors, such as hip fracture, pregnancy, and immobility, and hereditary risk factors such as thrombophilias. The mechanisms underlying deep venous thrombosis are not fully elucidated; however, in recent years, important advances have shed light on the role of venous flow, endothelium, platelets, leukocytes, and the interaction between inflammation and hemostasis. It has been described that the alteration of venous blood flow produces endothelial activation, favoring the adhesion of platelets and leukocytes, which, through tissue factor expression and neutrophil extracellular traps formation, contribute to the activation of coagulation, trapping more cells, such as red blood cells. Thus, the concerted interaction of these phenomena allows the formation and growth of the thrombus. In this work, the main mechanisms involved in the pathophysiology of deep vein thrombosis will be described.

The Role of Coffee and its Bioactive Components in Platelet Function and Aging

Cardiovascular diseases (CVD) are known to be the world's leading cause of death, and different factors are known to increase the risk of death, including aging, mainly due to increased oxidative stress and inflammation observed in older people. Acute myocardial infarctions and cerebrovascular accidents belong to CVD, and are the ones that cause the most deaths and disabilities, where greater platelet activation plays an important role in pathophysiology. These diseases are more prevalent in older people, which have a clear relationship with increased platelet function and are strongly related to aging. Platelet function is affected by diet, which varies in its requirements and characteristics according to age. Coffee belongs to the family of diet elements that can alter platelet function and an increase in coffee consumption with advancing age and a U-shaped correlation with the risk of CVD have been reported. However, the effect of coffee consumption and its bioactive compounds on platelet function and aging presents controversial evidence, and therefore, a complex effect is not fully elucidated in the cardiovascular system. This review focuses on the relationship between coffee consumption (and its constituent bioactive compounds), and platelet function, and aging.

Aqueous Extract of Tomato (Solanum lycopersicum L.) and Ferulic Acid Reduce the Expression of TNF-α and IL-1β in LPS-Activated Macrophages

Acute inflammation is essential for defending the body against pathogens; however, when inflammation becomes chronic, it is harmful to the body and is part of the pathophysiology of various diseases such as Diabetes Mellitus type 2 (DM2) and Cardiovascular Disease (CVD) among others. In chronic inflammation macrophages play an important role, mainly through the secretion of proinflammatory cytokines such as Tumor necrosis factor (TNF)-α and Interleukin (IL)-1β, explained in part by activation of the Toll-like receptor 4 (TLR4), a signaling pathway which culminates in the activation of Nuclear factor (NF)-κB, an important transcription factor in the expression of these proinflammatory genes. On the other hand, the benefits on health of a diet rich in fruit and vegetables are well described. In this work, the effects of aqueous extract of tomato and ferulic acid on the expression of proinflammatory cytokines in LPS activated monocyte-derived THP-1 macrophages were investigated. In addition, using Western blot, we investigated whether the inhibition was due to the interference on activation of NF-κB. We found that both the tomato extract and ferulic acid presented inhibitory activity on the expression of TNF-α and IL-1β cytokine by inhibiting the activation of NF-κB. The current results suggest that tomatoes and ferulic acid may contribute to prevention of chronic inflammatory diseases.

Diabetes surgery in type 2 BMI 24-29 vs IMC 30-34 diabetic patients: is there differences among restrictive, malabsorptive and gastric bypass procedures?

Diabetes mellitus (DM) is a public health problem with a prevalence of 345 million people worldwide that it may double by the year 2030 and have a high costs and mortality. Gastrointestinal surgery is accepted as a form of treatment that was already suggested for obese in 1987 by Pories, confirmed for obese patients by the metaanalysis of Buchwald and the direct comparison of gastric bypass with medical treatment in the study of Schauer that demonstrate a 4 fold greater resolution rate of DM with surgery. Improvement occurs immediately after surgery, before the patients lose weight in with BMI > 35; but there is doubt if the existent evidence is enough to extrapolate these results to patients with BMI < 35 and especially with BMI < 30, in spite that four reviews in patients with this BMI and DM2 demonstrated the same results when stomach, duodenum and part of jejunum is bypassed as happen gastric bypass (better results with this of one anastomosis than of two anastomosis, Roux-en-Y) BPD. For patients with a BMI between 30 and 35 restrictive techniques: LAGB and SGL are good but not better than the mixed: RYGB, BAGUA, or SG-DJB with remission from 60 to 100%, minor in the derivative: BPD and above on the IID with a 81% of remission. There are no differences in the metabolic control in comparison to the obese, It is progressively better with DJB, SDS, IID and BAGUA especially in patients who do not require insulin, have less time with disease, have normal C peptide levels, and not so much relation with the initial BMI that is only important to decide the degree of restriction. Although several mechanisms has been suggested for explaining these results such as caloric intake, hormonal changes, bypass of the anterior or early stimulation of posterior intestine, fundectomy, intestinal gluconeogenesis and others, new ones will appear in the near future.

Effect of lamivudine on human T-cell leukemia virus type 1 (HTLV-1) DNA copy number, T-cell phenotype, and anti-tax cytotoxic T-cell frequency in patients with HTLV-1-associated myelopathy

Patients with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) typically have a high HTLV-1 proviral load in peripheral blood mononuclear cells and abundant, activated HTLV-1-specific cytotoxic T lymphocytes (CTLs). No effective treatment for HAM/TSP has been described so far. We report a 10-fold reduction in viral DNA for five patients with HAM/TSP during treatment with the reverse transcriptase inhibitor lamivudine. In one patient with recent-onset HAM/TSP, the reduction in viral DNA was associated with a fall in the frequency of CTLs specific to two peptides in the immunodominant viral antigen Tax. The half-life of peripheral blood mononuclear cell populations was estimated from changes in viral DNA copy number, CTL frequency, reduction in CD25 expression, and the loss of dicentric chromosomes following radiation-induced damage. Each of these four different techniques indicated a cellular half-life of approximately 3 days consistent with continuous lymphocyte replication and destruction. These results indicate that viral replication through reverse transcription significantly contributes to the maintenance of HTLV-1 viral DNA load. The relative contribution of proliferation versus replication may vary between infected people.

Bixin and norbixin in human plasma: determination and study of the absorption of a single dose of Annatto food color

A procedure was developed for the detection and determination of bixin and norbixin in human plasma by reversed-phase HPLC with a sensitivity limit of 5 micrograms l-1. A group of seven volunteers ingested a single dose of 1 ml of a commercial Annatto Food Color (16 mg of cis-bixin in soybean oil). The presence of bixin (cis and trans) and norbixin (cis and trans) was demonstrated in the plasma at average levels of 11.6, 10.1, 2.8 and 0 micrograms l-1 of bixin and 48, 58, 53 and 29 micrograms l-1 of norbixin after 2, 4, 6 and 8 h, respectively. Considerable individual variations were observed. Complete plasma clearance generally occurred for bixin by 8 h and for norbixin by 24 h after ingestion of cis-bixin.

Exploration of the relationship between tetrachlorohydroquinone dehalogenase and the glutathione S-transferase superfamily

Tetrachlorohydroquinone dehalogenase is found in Sphingomonas chlorophenolica, a soil bacterium that degrades pentachlorophenol, a widely used wood preservative. This enzyme converts tetrachlorohydroquinone (TCHQ) to trichlorohydroquinone (TriCHQ) and TriCHQ to dichlorohydroquinone (DCHQ) (Xun et al. (1992) J. Bacteriol. 174, 8003-8007). The reducing equivalents for each step are provided by two molecules of glutathione (Xun et al. (1992) Biochem. Biophys. Res. Commun. 182, 361-366). In addition to the expected TriCHQ and DCHQ products, the enzyme also produces substantial amounts of 2,3,5-trichloro-6-S-glutathionylhydroquinone (GS-TriCHQ) and an unidentified isomer of dichloro-S-glutathionylhydroquinone (GS-DCHQ). Treatment of the purified enzyme with dithiothreitol dramatically decreases the formation of GS-TriCHQ and GS-DCHQ. Furthermore, enzyme in freshly-prepared crude extracts forms only very small amounts of GS-TriCHQ and GS-DCHQ. We conclude that GS-TriCHQ and GS-DCHQ are produced by enzyme that has undergone some type of oxidative damage and are therefore not physiologically relevant products. The fact that the oxidative damage can be repaired by DTT suggests that a cysteine or methionine residue may be involved. We have created the C13S and C156S mutants of the enzyme. The C13S mutant converts TCHQ to GS-TriCHQ and GS-DCHQ, rather than to DCHQ. Thus, Cys13 is required for the reductive dehalogenation of TCHQ. A mechanism for the reaction which involves Cys13 is proposed.

Cross-protection between species of the Schistosoma haematobium group induced by vaccination with irradiated parasites

Mice vaccinated with irradiated cercariae of Schistosoma haematobium, S. bovis and S. margrebowiei showed good levels of resistance (38-62%) against an homologous challenge, and varying degrees of resistance (19-46%), against challenges with closely related species. No protection against S. mansoni was induced by vaccination with any of these species. This restricted cross-protection reflects the close phylogenetic relationship between species of the S. haematobium group and indicates that immunologically important epitopes are conserved within this species complex.

Molecular isoforms of chicken growth hormone (cGH): different bioactivities of cGH charge variants

It has been suggested that the functional diversity of growth hormone (GH) is related to its molecular complexity. Here we report a characterization of charge and mass variants of chicken growth hormone (cGH) through a variety of electrophoretic systems [nondenaturing (ND-PAGE), denaturing (SDS-PAGE), under reducing and nonreducing conditions, isoelectrofocusing (IEF), and bidimensional electrophoresis] followed by Western blot and immunostaining with a specific antibody directed against pure cGH. We also report the biological properties of two charge variants on two homologous assays. The studies were carried out with purified cGH and with fresh chicken pituitary extracts. Three charge variants were obtained by ND-PAGE (Rf = 0.23, 0.30, and 0.35), which showed the same molecular weight (26 kDa), while in IEF eight isoforms were observed, the most conspicuous being those with pI = 6.86, 7.5, 7.9, 8.05, and 8.18. In SDS-PAGE under reducing conditions four immunoreactive bands were observed: the monomer (26 kDa), a dimer (52 kDa), a fragment (16 kDa), and a minor band at 22 kDa. Higher MW variants were found under nonreducing conditions. Bidimensional analysis also showed several charge variants for the monomer and the dimer. Bioactivity of two charge variants (0.23 and 0.3) was evaluated with a lipolytic and an antilipolytic assay on chicken adipose tissue explants. It was shown that variant 0.23 was mainly lipolytic, in a dose-dependent response, but lacked antilipolytic effect. On the other hand, variant 0.30 did not show lipolytic effect but presented a clear antilipolytic activity.

[Fractionation protocols in radiotherapy]

Several investigations carried out recently have shown that cancer radiotherapy obtains better results in some tumors when multiple daily fractionation is employed. The authors review the different kinds of dose fractionation and the obtained results.