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While the seroprevalence of SARS-CoV-2 in healthy people does not differ significantly among age groups, those aged 65 years or older exhibit strikingly higher COVID-19 mortality compared to younger individuals. To further understand differing COVID-19 manifestations in patients of different ages, three age groups of ferrets are infected with SARS-CoV-2. Although SARS-CoV-2 is isolated from all ferrets regardless of age, aged ferrets (≥3 years old) show higher viral loads, longer nasal virus shedding, and more severe lung inflammatory cell infiltration, and clinical symptoms compared to juvenile (≤6 months) and young adult (1–2 years) groups. Furthermore, direct contact ferrets co-housed with the virus-infected aged group shed more virus than direct-contact ferrets co-housed with virus-infected juvenile or young adult ferrets. Transcriptome analysis of aged ferret lungs reveals strong enrichment of gene sets related to type I interferon, activated T cells, and M1 macrophage responses, mimicking the gene expression profile of severe COVID-19 patients. Thus, SARS-CoV-2-infected aged ferrets highly recapitulate COVID-19 patients with severe symptoms and are useful for understanding age-associated infection, transmission, and pathogenesis of SARS-CoV-2. Here, Kim et al. characterize SARS-CoV-2 infection in juvenile, young, and old aged ferrets to provide a further understanding of differences in COVID-19 severity in humans at different ages. Aged ferrets have higher viral loads, shed virus longer, and mimic the transcriptomic profile of severely infected patients.

Mycobacterium avium subspecies paratuberculosis (MAP) is the causative agent of Johne’s disease, a chronic emaciating disease of ruminants that causes enormous economic losses to the bovine industry, globally. However, there are still remaining clues to be solved in the pathogenesis and diagnosis of the disease. Therefore, an in vivo murine experimental model was tried to understand responses in early stage of MAP infection by oral and intraperitoneal (IP) routes. In the MAP infection size, and weight of spleen and liver were increased in the IP group compared with oral groups. Severe histopathological changes were also observed in the spleen and liver of IP infected mice at 12 weeks post-infection (PI). Acid-fast bacterial burden in the organs was closely related to histopathological lesions. In the cytokine production from splenocytes of MAP-infected mice, higher amounts of in TNF-α, IL-10, and IFN-γ were produced at early stage of IP-infected mice while IL-17 production was different at time and infected groups. This phenomenon may indicate the immune shift from Th1 to Th17 through the time course of MAP infection. Systemic and local responses in the MAP-infection were analyzed by using transcriptomic analysis in the spleens and mesenteric lymph nodes (MLN). Based on the analysis of biological processes at 6 weeks PI in spleen and MLN in each infection group, canonical pathways were analyzed with ingenuity pathway analysis in the immune responses and metabolism especially lipid metabolism. Infected host cells with MAP increased in the production of proinflammatory cytokines and reduced the availability of glucose at early stage of infection ( p < 0.05). Also, host cells secreted cholesterol through cholesterol efflux to disturb energy source of MAP. These results reveal immunopathological and metabolic responses in the early stage of MAP infection through the development of a murine model.

A variety of metabolic disorders are associated with a decrease in estradiol (E2) during natural or surgical menopause. Postmenopausal women are prone to excessive fat accumulation in skeletal muscle and adipose tissue due to the loss of E2 via abnormalities in lipid metabolism and serum lipid levels. In skeletal muscle and adipose tissue, genes related to energy metabolism and fatty acid oxidation, such as those encoding peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and estrogen-related receptor alpha (ERRα), are downregulated, leading to increased fat synthesis and lipid metabolite accumulation. The same genes regulate lipid metabolism abnormalities in the bone marrow. In this review, abnormalities in lipid metabolism caused by E2 deficiency were investigated, with a focus on genes able to simultaneously regulate not only skeletal muscle and adipose tissue but also bone metabolism (e.g., genes encoding PGC-1α and ERRα). In addition, the mechanisms through which mesenchymal stem cells lead to adipocyte differentiation in the bone marrow as well as metabolic processes related to bone marrow adiposity, bone loss, and osteoporosis were evaluated, focusing on the loss of E2 and lipid metabolic alterations. The work reviewed here suggests that genes underlying lipid metabolism and bone marrow adiposity are candidate therapeutic targets for bone loss and osteoporosis in postmenopausal women.

Retinal fundus images are used to detect organ damage from vascular diseases (e.g. diabetes mellitus and hypertension) and screen ocular diseases. We aimed to assess convolutional neural network (CNN) models that predict age and sex from retinal fundus images in normal participants and in participants with underlying systemic vascular-altered status. In addition, we also tried to investigate clues regarding differences between normal ageing and vascular pathologic changes using the CNN models. In this study, we developed CNN age and sex prediction models using 219,302 fundus images from normal participants without hypertension, diabetes mellitus (DM), and any smoking history. The trained models were assessed in four test-sets with 24,366 images from normal participants, 40,659 images from hypertension participants, 14,189 images from DM participants, and 113,510 images from smokers. The CNN model accurately predicted age in normal participants; the correlation between predicted age and chronologic age was R 2  = 0.92, and the mean absolute error (MAE) was 3.06 years. MAEs in test-sets with hypertension (3.46 years), DM (3.55 years), and smoking (2.65 years) were similar to that of normal participants; however, R 2 values were relatively low (hypertension, R 2  = 0.74; DM, R 2  = 0.75; smoking, R 2  = 0.86). In subgroups with participants over 60 years, the MAEs increased to above 4.0 years and the accuracies declined for all test-sets. Fundus-predicted sex demonstrated acceptable accuracy (area under curve > 0.96) in all test-sets. Retinal fundus images from participants with underlying vascular-altered conditions (hypertension, DM, or smoking) indicated similar MAEs and low coefficients of determination (R 2 ) between the predicted age and chronologic age, thus suggesting that the ageing process and pathologic vascular changes exhibit different features. Our models demonstrate the most improved performance yet and provided clues to the relationship and difference between ageing and pathologic changes from underlying systemic vascular conditions. In the process of fundus change, systemic vascular diseases are thought to have a different effect from ageing. Research in context. Evidence before this study . The human retina and optic disc continuously change with ageing, and they share physiologic or pathologic characteristics with brain and systemic vascular status. As retinal fundus images provide high-resolution in-vivo images of retinal vessels and parenchyma without any invasive procedure, it has been used to screen ocular diseases and has attracted significant attention as a predictive biomarker for cerebral and systemic vascular diseases. Recently, deep neural networks have revolutionised the field of medical image analysis including retinal fundus images and shown reliable results in predicting age, sex, and presence of cardiovascular diseases. Added value of this study . This is the first study demonstrating how a convolutional neural network (CNN) trained using retinal fundus images from normal participants measures the age of participants with underlying vascular conditions such as hypertension, diabetes mellitus (DM), or history of smoking using a large database, SBRIA, which contains 412,026 retinal fundus images from 155,449 participants. Our results indicated that the model accurately predicted age in normal participants, while correlations (coefficient of determination, R 2 ) in test-sets with hypertension, DM, and smoking were relatively low. Additionally, a subgroup analysis indicated that mean absolute errors (MAEs) increased and accuracies declined significantly in subgroups with participants over 60 years of age in both normal participants and participants with vascular-altered conditions. These results suggest that pathologic retinal vascular changes occurring in systemic vascular diseases are different form the changes in spontaneous ageing process, and the ageing process observed in retinal fundus images may saturate at age about 60 years. Implications of all available evidence . Based on this study and previous reports, the CNN could accurately and reliably predict age and sex using retinal fundus images. The fact that retinal changes caused by ageing and systemic vascular diseases occur differently motivates one to understand the retina deeper. Deep learning-based fundus image reading may be a more useful and beneficial tool for screening and diagnosing systemic and ocular diseases after further development.

Valvular inflammation triggered by hyperlipidemia has been considered as an important initial process of aortic valve disease; however, cellular and molecular evidence remains unclear. Here, we assess the relationship between plasma lipids and valvular inflammation, and identify association of low-density lipoprotein with increased valvular lipid and macrophage accumulation. Single-cell RNA sequencing analysis reveals the cellular heterogeneity of leukocytes, valvular interstitial cells, and valvular endothelial cells, and their phenotypic changes during hyperlipidemia leading to recruitment of monocyte-derived MHC-II hi macrophages. Interestingly, we find activated PPARγ pathway in Cd36 + valvular endothelial cells increased in hyperlipidemic mice, and the conservation of PPARγ activation in non-calcified human aortic valves. While the PPARγ inhibition promotes inflammation, PPARγ activation using pioglitazone reduces valvular inflammation in hyperlipidemic mice. These results show that low-density lipoprotein is the main lipoprotein accumulated in the aortic valve during hyperlipidemia, leading to early-stage aortic valve disease, and PPARγ activation protects the aortic valve against inflammation. Identifying the mechanisms underlying the early inflammatory phase of aortic valve disease is crucial for disease prevention. Here the authors perform single-cell RNA sequencing to show the immunomodulatory role of PPARγ in valvular endothelial cells during hyperlipidemia.

Background Targetable molecular drivers of gastric cancer (GC) metastasis remain largely unidentified, leading to limited targeted therapy options for advanced GC. We aimed to identify molecular drivers for metastasis and devise corresponding therapeutic strategies. Methods We performed an unbiased in vivo genome-wide CRISPR/Cas9 knockout (KO) screening in peritoneal dissemination using genetically engineered GC mouse models. Candidate genes were validated through in vivo transplantation assays using KO cells. We analyzed target expression patterns in GC clinical samples using immunohistochemistry. The functional contributions of target genes were studied through knockdown, KO, and overexpression approaches in tumorsphere and organoid assays. Small chemical inhibitors against Bcl-2 members and YAP were tested in vitro and in vivo . Results We identified Nf2 and Rasa1 as metastasis-suppressing genes through the screening. Clinically, RASA1 mutations along with low NF2 expression define a distinct molecular subtype of metastatic GC exhibiting aggressive traits. NF2 and RASA1 deficiency increased in vivo metastasis and in vitro tumorsphere formation by synergistically amplifying Wnt and YAP signaling in cancer stem cells (CSCs). NF2 deficiency enhanced Bcl-2-mediated Wnt signaling, conferring resistance to YAP inhibition in CSCs. This resistance was counteracted via synthetic lethality achieved by simultaneous inhibition of YAP and Bcl-2. RASA1 deficiency amplified the Wnt pathway via Bcl-xL, contributing to cancer stemness. RASA1 mutation created vulnerability to Bcl-xL inhibition, but the additional NF2 deletion conferred resistance to Bcl-xL inhibition due to YAP activation. The combined inhibition of Bcl-xL and YAP synergistically suppressed cancer stemness and in vivo metastasis in RASA1 and NF2 co-deficiency. Conclusion Our research unveils the intricate interplay between YAP and Bcl-2 family members, which can lead to synthetic lethality, offering a potential strategy to overcome drug resistance. Importantly, our findings support a personalized medicine approach where combined therapy targeting YAP and Bcl-2, tailored to NF2 and RASA1 status, could effectively manage metastatic GC.

PurposeThis cross-sectional study aimed to assess the effect of environmental cadmium (Cd) exposure and essential metal imbalance on renal tubular damage and oxidative stress in 979 adults living in a Cd-polluted area near an abandoned copper (Cu) refinery.MethodsWe analyzed urinary Cd concentrations, renal tubular damage and oxidative stress markers, such as beta-2 microglobulin (β2-MG) and N-acetyl-β-d-glucosaminidase (NAG) activity and urine malondialdehyde (MDA) levels. The serum copper-to-zinc ratio (CZR) was used as an essential metal imbalance indicator. We divided the subjects into two Cd exposure groups based on the reference level of urinary Cd for renal dysfunction (2 μg/g creatinine).ResultsThe geometric mean concentration of urinary Cd in all subjects was 2.25 μg/g creatinine. In both low and high Cd exposure groups, urinary Cd levels were positively correlated with urinary NAG activity, but not with serum CZR. After multivariate adjustment, serum CZR was strongly associated with urinary β2-MG levels in the low Cd exposure group (β = 1.360, P = 0.019) and was significantly associated with urinary MDA levels, regardless of Cd exposure level. In addition, the risk of renal tubular damage was significantly associated with urinary Cd level, particularly in the lowest or highest CZR tertile groups.ConclusionsEssential metal imbalance may be a determinant of oxidative stress and renal tubular damage in a chronically Cd-exposed population, and proper zinc supplementation will be effective in preventing adverse health effects due to Cd exposure.

Although particulate matter (PM) is a Group 1 carcinogen, few studies have evaluated the effect of PM exposure after a cancer diagnosis on survival. Herein, we evaluated the effect of exposure to ambient PM10 after a cancer diagnosis on survival using data from the Regional Cancer Registry cohort in Chungbuk Province, Korea. A total of 44,432 patients with cancer who survived for >1 year after being diagnosed between 2005 and 2018 were followed until 31 December 2019; there were 32,734 survivors (73.7%) and 11,698 deceased (26.3%). The average follow-up period was 67.7 months, and the cumulative average concentration of PM10 exposure of patients with cancer after a diagnosis was 49.0 µg/m3. When PM10 concentration increased by 1 standard deviation (5.2 µg/m3), the all-cause mortality risk increased 2.06-fold (95% CI: 2.02–2.11). This trend was most pronounced in the younger patient group and in patients with local-stage cancer. This study demonstrates that exposure to PM10 after cancer diagnosis might influence the survival of patients with cancer, requiring environmental preventive measures such as lower pollutant exposure.

Mesenchymal stem cells (MSCs) spontaneously assemble into three-dimensional (3D) spheroids under matrix-deficient conditions such as the synovial cavity, although their functional significance has yet to be fully elucidated. In this study, we used concave microwell cultures to promote the spontaneous aggregation of adipose-derived MSCs (ASCs) from OA patients, thereby mimicking the intra-articular microenvironment. We analyzed the paracrine factors of ASC aggregates and compared it with that of conventional 2D monolayer cultures. Notably, 3D aggregation significantly increased the secretion of HGF and VEGF, whereas FGF2 levels remained relatively unchanged. These results indicate that the structural characteristics of ASC aggregates enhance the secretion of key paracrine factors involved in angiogenesis and tissue repair. To functionally evaluate the biological relevance of the secreted factors, conditioned media (CM) from ASC aggregates were applied to human articular chondrocytes. The CM significantly promoted chondrocyte proliferation, an effect that was abolished by the addition of HGF-neutralizing antibodies, thereby highlighting HGF as a central mediator of the regenerative response. Additionally, we further explored whether extracellular factors could modulate growth factor expression such as HGF. In this context, we investigated the impact of low-concentration hyaluronic acid (HA), a key synovial component widely used in OA treatment. Co-treatment with HA not only amplified the expression and secretion of HGF, VEGF, and FGF2, but also promoted ASC proliferation. ASCs forming functional aggregates may exert regenerative effects as active paracrine modulators, and the addition of low-dose hyaluronic acid is expected to further enhance this function, offering a promising strategy for MSC-based osteoarthritis therapy.

This study aimed to design and evaluate a novel trans-bleb device (TBD) for draining aqueous humor trapped within fibrotic blebs following Ahmed glaucoma valve (AGV) implantation in dogs. Two clinically normal, purpose-bred Beagles underwent AGV implantation surgery in one eye. When a bleb was formed with increased intraocular pressure (IOP), the TBD was inserted through a fenestration created in the bleb. IOP measurements, slit-lamp biomicroscopic and ultrasound biomicroscopic (UBM) evaluations were performed during follow-up. Results showed that IOP in the eyes undergoing AGV surgery was significantly lower than in the contralateral normal eye ( P  < .001). After 3 weeks, the IOP increased, and the UBM examination confirmed the presence of a bleb wall and an underlying cavity. After TBD application surgery, a significant decrease in IOP was observed ( P  < .001). Histological findings indicated that the TBD effectively penetrated the fibrotic membrane surrounding the AGV, with observed mild inflammatory cell infiltration, neovascularization, and myofibroblast differentiation, suggesting filtering bleb formation. The TBD may offer a novel approach to address bleb fibrosis-related failure following glaucoma surgery, restoring aqueous humor flow, and thus reducing IOP. Further research is needed to validate its effectiveness, optimize its design, and assess long-term outcomes.