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More action needed to prevent arthritis, say researchers

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MSU researchers have concluded that little is being done to address the prevalence of early knee osteoarthritis (OA) symptoms faced by patients after anterior cruciate ligament (ACL) reconstruction, calling for more action.

Scholars from Michigan State University’s Department of Kinesiology have published a new study in the Journal of Athletic Training in January showing these OA symptoms persist throughout the first year following surgery and need to be addressed with early intervention.

“We’re trying to change the narrative,” said Assistant Professor Matthew Harkey, who authored the study. “We see fairly young, active individuals experiencing extensive symptoms, but these symptoms are not interpreted by clinicians as something that may be related to osteoarthritis.

“Ignoring these symptoms might be setting them up to experience long term decline and function.”

ACL reconstruction is an arthroscopic surgical procedure that replaces torn anterior cruciate ligament in the knee with a graft. According to the National Institutes of Health, approximately 400,000 procedures are completed each year in the United States.

A 2017 study showed that approximately 14 million individuals in the United States alone suffer from symptomatic early knee OA.

The research team examined a data set of 82 individuals who underwent ACL reconstruction, each of whom completed a survey regarding their knee pain and symptoms following surgery. The results showed nearly one-in-four participants reported persistent early arthritis symptoms from 6 to 12 months after knee surgery.

In April 2024, Harkey will head to Austria and present similar research at the Osteoarthritis Research Society International Conference. This time, he used data from 3,200 individuals supplied by the New Zealand ACL Registry and found that close to one-in-three had early knee OA symptoms up to 24 months after ACL reconstruction.

The importance of intervention

Not addressing these symptoms in a timely manner places patients at risk for long-term structural decline, says Harkey. Although the study doesn’t show that patients experiencing symptoms will develop early OA, it heightens athletic trainers’ awareness of the possibility of symptoms, which could be addressed with intervention.

“It’s a bit complex – we can’t outright say arthritis is developing, but there’s a large group of patients whose symptoms linger long after surgery,” Harkey pointed out. “Often, clinicians assume that these post-operative symptoms will naturally improve as patients reengage with their usual activities. However, what we’re seeing suggests these symptoms persist and likely require a targeted approach to manage or improve them.”

According to Harkey, intervention could include exercise or physical therapy to help maintain strength and movement. He added that the healthcare infrastructure remains a barrier for patients, who often are limited to a low number of physical therapy visits through their healthcare plans.

The co-authors of the study with MSU affiliations include Ashley Triplett, assistant professor in the College of Education; Sheeba Joseph, associate professor, Colleges of Human and Osteopathic Medicine; Francesca Genoese, doctoral student in the Department of Kinesiology; Michael Shingles and Andrew Schorfhaar of Sparrow Hospital, alums of the College of Osteopathic Medicine.

Moving forward, Harkey aims to demonstrate how early knee OA after ACL reconstruction may lead to structural joint damage over time.

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Ageing fight revealed in new ‘muscle map’

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The first comprehensive cell atlas of ageing human muscle reveals the intricate genetic and cellular processes behind muscle deterioration and mechanisms to counteract it.

How muscle changes with ageing, and tries to fight its effects, is now better understood at the cellular and molecular level with the first comprehensive atlas of ageing muscles in humans.

Researchers from the Wellcome Sanger Institute and their collaborators at Sun Yat-sen University, China applied single-cell technologies and advanced imaging to analyse human skeletal muscle samples from 17 individuals across the adult lifespan. By comparing the results, they shed new light on the many complex processes underlying age-related muscle changes.

The atlas uncovers new cell populations that may explain why some muscle fibres age faster than others. It also identifies compensatory mechanisms the muscles employ to combat ageing.

The findings offer avenues for future therapies and interventions to improve muscle health and quality of life as we age.

This study is part of the international Human Cell Atlas initiative to map every cell type in the human body, to transform understanding of health and disease.

As we age, our muscles progressively weaken. This can affect our ability to perform everyday activities like standing up and walking. For some people, muscle loss worsens, leading to falls, immobility, a loss of autonomy and a condition called sarcopenia. The reasons why our muscles weaken over time have remained poorly understood.

In this new study, scientists from the Wellcome Sanger Institute and Sun Yat-sen University, China used both single-cell and single-nucleus sequencing techniques along with advanced imaging to analyse human muscle samples from 17 individuals aged 20 to 75.

The team discovered that genes controlling ribosomes, responsible for producing proteins, were less active in muscle stem cells from aged samples. This impairs the cells’ ability to repair and regenerate muscle fibres as we age. Further, non-muscle cell populations within these skeletal muscle samples produced more of a pro-inflammatory molecule called CCL2, attracting immune cells to the muscle and exacerbating age-related muscle deterioration.

Age-related loss of a specific fast-twitch muscle fibre subtype, key for explosive muscle performance, was also observed. However, they discovered for the first time several compensatory mechanisms from the muscles appearing to make up for the loss. These included a shift in slow-twitch muscle fibres to express genes characteristic of the lost fast-twitch subtype, and increased regeneration of remaining fast-twitch fibre subtypes.

The team also identified specialised nuclei populations within the muscle fibres that help rebuild the connections between nerves and muscles that decline with age. Knockout experiments in lab-grown human muscle cells by the team confirmed the importance of these nuclei in maintaining muscle function.

Veronika Kedlian, first author of the study from the Wellcome Sanger Institute, said: “Our unbiased, multifaceted approach to studying muscle ageing, combining different types of sequencing, imaging and investigation reveals previously unknown cellular mechanisms of ageing and highlights areas for further study.”

Professor Hongbo Zhang, senior author of the study from Sun Yat-sen University, Guangzhou, China, said: “In China, the UK and other countries, we have ageing populations, but our understanding of the ageing process itself is limited. We now have a detailed view into how muscles strive to maintain function for as long as possible, despite the effects of ageing.”

Dr Sarah Teichmann, senior author of the study from the Wellcome Sanger Institute, and co-founder of the Human Cell Atlas, said: “Through the Human Cell Atlas, we are learning about the body in unprecedented detail, from the earliest stages of human development through to old age.With these new insights into healthy skeletal muscle ageing, researchers all over the world can now explore ways to combat inflammation, boost muscle regeneration, preserve nerve connectivity, and more. Discoveries from research like this have huge potential for developing therapeutic strategies that promote healthier ageing for future generations.”

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UK body calls for more ageing research backing

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The British Society for Research on Ageing (BSRA) is calling for more public backing in the UK for research to help people stay healthier for longer, as an alternative to charities that support research on diseases.

The greatest risk factor for disease is ageing, but we have very little charitable support for research into how to slow ageing, the organisation warns.

Many diseases such as cancers and heart disease tragically shorten lives far too early, or like Alzheimer’s and arthritis, destroy quality of life for patients and carers. There is understandably huge public charitable support for more research. However, the greatest risk factor for those diseases, and even infectious diseases like COVID, is ageing.

Yet in comparison there is currently very little support for research to understand how we can slow ageing to prevent disease. This approach may be more productive in the long term to fight disease. Furthermore, keeping people healthier for longer, or avoiding chronic diseases all together, would be the most favourable outcome.

The UK population is ageing fast, putting pressure on the NHS and the economy. Despite this pressing problem all around us, there is no accessible way for people to support research into ageing in the UK. The BSRA aims to change that.

With a very small budget and almost completely run by volunteers, the BSRA has successfully funded several small research projects but progress needs to be accelerated. More funding is needed because it takes years to see the effects of ageing, so studies are long. Also ageing affects individuals in different ways, meaning that large numbers of people must be studied to make firm conclusions.

Therefore, there is an urgency to get studies funded and the BSRA has decided to launch an ambitious fundraising campaign to boost research into ageing. Initially, the Society aims to fund a series of one year research projects at the Masters degree level at universities across the UK and with plans to raise much more in the future to support longer and more ambitious projects that will impact the lives of the general public.

Chair of the BSRA, Prof David Weinkove from Durham University, says “The time is now to really get behind research into the biology of ageing. We have fantastic researchers across the country, but they are held back by a lack of funding. Evidence-based research is needed to understand how we people can stay healthier for longer, and to then we must make that knowledge available to as many people as possible”.

Dr Jed Lye says “This is a great opportunity for the public to help, for corporations to contribute, or philanthropists wanting a large impact with a relatively small donation; every £20,000 we raise can fund an entire year of research into ageing and longevity, and gets a budding scientist their research qualification.”

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Agetech World podcast: The age-old lessons we can learn from Japan

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With governments across the globe facing a ticking timebomb when it comes to funding the care needs of their ageing populations, a leading social and medical anthropologist has told the latest Agetech World podcast that there is much Japan can teach policymakers.

Click here to listen to the latest Agetech World podcast

Among Dr Iza Kavedžija’s main research interests is exploring the lived experience of ageing in urban Japan.

The Assistant Professor of Medical Anthropology in Cambridge University’s Department of Social Anthropology has lived in Japan and conducted extensive ethnographic fieldwork with two distinct groups of people in the Kansai region.

This led to her first in-depth study, Making Meaningful Lives: Tales from an Ageing Japan, and has underpinned a series of journal articles addressing a broad range of topics including care, hope and hopelessness, and happiness and gratitude.

In conversation with Agetech World, Dr Kavedžija said Japan had long been known for its widespread respect for the older population and its sense of obligation to caring for them.

The country has one of the world’s oldest populations, with nearly 30% of its 125m inhabitants aged over 65. This age group is expected to account for 34.8% of the populace by 2040.

Whilst this is inevitably putting a strain on Japan’s long-term care system, the country’s politicians and wider society are continuing to learn, evolve, and devise radical solutions to meeting this growing demographic challenge.

Japan has always had a strong tradition of family caring for its older citizens. But to this has been added a Long-Term Care Insurance (LCT) scheme, a complete package for the over-65s covering both the financing and the implementation of social care according to needs, supported by mandatory premiums levied on those aged 40-plus and co-payments from users.

Further responding to the nation’s ageing society, Japan is preparing to introduce a new Community-based Integrated Care System by 2025, with the aim of ensuring the comprehensive provision of health and nursing care, housing, and livelihood support.

Japan has also been working on developing robots to automate care for older adults, and other innovations include government investment in non-medical activities that can help prevent age-related illnesses; helping the over-65s flourish by working with them in their homes and communities rather than expecting them to conform to current societal norms or live in neglect; and making their towns and cities easier to navigate so seniors can still participate in everyday life whether for pleasure or work.

The number of residential homes is restricted with the emphasis on community care

Dr Iza Kavedžija

Asked what Japan can teach the likes of the UK – which is facing a soaring health and care crisis – Dr Kavedžijan said: “I think there are many things that Japan has paid close attention to.

“I think the Long-Term Care Insurance is one of a kind… that allows for the drawing on services from various sectors, so it is possible to create a mix of forms of support, whether it be home care, whether it be various forms of assisted living…so a lot of interventions that are in the community and a lot of providers that range from non-governmental to the state sector to the private sector, where one can create a plan of care and support with a care manager that’s tailored to the needs (of the individual) drawing from the broad range of services.

“It isn’t always the same sort of story where the plan has led towards institutional living.

“In this sense I think Japan has been particularly successful. Of course, as the proportion of older people is so high in the population, this system is somewhat coming under strain. I don’t want to represent it as a particularly rosy situation. It isn’t. There are challenges to it.

“But I think nonetheless that this very, very well thought out system of support is important and it also cultivates these various forms of dependence, or interdependence, where one can draw on different types of assistance.”

Dr Kavedžija added: “It actually also allows people to continue living relatively independent lives….it doesn’t necessarily mean they have to move in with their children.

“So, they think of older people as the ones who continue the tradition and social changes as something that is brought on by younger people.

“In this case, I think we have seen very clearly that it is older people themselves that have often been the active leaders in social change. They have been the ones often saying, ‘I know there is an expectation for me to depend on my older son, but I don’t want to be a burden on my children.’

“So, they cultivate various forms of care in the community and they themselves become very involved in a huge range of activities, volunteer activities, that foster support in the community and create these communities of care.

“That is, I think another lesson that would translate well elsewhere.”

But Dr Kavedžijan also gave a note of caution. “I don’t want to paint too much of a positive picture because certainly challenges are there. That is something that again is perhaps an important lesson, and that is to do with the circulation of care, as I like to call it, where we need to think of care in systemic ways.

“For instance, elder care largely depends on a volunteer workforce, and that had for many years often consisted of women.

“In order to support better care for elders I think it is necessary to consider in which ways we can perhaps support childcare. So, to think about these flows of care in a much broader way and try and foster support across the board rather than thinking of them as separate units…that are not intertwined.”

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