Современная геронтология рассматривает старение как пластичный процесс, открывающий возможности для его модуляции через нутритивные и фармакологические интервенции. В фокусе данного обзора находится комплексный анализ уникального морского биоисточника — тканей голотурий (морских огурцов), рассматриваемого в качестве многообещающей поликомпонентной основы для разработки новейших геропротекторных средств. Детальному рассмотрению подвергнуты ключевые биологически активные соединения, выделяемые преимущественно из стенки тела, — низкомолекулярные пептиды-матрикины и уникальный спектр тритерпеновых гликозидов. Освещена их способность к синергическому, мультитаргетному воздействию на ключевые механизмы клеточного и тканевого старения, такие как регуляция окислительного стресса через активацию пути Nrf2, подавление хронического воспаления (инфламэйджинга) посредством ингибирования сигнального каскада NF-κB, поддержание гомеостаза внеклеточного матрикса и модуляция клеточного метаболизма. В обзоре систематизированы актуальные экспериментальные данные, демонстрирующие эффективность гидролизата голотурии в моделях фотостарения кожи, ускорения репарации ран, снижения атеросклеротических проявлений, нейропротекции, коррекции метаболических нарушений и т. п. Отдельное внимание уделено критическому ограничению для пероральных форм — проблеме возраст-ассоциированной биодоступности активных компонентов. Проанализированы перспективные фармакотехнологические решения для её преодоления, в частности инновационные системы доставки на основе альгинатных матриц. Цель обзора — систематизация современных экспериментальных данных о молекулярных основах геропротекторного действия биоактивных компонентов голотурии с акцентом на синергическое мультитаргетное влияние пептидов-матрикинов и тритерпеновых гликозидов на ключевые механизмы клеточного и тканевого старения, а также анализ перспективных фармакотехнологических решений для повышения их биодоступности. Представленные данные обосновывают перспективу создания безопасных, стандартизированных комплексов на основе гидролизата голотурии, что соответствует современным трендам превентивной, мультитаргетной и персонализированной геронтологии. Modern gerontology views aging as a plastic process, opening opportunities for its modulation through nutritional and pharmacological interventions. This review focuses on a comprehensive analysis of a unique marine biological source — holothurian (sea cucumber) tissues — considered as a promising multicomponent basis for the development of novel geroprotective agents. Key bioactive compounds, primarily isolated from the body wall, are examined in detail: low-molecular-weight matrikine peptides and a unique spectrum of triterpene glycosides. Their ability for synergistic, multitargeted action on key mechanisms of cellular and tissue aging is highlighted, such as the regulation of oxidative stress via activation of the Nrf2 pathway, suppression of chronic inflammation (inflammaging) through inhibition of the NF-κB signaling cascade, maintenance of extracellular matrix homeostasis, and modulation of cellular metabolism. The review systematizes current experimental data demonstrating the efficacy of holothurian hydrolysate in models of skin photoaging, accelerated wound repair, reduction of atherosclerotic manifestations, neuroprotection, and correction of metabolic disorders, among others. Particular attention is paid to a critical limitation for oral forms — the problem of age-associated bioavailability of active components. Promising pharmacotechnological solutions to overcome it are analyzed, particularly innovative delivery systems based on alginate matrices. This review aims to systematically summarize current experimental data on the molecular mechanisms underlying the geroprotective effects of bioactive compounds from sea cucumbers. The focus is on the synergistic, multitarget action of matrikine peptides and triterpene glycosides on key drivers of cellular and tissue aging. In addition, the review examines promising pharmacotechnological strategies designed to enhance the bioavailability of these compounds. The presented data substantiate the prospect of creating safe, standardized complexes based on holothurian hydrolysate, which aligns with current trends in preventive, multitargeted, and personalized gerontology.
Epigenetic mechanisms, including DNA methylation, histone modification, and regulation by non-coding RNAs, play a key role in cell cycle and cell senescence control. A special place among epigenetic regulators is occupied by sirtuins, NAD⁺-dependent deacetylases involved in maintaining genomic stability, DNA repair, and transcription regulation. In this article, we consider the role of sirtuins (SIRT1, SIRT2, SIRT6, SIRT7) as integrators of epigenetic signals affecting the passage of the cell cycle and cell aging.
This review analyzes the efficacy and safety of total arterial revascularization (TAR) in elderly patients. Given the global demographic aging and the high prevalence of coronary artery disease in individuals over 60, selecting the optimal coronary artery bypass grafting strategy is of paramount importance. The traditional use of autologous vein grafts is limited by their high susceptibility to atherosclerosis and occlusion in the long term. The TAR strategy, which utilizes only arterial bypasses (bilateral internal thoracic arteries, radial artery), aims to overcome this drawback.
Long-lived individuals are systematically excluded from large studies, creating a gap in the evidence base for managing myocardial infarction (MI) in this age group. Aim - to research the features of MI course and outcomes in long-lived patients depending on treatment strategies. Retrospective analysis of 32 medical records of long-lived patients (≥90 years) with MI. Clinical, laboratory, instrumental data, and treatment outcomes were evaluated. The mortality rate was 37,5%. Characteristic features included high comorbidity (100% - hypertension, 50% - atrial fibrillation). The most unfavorable prognostic factors were acute heart failure, atrial fibrillation, as well as elevated creatinine and leukocyte levels. Mortality in the percutaneous coronary intervention group was lower than in the conservative treatment group (27% vs. 43%). MI in long-lived patients occurs against a background of high comorbidity. Percutaneous coronary intervention is associated with lower mortality; however, this issue requires further prospective studies.
The analysis of the progression of chronic kidney disease (CKD) and cardiovascular events was performed in 318 patients aged 80 years and older during 12 months after myocardial infarction (MI). Patients were divided into 2 groups: with CKD (n=164) and without CKD (n=154). It was found that in patients with CKD, the urinary concentration of KIM-1 and the level of microalbuminuria (UACR) were significantly higher and remained elevated during the year, correlating with the rate of eGFR decline (r=-0,47; p<0,01) and NT-proBNP level. The median time to cardiovascular event in the CKD group was 198 [112; 289] days versus 312 [245; 358] days in the comparison group (p<0,001). The risk of the composite endpoint (death, recurrent MI, stroke) in the CKD group was 2,9 times higher (p<0,001). Independent predictors of adverse outcomes were KIM-1 >1,5 ng/ml (HR=2,3), UACR >30 mg/g (HR=2,1) and anemia (HR=1,8). The obtained data confirm that KIM-1 and microalbuminuria are significant predictors of adverse renal and cardiac prognosis in geriatric patients.
A single-center, retrospective study included 41 patients over 90 years of age who underwent primary percutaneous coronary intervention for the treatment of acute coronary syndrome in the period from 01.2019 to 01.2023. Based on electrocardiography data, patients were divided into 2 groups: Group 1 (n=21) with ST-segment elevation acute coronary syndrome (ST-ACS), Group 2 (n=20) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Multivessel coronary artery disease was detected in 71% of cases in STE-ACS versus 65% of cases in the NSTE-ACS group (p=0,658). Moreover, simultaneous complete revascularization was predominantly performed in NSTE-ACS (p=0,043). The length of stay in the intensive care unit was comparable (p=0,575), as was the overall length of hospital stay (p=0,463). In-hospital mortality was 35% for NSTE-ACS and 38,1% for STE-ACS (p=0,837). The incidence of hospital-acquired pneumonia, stroke, and bleeding did not differ significantly between the comparison groups. According to the data obtained, patients over 90 years of age with acute coronary syndrome with and without ST-segment elevation can successfully and safely undergo percutaneous coronary intervention.
The presence of aortic valve defects in patients is associated with a more severe course of coronary heart disease and heart failure. This article examines the impact of aortic valve defects on the risk of developing and progressing coronary heart disease. The study was conducted based on a retrospective statistical assessment of own clinical experience (a sample of 193 patients in whom the most significant indicators of cardiac function and hemodynamics were determined) and literature data. A significant decrease in the heart's ability to relax and, consequently, greater severity of diastolic dysfunction, manifested by an increase in the size of the left atrium and the diastolic diameter of the LV, were found in patients with aortic valve defects. A relationship between aortic valve defects and the presence of multivessel atherosclerotic lesions was established. For all parameters, p<0,05. The presence of aortic valve defects negatively impacts the course of coronary artery disease, leading to disruption of myocardial structure and function. This fact must be taken into account when assessing the severity of the disease, choosing treatment strategies, and determining the patient's prognosis.
Inflammaging is considered as a fundamental mechanism of age-related skin involution, mediated by chronic inflammation, fibroblast dysfunction and collagen matrix degradation. The study considers the modulating effect of exosomes on the culture of dermal fibroblasts (DF1) during inflammaging. The experimental model included three groups: intact control, induced inflammaging, inflammaging in the presence of exosomes. The methodology was based on an MTT test to assess the metabolic activity of cells and immunohistochemical analysis with detection of a panel of markers involved in the regulation of inflammation (NF-κB/p65, CCN1), redox homeostasis (superoxide dismutase, prohibitin), cell cycle (p53, Ki-67), as well as endogenous geroprotective factors (Klotho, SIRT6) and receptor apparatus (EGFR). It has been shown that exosomes initiate a multiple cytoprotective response. At the same time, endogenous antioxidant systems are activated (the expression of Klotho and prohibitin increases), which is accompanied by an increase in the activity of superoxide dismutase and a reduction in oxidative stress. There is also suppression of stress-induced signaling cascades - inhibition of p53 correlates with the preservation of the proliferative potential of fibroblasts, while suppression of transduction along the NF-κB/CCN1 axis reduces the pro-inflammatory load and stabilizes the extracellular matrix. Thus, the results of the study indicate that exosomes, acting on the key pathogenetic links of cell aging, can be considered as potential geroprotectors.
The metabolic profile and proinflammatory status of young patients and their age-related dynamics are often underestimated in clinical practice, despite the fact that the early development of inflammaging processes is a predictor of cardiovascular events. The aim of our study is to assess the features of metabolic phenotypes and proinflammatory status in young normal weight and overweight adults without significant somatic pathology in 2 groups: up to 35 years and ≥35 years. A cross-sectional study included 159 individuals aged 18 to 45 years with normal and overweight body mass. In addition to standard clinical and laboratory examinations, indices reflecting metabolic disorders and pro-inflammatory status were calculated for all patients. A glucose tolerance test was performed on 61 patients, and the area under the curve (AUC) of plasma glucose levels was assessed. In the subgroup of patients aged 35 years and older, abdominal obesity was twice as common compared to patients younger than 35 years (p<0,001) at comparable body mass index. Patients in the older age group were characterized by higher fasting blood glucose levels (p=0,042), glucose levels 1 hour (p=0,011) and 2 hours (p=0,020) after a standard carbohydrate load, as well as a higher prevalence of dyslipidemia (p=0,001), while no significant differences in pro-inflammatory status were identified. Using a decision tree, the characteristics of metabolic phenotypes in the two age subgroups were determined, taking into account the presence of abdominal obesity and plasma glucose AUC characteristics. Thus, in patients aged 35 years and older, subclinical disorders of carbohydrate and lipid metabolism, as well as abdominal obesity, play a significant role in the development of a metabolically «unhealthy» phenotype. This phenotype is associated with an increased risk of cardiovascular events and indicates early subclinical aging.
The article discusses the results of a formative experiment on the development of the vitality of an elderly person using quantitative and qualitative methods of psychological research. The relevance of a comprehensive approach, which includes nomothetic and ideographic ways of obtaining knowledge about psychological phenomena and processes, one of which is human vitality, is substantiated. The article describes the results of applying a standardized psychodiagnostic method for diagnosing vitality, training, and narrative interviews in the process of developing a person's vitality in old age. It has been proven that the use of narrative has a more significant impact on vitality compared to traditional training. The narrative method provided an opportunity for in-depth exploration of an individual's vitality and facilitated a nuanced interpretation of the results. The data were analyzed using the classical sign test and multivariate cluster analysis with intergroup connectivity. The results of the study can be used in psychocorrectional and consultative practice.
Myocardial infarction is a life-threatening condition with high mortality, which is especially important for patients over 75 years of age who have an increased risk of complications and death. Objective - to assess the incidence of in-hospital mortality and adverse cardiovascular events in patients aged over 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention. An analysis of data from a prospective registry of patients with ACS hospitalized in the vascular center based on the Alexandrovskaya City Hospital from January 2016 to November 2024 was performed. The initial sample included 14 420 cases of hospitalization, including 10 126 patients with NSTE-ACS. For the analysis, patients were stratified into four groups: 1st - up to 60 years old; 2nd - 60-74 years old; 3rd - 75-89 years old; 4th - 90 years and older. Data processing was performed using Excel, Jamovi, IBM SPSS Statistic 24, R statistical programs. Values of p<0,05 were considered statistically significant. Coronary angiography was performed in 98,6 % of patients. With increasing age, the following are noted: an increase in the proportion of women, an increase in the number of comorbidities, the Charlson comorbidity index, the number of points on the Killip, CRUSADE, GRACE scales, an increase in the number of complications and fatal outcomes. Among patients over 75 years of age, the PCI group had a higher incidence of adverse events, total complications, and mortality compared to the conservative management group. The strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications. Predictors of the composite endpoint were elevated CPK-MB levels, AIM Score, and systolic blood pressure at admission. Elderly patients and long-term survivors with MI represent a high-risk group, necessitating an individualized and balanced approach at all stages of treatment. Further research is needed to determine optimal treatment strategies for non-ST-elevation ACS in older age groups.
Aim - an appropriate experimental model is required to investigate the development of chronic heart failure in the elderly and to evaluate pharmacological interventions. Models based on aged animals remain insufficiently characterized. To assess the degree of impairment in myocardial contractility and morphological changes in vital organs in 24-month-old rats with isoproterenol-induced chronic heart failure. Chronic heart failure was induced in 24-month-old male Wistar rats (550-600 g) by subcutaneous injections of isoproterenol hydrochloride (ISO; Sigma-Aldrich, USA). Animals in the experimental group (n=7) received ISO at a dose of 10 mg/kg four times at 3-day intervals. Control animals (n=7) received equivalent volumes of saline according to the same protocol. Sixty days after the final injection, cardiac pump function was assessed in isolated hearts using the Langendorff perfusion technique. Tissue samples from the myocardium, kidneys, lungs, and brain were fixed in formalin, stained with hematoxylin and eosin, and subjected to histopathological examination. Cardiomyocyte myofibrillar structure was evaluated using polarization microscopy. Heart rate was significantly higher in the experimental group compared with controls. At the same time, no statistically significant differences were observed in contractility parameters of isolated perfused hearts between the groups. Histological examination of myocardial, renal, pulmonary, and brain tissues revealed changes characteristic of chronic heart failure. Repeated administration of ISO (10 mg/kg, four injections) induces a compensated chronic heart failure phenotype in 24-month-old rats by day 60, characterized by morphological alterations in the myocardium and multiple organs in the absence of myocardial contractile dysfunction.
A retrospective study included 171 patients with acute coronary syndrome who underwent primary percutaneous coronary intervention between 2019 and 2023. Elderly and long-lived patients with ST-ECS and NSTE-ACS are characterized by significant comorbidity, with significantly more severe coronary pathology, as measured by the Syntax Score. In-hospital and long-term mortality were significantly higher in patients over 75 years of age. However, the incidence of late stroke and bleeding did not differ statistically between the study groups. Patients 75 years and older are a complex, heterogeneous group with a very high risk of in-hospital and long-term mortality, requiring a balanced and individualized approach from medical personnel at all stages of treatment.
The COVID-19 pandemic and the restrictive measures introduced during this period had a significant impact on the health status of older adults. In this regard, particular interest is focused on assessing changes in geriatric status, especially the transition from prefrailty to established frailty syndrome under conditions of prolonged physical inactivity and social isolation. The aim of the study was to analyze the dynamics of geriatric status in older patients during prolonged exposure to reduced mobility conditions during lockdown. The study included 525 patients aged 65-74 years residing in residential social care institutions. All participants underwent comprehensive geriatric assessment, including monitoring of somatic parameters (blood pressure, heart rate, and body mass index), handgrip dynamometry, and the six-minute walk test. Examinations were performed at baseline and repeated after 1 and 6 months of follow-up. It was established that marked unfavorable changes in the structure of geriatric status occurred over the six-month observation period. The prevalence of prefrailty decreased from 35,8 to 14,1%, which was associated with the transition of a substantial proportion of patients to the frailty category. At the same time, the prevalence of frailty syndrome increased from 49,5 to 72%. In addition, the number of patients with mild, moderate, and severe frailty increased by 11,6; 6,1 and 4,4%, respectively. The obtained results indicate that prolonged mobility restriction and social isolation are significant factors contributing to deterioration of geriatric status and acceleration of frailty progression. These findings confirm the importance of early identification of prefrailty and timely implementation of preventive and corrective interventions aimed at preserving functional independence in older patients.
The purpose of this review is to summarize and critically analyze data on markers of metabolic and mitochondrial stress in atherosclerosis in older and oldest-old patients, highlighting differences between circulating clinical biomarkers, metabolic-epigenetic indicators, and intracellular regulators of mitochondrial quality control, as well as the limitations of age-specific interpretation. An analytical narrative review of the literature was performed using PubMed, Scopus, and Web of Science for 2010-2025; the last control search was conducted on April 27, 2026. The keywords used were signaling molecules, FGF21, GDF15, endothelial dysfunction, mitochondrial dysfunction, lactate, endothelial aging, and cellular senescence. The analysis included 38 sources with a focus on clinical cohorts, age-stratified data, experimental studies on vascular aging, and publications with translational potential. The selection of markers was based on their representation of different levels of the pathological process: systemic stress response, metabolic-epigenetic remodeling, and intracellular mitochondrial quality control. The most clinically relevant circulating candidates are FGF21 (fibroblast growth factor 21) and GDF15 (growth differentiation factor 15). FGF21 is associated with atherosclerotic lesions and cardiovascular risk, but its increase should be interpreted as a reflection of an activated stress response rather than as an independent diagnostic criterion. GDF15 is associated with age, functional decline, comorbidity, and poor prognosis, but it is not a specific marker of atherosclerosis. Lactate and lactylation represent a promising metabolic-epigenetic mechanism linking glycolytic shift, cellular senescence, and vascular inflammation, but evidence of correspondence between circulating and tissue levels is still required. AMPK, PGC-1α, and PINK1/Parkin have predominantly mechanistic significance and should currently be considered intracellular regulators and therapeutic targets rather than clinically validated biomarkers. In atherosclerosis in older and oldest-old patients, markers of metabolic and mitochondrial stress should be assessed within a hierarchical evidence model and with mandatory consideration of age, comorbidity, and treatment-related confounders. FGF21 and GDF15 are the closest to clinical validation; lactate and lactylation represent a promising direction for translational research; AMPK, PGC-1α, and PINK1/Parkin form the pathogenic basis of mitochondrial quality control but require clinically reproducible assessment methods.
Visual age reflects a set of external signs formed under the influence of genetic factors, environmental conditions, lifestyle, and general health status. The relationship between visual age, biological age, and cardiovascular and metabolic disorders is discussed. Particular attention is given to morphological changes of facial skin and soft tissues, as well as to the role of endothelial dysfunction and oxidative stress in accelerating aging processes. Assessment of visual age may serve as an additional indicator for identifying premature aging.
The aim of the study was evaluate effectiveness of 21-day comprehensive functional activity restoration programs among patients 60 years and older with risk of malnutrition («RM+») and normal nutritional status («RM-»). The study included 482 patients (81% women), with 96 (19,9%) patients at risk of malnutrition. At Visit 1, a comprehensive geriatric assessment was performed and an individual geriatric rehabilitation program was developed. Visit 2 was conducted after completion of the rehabilitation programs to evaluate the course's effectiveness. Patients in the RM+ group were older than RM- patients (80,3±7,5 vs 78,2±7,7 years respectively, p=0,014), had a lower body mass index (27,8±5 vs 29,5±6,2 kg/m2 respectively, p=0,017) and took more medications (5,4±2,6 vs 4,7±2,6 respectively, p=0,017). In the RM+ group, compared to the RM- group, there were significantly more patients with frailty (52,1% vs 30,9% respectively, p=0,006), dependence on outside help - both basic (25% vs 13.6%, p=0,012) and instrumental (7,3% vs 0,8%, p=0,001), more frequent falls over the past year (36,8% vs 25,3%, p=0,03), cognitive impairment (61,5% vs 49,5%, p=0,04), 2 times more often symptoms of depression were detected (40,6% vs 20,8%, p<0,001). In both groups, the comprehensive programs turned out to be effective - over time, a significant increase in functional activity indicators, improvement in cognitive testing results, a decrease in the severity of chronic pain syndrome, insomnia and symptoms of depression were noted. The RM+ group of patients demonstrated significantly greater improvements in baseline and instrumental functional activity compared to the RM- group. The study demonstrated the effective implementation of a comprehensive domain-based 21-day geriatric rehabilitation approach, improving functional and psycho-emotional status, and reducing pain and insomnia. Patients in the RM+ group, who had a more pronounced decline in functional activity at baseline, demonstrated better recovery.
Objective - to evaluate the experience of implementing a digital clinical calculator for individual clinical and metabolic control goals in routine outpatient medical care for elderly patients with type 2 diabetes mellitus (DM2). A cross-sectional observational sample study was performed in a sample of elderly patients with DM2 who sought routine medical care at an outpatient medical organization (n=77); participants were examined according to the standard protocol of outpatient follow-up of an elderly patient with DM2, including 124 clinical and laboratory indicators; a developed digital calculator was used to assess individual therapeutic control goals The frequency of achieving treatment goals and the structure of drug therapy are determined. A high incidence of atherogenic pathology was confirmed: coronary heart disease (41,6%), chronic heart failure (27,3%), hypertension (62,3%), obesity (50,6%), dyslipidemia (46,8%), exceeding population values; an imbalance in achieving therapeutic goals was revealed: indicators glycemic control levels are close to optimal values (HbA1c 7,5±1,5%), while LDL exceeds the target level by 2 times (3,1±0,9 mmol/l); 88% of participants do not achieve the goal of lipidemic control calculated according to regulatory criteria; biguanides predominate in the structure of drug therapy (55,8%). For elderly patients with DM2, diseases associated with increased cardiovascular risk pose the greatest danger; insufficient detection of dyslipidemia in conditions of limited outpatient admission may be due to the complexity of the algorithm for stratifying lipid control goals; the use of digital tools allows to identify reserves for prescribing lipid-lowering and hypoglycemic therapy and optimize the trajectory of drug treatment if the target values of biomarkers of clinical and metabolic control; to focus the doctor's attention on the priority task of increasing the effectiveness of evidence-based risk management.
The study was conducted to optimize the handling of elderly and elderly patients in emergency conditions at the clinic by using an express survey to identify aging syndrome. The study involved 333 patients aged 65-90 who visited the emergency department of the polyclinic, 234 of whom were diagnosed with dementia syndrome using a rapid response questionnaire «The validated index for detecting aging syndrome in the emergency department of the clinic». When analyzing the case score after 1 month, statistically significant differences were found (p<0,001). In the 1st group, after 1 month 62,8% of patients were under observation by a district physician-therapist, in the 2nd group 41,4%. Without medical supervision, 43,4% of patients remained in the 2nd group and 29,5% in the 1st group. In the 2nd group, the number of fatalities was higher than in the 1st group: 2 and 0,4%, respectively. In the 2nd group, there were repeated requests to the emergency department (6,1%) unlike the 1st group (0%). Thus, the 1st group is characterized by: higher levels of medical surveillance, absence of repeated referrals, lower lethality. In the 2nd group, patients are more often left unmonitored, showing higher rates of retreatment and mortality.
The aim of this study was to investigate the morphofunctional organization of microglia and macrophages in the pineal gland of the rat brain using an immunohistochemical reaction to Iba-1. It was found that in the rat pineal gland, Iba-1-immunopositive cells are characterized by a rounded body and short thickened processes. Such morphology indicates their activated state, which is probably associated with the presence of fenestrated capillaries in the pineal gland and the need for more active monitoring and phagocytosis of pathogenic factors. Microglia/macrophages are predominantly localized in the perivascular space around blood vessels and are less commonly found in the parenchyma among pinealocytes. Another distinctive feature of the organization of Iba-1+-cells in the rat pineal gland was the formation of cell clusters. A small but significant decrease in the number of Iba-1+-cells with age was observed, which may be associated with possible dystrophic changes in these cells due to their active interaction with pathogens.
