Deregulation of IL-37 and Its Mirnas Modulators in Sarcopenic Patients
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La Rosa et al. J Transl Med (2021) 19:172 https://doi.org/10.1186/s12967-021-02830-5 Journal of Translational Medicine RESEARCH Open Access Deregulation of IL-37 and its miRNAs modulators in sarcopenic patients after rehabilitation Francesca La Rosa1* , Simone Agostini1, Marina Saresella1, Andrea Saul Costa1, Federica Piancone1, Rossella Miglioli2, Fabio Trecate2 and Mario Clerici1,3 Abstract Background: sarcopenia is a highly prevalent condition in elderly individuals which is characterized by loss of mus- cle mass and functions; recent results showed that it is also associated with infammation. Rehabilitation protocols for sarcopenia are designed to improve physical conditions, but very scarce data are available on their efects on infam- mation We verifed whether in sarcopenic patients the infammation is reduced by rehabilitation and investigated the biological correlates of such efect. Methods: Twenty-one sarcopenic patients undergoing a specifcally-designed rehabilitation program were enrolled in the study. Physical, cognitive and nutritional parameters, as well as the concentration of C-Reactive Protein (CRP), pro-and anti-infammatory cytokines and cytokine production-modulating miRNAs were measured at the beginning (T0) and at end (30-days; T1) of the rehabilitation. Results: Rehabilitation resulted in a signifcant improvement of physical and cognitive conditions; this was accom- panied by a signifcant reduction of CRP (p 0.04) as well as of IL-18 (p 0.008) and IL-37 (p 0.009) concentration. Notably, the concentration of miR-335-3p (p= 0.007) and miR-657, the =two known post-transcriptional= regulators of IL-37 production, was increased by the rehabilitation= protocol. Conclusions: Results herein confrm that successful rehabilitation for sarcopenia results in a reduction of the infam- matory milieu, raise the possibility that IL-37 may be a key target to monitor the rehabilitation-associated improve- ment in sarcopenia, and suggest that this cytokine could be a therapeutic target in sarcopenic patients. Keywords: Cytokines, IL-37, Infammaging, MiRNAs, Rehabilitation, Sarcopenia Background People (EWGSOP) [5] developed defnitions, diagnostic Sarcopenia is a condition characterized by a progres- criteria, categories, and stages in sarcopenia and identi- sive decline of muscle mass, quality, and strength [1, 2]. fed sedentary life as one of the main predisposing factors Te prevalence of sarcopenia among people older than for age-related muscle loss [6–8]. Notably, sarcopenia is 65 years is estimated to be as high as 15%, and 50% of also associated with infammation [9] within the so called people over the age of 80 sufer from this condition [3, infammaging process: the preferential production of 4]. Te European Working Group on Sarcopenia in Older proinfammatory cytokines during aging, possibly as a consequence of an age-related redox imbalance that acti- vates pro-infammatory signaling pathways [10]. Infam- *Correspondence: [email protected] matory markers including interleukin 6 (IL-6), C Reactive 1 IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Milano, Italy Full list of author information is available at the end of the article Protein (CRP) and tumor necrosis factor-alpha (TNF-a) © The Author(s) 2021. 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The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. La Rosa et al. J Transl Med (2021) 19:172 Page 2 of 8 were shown to positively correlate with sarcopenia [11]. 30 days; during this period they underwent the following However, because several factors are known to afect rehabilitative treatment: twice daily session of 40′ in the the production of infammatory proteins, it is difcult morning and 30′ in the afternoon with assisted mobiliza- to understand their potential usefulness in the diagnosis tion, progressive muscle strengthening, associated with and the monitoring of sarcopenia is difcult. More-in- progressivity of the load, standing work proprioceptive depth analyses of vast panels of immune markers, thus, postural balance, walking training frstly with an assisted could help in the identifcation of new biomarkers for way and then without. sarcopenia. Physical activity, such as aerobic exercise For each subject, Short Physical Performance Battery training, remains the most import strategy to prevent (SPPB) [23], Barthel Index [24, 25], and the Tinetti Bal- age-related muscle decline [12–16], but the observation ance Test to predict falls among individuals [26–28] were that sarcopenia is associated with infammation raised calculated before and after treatment; anthropometric the possibility that interventions to reduce age-associate measurements including age, sex, weight (kg) and height muscular degeneration could target such process [17, 18]. (cm) were measured while patients were wearing light Infammation is an extremely complex process that clothes without shoes. Te study conformed to the ethi- involves a number of diferent proteins. Interleukin 37 cal principles of the Declaration of Helsinki; all subjects (IL-37), in particular, is a cytokine with anti-infamma- gave informed and written consent according to a pro- tory properties that was shown to play a critical role in tocol approved by the local ethics committee of the Don limiting excessive infammatory responses [19, 20]. In Carlo Gnocchi Foundation–ONLUS, Milan, Italy. humans, IL-37 production is not constitutive but is rather activated by pro-infammatory stimuli, including the Comprehensive geriatric assessment, nutrition status production of IL-1β, IL-18, TNF-α, IFN-γ, as a protec- function and social behavior tive mechanism to prevent excessive infammation and At baseline all the individuals enrolled in the study under- tissue damage [21]. As is the case with all genes, IL-37 went a comprehensive geriatric multidimensional evalu- expression is modulated by microRNAs (miRNAs), short ation that included cognitive function evaluation with non-coding RNAs (about 20–24 nucleotides) involved in Mini-Mental State Examination (MMSE) [29] and Clock mRNA silencing and post-transcriptional regulation via Drawing test (CDT) (score range 0–5) [30]. Emotional their ability to bind the 3′untranslated region (3′UTR). status was evaluated via the Yesavage Geriatric Depres- Data on miRNAs-mediated IL-37 regulation are scarce: sion Scale (Yesavage GDS) [31] and comorbidity was very recent results obtained in women with a diagnosis of evaluated with Charlson Comorbidity Index (CCI) [32]. gestational diabetes mellitus showed that miR-657 modu- Functional status was assessed using A.D.L. (activitiy of lates IL-37, infuencing the infammatory response [22]. daily living or KATZ index) (bathing, dressing, toilet- In silico analysis (see mirtarbase and genecards) indi- ing, transfer, feeding, continence) and I.A.D.L (Lawton- cated that miR-335-3p can modulate the IL-37 expres- Brody instrumental activity of daily living) (telephone sion as well. use, housekeeping, laundry, medication use, transporta- In this pilot work we analyzed whether rehabilitation tion, preparing meal, shopping, handling fnances) tests programs designed to improve function in sarcopenic [33–36]. Finally, Mini-Nutritional Assessment (MNA) patients would result in a reduction of infammation. was applied to all participants to analyze the nutritional Results indicating that rehabilitation-associated improve- status [37]. ment in the parameters used to monitor sarcopenia cor- related with a signifcant reduction of IL-37 led us to Whole blood and plasma sampling and processing investigate the post-transcription miRNA-mediated About thirty milliliters of whole blood were collected in mechanism involved in IL-37 production, including miR- EDTA-containing vacutainer tubes (Becton Dickinson 657 and miR-335-3p. and Co., Rutherford, NJ, USA). Peripheral blood mono- nuclear cells (PBMCs) were separated on lymphocyte Methods separation medium (Organon Teknika Corp., Durham, Participant recruitment NC, USA), and washed twice in PBS. Leukocytes viabil- Te study was conducted between January 2019 and ity was determined using a Bio-Rad TC20 Automated September 2019 at the Palazzolo Institute, Don Gnoc- Cell Counter (Bio-Rad, Hercules, CA, USA) and cryo- chi Foundation, Milan, Italy. Twenty-one patients were preserved at − 80 °C in RPMI 1640 containing 50% fetal recruited (13 Females and 8 Males). Patients were diag- bovine serum (FBS) and 10% dimethylsulfoxide (DMSO) nosed as being afected by severe sarcopenia according until using. to the European Working Group on Sarcopenia in Older Plasma was obtained from blood collected