Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Geriatría, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Mol Aspects Med. 2024 Jun;97:101271. doi: 10.1016/j.mam.2024.101271. Epub 2024 Apr 16.
Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.
已经提出了几种生物标志物来识别衰弱，这是一种多系统与年龄相关的综合征。然而，复杂的病理生理学以及缺乏对全面和通用定义的共识，使得确定单一的生物标志物或一组生物标志物来明确表征衰弱变得具有挑战性。本综述深入探讨了主要的实验室生物标志物，特别强调了与各种与衰弱状况密切相关的途径相关的生物标志物，如炎症、氧化应激、线粒体功能障碍、代谢和内分泌改变以及 microRNA。此外，我们提供了不同临床生物标志物的摘要，这些生物标志物涵盖了不同的工具，这些工具已被提出用于评估衰弱。我们进一步讨论了各种成像生物标志物，如双能 X 射线吸收法、生物电阻抗分析、计算机断层扫描和磁共振成像、超声和 D3 肌酸稀释。干预治疗衰弱，包括非药物干预，特别是涉及体育锻炼和营养的干预，以及药物干预，包括针对特定机制的干预，如肌肉生长抑制素抑制剂、胰岛素增敏剂二甲双胍，以及激素治疗的特殊相关性，都被提及。我们进一步探讨了监测这些干预措施潜在积极效果的不同生物标志物的水平。尽管有许多生物标志物，但它们在临床中的性能和实用性还远远不能令人满意。考虑到衰弱的多因性，越来越需要评估生物标志物组的作用以及实验室、临床和图像生物标志物之间的组合，就敏感性、特异性和预测值而言，用于诊断和预测衰弱的不同结局，以改善对衰弱或有发展为衰弱风险的老年人的检测和监测，这是日常临床实践中的一个需求。
