Background: Multimorbidity is associated with mortality and service use, with specific types of multimorbidity having differential effects. Additionally, multimorbidity is often negatively associated with participation in research cohorts. Therefore, we set out to identify clusters of multimorbidity patients and how they are differentially associated with mortality and service use across age groups in a population-representative sample. Methods: Linked primary and secondary care electronic health records contributed by 382 general practices in England to the Clinical Practice Research Datalink (CPRD) were used. The study included a representative set of multimorbid adults (18 years old or more, N = 113,211) with two or more long-term conditions (a total of 38 conditions were included). A random set of 80% of the multimorbid patients (N = 90,571) were stratified by age groups and clustered using latent class analysis. Consistency between obtained multimorbidity phenotypes, classification quality and associations with demographic characteristics and primary outcomes (GP consultations, hospitalisations, regular medications and mortality) was validated in the remaining 20% of multimorbid patients (N = 22,640). Results: We identified 20 patient clusters across four age strata. The clusters with the highest mortality comprised psychoactive substance and alcohol misuse (aged 18-64); coronary heart disease, depression and pain (aged 65-84); and coronary heart disease, heart failure and atrial fibrillation (aged 85+). The clusters with the highest service use coincided with those with the highest mortality for people aged over 65. For people aged 18-64, the cluster with the highest service use comprised depression, anxiety and pain. The majority of 85+-year-old multimorbid patients belonged to the cluster with the lowest service use and mortality for that age range. Pain featured in 13 clusters. Conclusions: This work has highlighted patterns of multimorbidity that have implications for health services. These include the importance of psychoactive substance and alcohol misuse in people under the age of 65, of co-morbid depression and coronary heart disease in people aged 65-84 and of cardiovascular disease in people aged 85+.

b-catenin is a multifunctional protein identified to be pivotal in embryonic patterning, organogenesis and adult homeostasis. It plays a critical structural role in mediating cadherin junctions and is also an essential transcriptional co-activator in the canonical Wnt pathway. Evidence has been documented that both the canonical Wnt pathway and cadherin junctions are deregulated or impaired in a plethora of human malignancies. In the light of this, there has been a recent surge in elucidating the mechanisms underlying the etiology of cancer development from the perspective of b-catenin. Here, we focus on the emerging roles of b-catenin in the process of tumorigenesis by discussing novel functions of old players and new proteins, mechanisms identified to mediate or interact with b-catenin and the most recently unraveled clinical implications of b-catenin regulatory pathways toward tumor suppression.Since its identification as an essential and central component in the Wnt signaling cascade, and the subsequent finding of its pivotal role in cadherin-based cell-cell adhesion, b-catenin has been critically studied to elucidate the coordination of these two pathways. The significance of this coordination is substantiated in a plethora of metabolic processes, such as axis and mesoderm formation, stem cell differentiation and carcinogenesis. 1,2 Generally, the Wnt pathway is divided into four branches, namely the canonical Wnt/b-catenin pathway, and the noncanonical (or heretical) Wnt/Ca 2þ and planar cell polarity pathways. Amongst them, the canonical Wnt pathway is the best studied and is reported to be highly conserved through evolution but is frequently altered in many human malignancies such as colorectal cancers, hepatocellular carcinomas and gastric cancers. 3-6 Ca 2þ -dependent cellcell adhesion in the cadherin family of proteins is typified by an extracellular segment that consists of five distinct Ca 2þ -binding domains and a conserved cytoplasmic domain, which interacts with b-catenin and p120 catenin (herein p120); b-catenin then provides a binding site for a-catenin. Cadherin junctions, among other cell-cell adhesion complexes, are essential for cellular processes such as cell polarity and migration. 7,8 Since an indispensible morphological hallmark of malignant tumors is reduced cell-cell adhesiveness, it is predicted that the components of cadherin junctions in many human malignancies, such as breast cancer, colorectal cancer and prostate cancer, are genetically altered. 9-11 Besides cellcell adhesion, cadherin junctions function as a potent competitor of free cytosolic b-catenin. This is supported by studies of the co-crystal structures of b-catenin/cadherin and b-catenin/TCF revealing that the two b-catenin ligands shared overlapping binding regions along b-catenin. 12 The role of the cadherin junction in the subcellular distribution of b-catenin has recently been further extended as discussed below.In this review, a myriad of recently emerged mechanisms governing the signaling and adhesive activity of ...

Background Major depressive disorder (MDD) is a highly prevalent psychiatric disorder, and inflammation has been considered crucial components of the pathogenesis of depression. NLRP1 inflammasome-driven inflammatory response is believed to participate in many neurological disorders. However, it is unclear whether NLRP1 inflammasome is implicated in the development of depression. Methods Animal models of depression were established by four different chronic stress stimuli including chronic unpredictable mild stress (CUMS), chronic restrain stress (CRS), chronic social defeat stress (CSDS), and repeat social defeat stress (RSDS). Depressive-like behaviors were determined by sucrose preference test (SPT), forced swim test (FST), tail-suspension test (TST), open-field test (OFT), social interaction test (SIT), and light-dark test (LDT). The expression of NLRP1 inflammasome complexes, BDNF, and CXCL1/CXCR2 were tested by western blot and quantitative real-time PCR. The levels of inflammatory cytokines were tested by enzyme-linked immunosorbent assay (ELISA) kits. Nlrp1a knockdown was performed by an adeno-associated virus (AAV) vector containing Nlrp1a-shRNA-eGFP infusion. Results Chronic stress stimuli activated hippocampal NLRP1 inflammasome and promoted the release of pro-inflammatory cytokines IL-1β, IL-18, IL-6, and TNF-α in mice. Hippocampal Nlrp1a knockdown prevented NLRP1 inflammasome-driven inflammatory response and ameliorated stress-induced depressive-like behaviors. Also, chronic stress stimuli caused the increase in hippocampal CXCL1/CXCR2 expression and low BDNF levels in mice. Interestingly, Nlrp1a knockdown inhibited the up-regulation of CXCL1/CXCR2 expression and restored BDNF levels in the hippocampus. Conclusions NLRP1 inflammasome-driven inflammatory response contributes to chronic stress induced depressive-like behaviors and the mechanism may be related to CXCL1/CXCR2/BDNF signaling pathway. Thus, NLRP1 inflammasome could become a potential antidepressant target.

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