Hematopoiesis, Inflammation and Aging—The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals

Abstract

Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Such aging-associated alterations of hematopoietic stem cells are probably caused by complex mechanisms and depend on both the aging of hematopoietic (stem) cells and on the supporting stromal cells. The function of inflammatory or immunocompetent cells is also altered by aging. The intracellular signaling initiated by soluble proinflammatory mediators (e.g., IL1, IL6 and TNFα) is altered during aging and contributes to the development of both the inhibition of erythropoiesis with anemia as well as to the development of the acute-phase reaction as a systemic sign of inflammation with increased CRP levels. Both anemia and increased CRP levels are associated with decreased overall survival and increased cardiovascular mortality. The handling of elderly patients with inflammation and/or anemia should in our opinion be individualized; all of them should have a limited evaluation with regard to the cause of the abnormalities, but the extent of additional and especially invasive diagnostic evaluation should be based on an overall clinical evaluation and the possible therapeutic consequences.

Serum high-sensitive C-reactive protein is a simple indicator for all-cause among individuals with MAFLD

“…One of the questions is whether the hs-CRP is only a mediator or an independent risk factor for the prognosis of MAFLD. CRP had been found to have complex interactions between several risk factors in elderly individuals, including smoking, diabetes, hypertension, BMI, and lipid metabolism ( Nadrowski et al, 2016 ; Bruserud et al, 2022 ). All these factors are also associated with MAFLD.…”

“…Low-grade inflammation is linked to the initiation and progression of MAFLD ( Power Guerra et al, 2020 ; Francque et al, 2021 ; Zhang et al, 2022 ). Additionally, hs-CRP is a marker of senescence and aging, which is characterized by the accumulation of senescent cells that release proinflammatory cytokines, chemokines and other mediators that lead to inflammatory microenvironments in many tissues and organs ( Bruserud et al, 2022 ). Moreover, CRP level is correlated to the endothelial dysfunction and may reflect the development of atherosclerosis ( Della Corte et al, 2016 ; Maio et al, 2021 ).…”

A pilot study of the metabolic profiles of apheresis platelets modified by donor age and sex and in vitro short‐term incubation with sex hormones

“…Most of the aberrant metabolites were found to be elevated in platelets from OM donors, an observation that may be in part explained by cell size or cell count issues in this group compared to young males or females, independently of age. Indeed, inflammatory events 55 driving the so‐called anemia of aging in ~15% of people aged 60 and over 56 may skew hematopoietic stem cells towards precocious myeloid differentiation at the expense of self‐renewal, 57 ultimately impacting both hematocrit and platelet counts. Also, all metabolic observations in the present study rely on steady‐state measurements.…”

Hematopoietic Stem Cells and the Immune System in Development and Aging

“…Anaemia can be caused by nutritional factors, blood loss, chronic kidney disease, chronic inflammation, or clonal haematopoiesis [ 221 , 222 ]. The latter two factors are directly related to aging processes in the hematopoietic system [ 223 , 224 ]. The exact mechanisms of clonal haematopoiesis-related anaemia are unknown.…”