Search Results (8,719)

Sarcopenia is an age-related syndrome characterized by the progressive loss of skeletal muscle mass, strength, and function, significantly impairing older adults’ independence and quality of life. Given their anti-inflammatory, antioxidant, and metabolic regulatory properties, n-3 polyunsaturated fatty acids (n-3 PUFAs) have emerged as a promising nutritional strategy to mitigate this muscle degeneration. This review systematically synthesizes existing evidence regarding the association between n-3 PUFAs and sarcopenia. To capture the relevant literature, we searched PubMed, Web of Science, CNKI, and Wanfang Data using a combination of subject headings and free-text terms. We supplemented primary search terms—such as “n-3 polyunsaturated fatty acids,” “omega-3 fatty acids,” “sarcopenia,” and “muscle mass”—with mechanism-related keywords like “inflammation,” “muscle satellite cells,” and “oxidative stress.” We also manually screened the reference lists of the included literature. Our inclusion criteria encompassed interventional studies, observational studies, and high-quality reviews, while excluding conference abstracts, duplicate publications, and studies with incomplete data. This review first outlines the established biological mechanisms linking n-3 PUFAs to the pathological progression of sarcopenia, specifically detailing how these fatty acids improve muscle satellite cell function, suppress inflammation and oxidative stress, and ameliorate metabolic disorders. Next, we critically evaluate recent clinical studies and reviews, analyzing sources of study heterogeneity such as variations in sample size, intervention dose and duration, outcome measures, and baseline participant characteristics. We also highlight current research hotspots—including specialized pro-resolving mediators (SPMs), the gut–organ axis, combined interventions, and precision nutrition strategies—while emphasizing the functional differences between EPA and DHA to guide future intervention designs. Current evidence indicates that while n-3 PUFA supplementation can improve muscle strength and physical performance in older adults, its effects on muscle mass remain inconsistent. Addressing key research gaps, particularly the lack of standardized core outcome measures and unclear dose–response relationships, is critical. Ultimately, future research must prioritize developing high-bioavailability formulations, conducting personalized trials based on baseline n-3 PUFA status, and deepening investigations into inter-organ networks to translate these nutritional insights into effective sarcopenia prevention and management strategies. Full article

Geroprotective molecules are currently being actively investigated for the prevention of skin aging. An overview of geroprotectors in dermatology encompasses agents such as antioxidants, ultraviolet (UV) photoprotective agents, chemical peels, and carbon dioxide (CO₂) lasers, each with inherent limitations, including poor tolerability in individuals with sensitive skin. Regarding biostimulators, high-molecular-weight peptides (exceeding 500 kDa) exhibit limited cutaneous bioavailability, underscoring the need for low-molecular-weight geroprotective compounds. One such candidate is dehydroepiandrosterone DHEA, a neurosteroid with anti-aging and anti-stress properties, which also serves as a precursor to sex steroids. Although topical hormone replacement therapy with estrogens and androgens is being utilized, it remains confined to formal hormone replacement regimens and is associated with a significant adverse effect profile. The aim of this review was to analyze the key molecular mechanisms underlying the effects of DHEA on the skin, with particular emphasis on its metabolism and sex- and age-dependent mechanisms of action. Additionally, this review seeks to elucidate the factors contributing to the absence of approved topical DHEA formulations and to outline the potential of DHEA as an anti-aging agent in dermatological applications. DHEA has demonstrated significant skin-improving effects in several studies; its investigation has been predominantly confined to postmenopausal women. Furthermore, the outcome measures employed in these studies lacked specificity. DHEA is not permitted for use in cosmetic products within the European Union due to its hormonal activity. Its use is only allowed as an extemporaneous formulation under the established regulatory frameworks of individual countries. The indications for its use and the appropriate dosage for men and women must be clearly defined based on the results of future clinical studies. Promising research directions include the pharmacogenetic characterization of steroidogenic enzymes and sex hormone receptors, as well as the evaluation of DHEA in both sexes, specifically in premenopausal women and in men presenting with late-onset hypogonadism. Additionally, the biological effects of the primary metabolites of DHEA, androstenedione, and 5-androstenediol, on the cutaneous function remain unexplored, including their potential anti-aging activity mediated through retinoid receptor activation. Full article

Background: Hepatitis D virus (HDV) causes one of the most severe forms of chronic viral hepatitis. Despite its severity, universal screening of hepatitis B surface antigen (HBsAg)-positive individuals, as recommended by European guidelines, is not widely implemented. This study aimed to evaluate the yield of reflex HDV testing and to characterize HBV carriers who tested positive or negative for anti-HDV. Methods: A retrospective cohort study was conducted using the Clalit Health Services database in northern Israel (2014–2024). HBsAg-positive patients were categorized into two groups: those screened for HDV via reflex testing (2019–2024) and those tested based on clinical discretion (2014–2019). We compared these cohorts to evaluate the impact of reflex screening on coverage, diagnostic yield, and time to diagnosis. Results: Among 1336 HBsAg-positive individuals, HDV screening rates increased from 57.5% to 93.1% following reflex implementation. HDV seropositivity increased from 3.17% to 6.48% (p = 0.02). Ethiopian-born individuals had significantly higher positivity than others (10.4% vs. 3.9%, p = 0.0221). The average time from HBV diagnosis to HDV testing decreased from 38.1 ± 31 months (median 37.5) to 1.3 ± 6.1 months (median 0). Conclusions: Anti-HDV reflex testing significantly improved screening coverage, increased detection of anti-HDV seropositive cases and was associated with shorter time to serologic identification. These findings support the integration of reflex testing into national screening policies to enable earlier diagnosis and reduce the burden of infection. Full article

C. asiatica (L.) Urban is a medicinal plant widely used in traditional Asian medicine with potential geroprotective properties. Its major bioactive compounds—including asiaticoside, madecassoside, asiatic acid, and madecassic acid—exhibit antioxidant, anti-inflammatory, regenerative, neuroprotective, and cytoprotective activities. Experimental studies demonstrate modulation of signaling pathways involved in oxidative stress, inflammation, apoptosis, extracellular matrix remodeling, and cellular survival, including NF-κB, PI3K/Akt/mTOR, MAPK, Nrf2/HO-1, and TGF-β/Smad pathways. Preclinical evidence further indicates attenuation of cellular senescence, improvement of mitochondrial function, enhanced collagen synthesis, and regulation of cytokine production. In experimental models, C. asiatica has shown beneficial effects on wound healing, skin aging, neuroinflammation, β-amyloid aggregation, neuroplasticity, metabolic dysfunction, and vascular protection. Preliminary preclinical findings also suggest possible effects on telomerase activity and telomere maintenance. However, clinical translation remains limited due to insufficient randomized controlled trials, low oral bioavailability of triterpenoids, variability in extract standardization, and limited pharmacokinetic and long-term safety data. This narrative review summarizes the phytochemistry, molecular mechanisms, pharmacological activities, and potential geroprotective applications of c. asiatica, highlighting its translational relevance in healthy aging and age-related disorders while emphasizing the need for standardized clinical studies. Full article

Background: Hepatitis A (HA) and E (HE) represent a significant global health burden. Despite the development of effective vaccines against hepatitis A virus (HAV) and hepatitis E virus (HEV), outbreaks of acute HA and HE continue to occur worldwide. This study aimed to assess the seroprevalence of anti-HAV and anti-HEV IgG antibodies (Abs) in the population of Belgrade and to analyze their association with socio-demographic and clinical factors. Materials and Methods: A cross-sectional study was conducted on a sample of 2533 healthy volunteers in Serbia in May 2024. Participation was voluntary and web-based, leading to an overrepresentation of women and middle-aged adults, while children were underrepresented. Due to this non-probabilistic recruitment, the absolute seroprevalence estimates have limited generalizability to the entire population of Belgrade. Serum samples were tested for anti-HAV and anti-HEV IgG using commercial ELISA kits. The anti-HEV estimate is based on a single ELISA without confirmatory testing and should be interpreted with this limitation in mind. Statistical analysis included confidence interval estimation, chi-square tests, and Spearman’s correlation. Results: Overall seroprevalence was 20.5% (95% CI: 18.9–22.1) for anti-HAV and 22.6% (95% CI: 21.0–24.3) for anti-HEV. A strong, non-linear increase in anti-HAV seroprevalence with age was observed, rising sharply from 2.8% in the 18–29 group to 78.3% in those aged 70+. Anti-HEV seroprevalence also featured a significant positive correlation with age (rs = 0.99, p < 0.0001), increasing from 4.2% in children (1–17 years) to 49.2% in the 70+ group. Men had significantly higher anti-HAV seroprevalence than women (23.1% vs. 19.3%, p = 0.029). Individuals with a history of surgical interventions or blood transfusions had significantly higher odds of being anti-HEV positive (OR = 1.41, p = 0.0005). Vaccination coverage against HAV was low (1.8%), and Abs were detected in only 28.6% of vaccinated individuals. Conclusions: This study suggests high HEV seroprevalence and an age-polarized HAV seroprevalence in Serbia, indicating a significant shift in the epidemiological landscape while acknowledging the sampling and assay limitations stated above. The findings underscore a growing population susceptible to HAV and highlight the need for reinforced vaccination strategies, improved diagnostics, and targeted public health interventions. Full article

Background/Objectives: Glutathione (GSH) is a fundamental tripeptide essential for maintaining cellular redox homeostasis, detoxification, and immune regulation. While GSH is synthesized endogenously, its levels typically decline with age, potentially increasing susceptibility to oxidative stress-related conditions. This review aims to discuss the benefits of GSH for the body and clarify the distinctions between dietary intake, endogenous synthesis, and supplementation as strategies for maintaining optimal GSH levels. Results: All studies show that GSH is a powerful antioxidant that plays a crucial role in maintaining various physiological processes in the body. It offers several benefits, primarily through its antioxidant properties and involvement in detoxification and immune regulation. This effect has potential implications for various health conditions associated with oxidative stress and inflammation, including neurodegenerative diseases, cardiovascular diseases, and metabolic disorders. Whether through diet or supplementation, ensuring adequate GSH levels can have profound benefits on longevity, immunity, and overall well-being. There are many foods known to contain GSH, and there are also many GSH supplements available on the market, but precursor-based supplements and compounds that activate GSH synthesis pathways show stronger and more consistent increases in human GSH. A diet rich in protein (for amino acids) and phytochemical-dense plants can support this, while targeted precursors (e.g., glycine, γ-glutamylcysteine) and Nrf2-activating foods or agents provide the most robust increases shown so far. Such supplementation can be beneficial, and it is most effective when combined with a diet rich in sulfur-containing foods and other nutrients that support GSH synthesis. Full article

Neuroinflammation is increasingly recognized as a key modulator of therapeutic response and adverse events in Alzheimer’s disease (AD), especially during anti-amyloid-β (Aβ) monoclonal antibody (Aβ-mAb) treatment. We applied longitudinal translocator protein (TSPO) positron emission tomography (PET) to evaluate TSPO-associated neuroinflammatory responses to chronic Aβ-mAb therapy and their modulation by the peroxisome proliferator-activated receptor γ (PPARγ) agonist pioglitazone. App^NL-G-F knock-in mice underwent TSPO-PET and Aβ-PET imaging at 5, 7.5, and 10 months of age across four treatment arms: placebo, Aβ-mAb, pioglitazone, and combination therapy. TSPO-PET detected early and progressive neuroinflammatory responses to Aβ-mAb that appeared lower with pioglitazone co-treatment. Both mono- and combination therapy were associated with altered temporal and spatial dynamics of the TSPO-PET signal. In addition, we applied a previously validated microglia desynchronization index based on TSPO-PET connectivity, which captured individual variation in regional TSPO-PET organization and correlated with cognitive performance. Together, TSPO-PET and its regional synchronicity can quantify longitudinal, region-specific treatment effects, which may help differentiate harmful from adaptive neuroinflammatory responses. These findings highlight the potential of TSPO-PET as a stratification biomarker to optimize therapeutic interventions. TSPO-PET therefore enables in vivo tracking of treatment-associated neuroinflammatory responses during anti-Aβ immunotherapy and provides a non-invasive framework for evaluating combination strategies targeting amyloid pathology and immune regulation in AD. Full article

Background/Objective: With rising per capita sugar consumption, skin glycation-related issues including dullness, homeostasis disruption and accelerated wrinkling have gained widespread attention. However, globally standardized and rigorous evaluation criteria for anti-glycation efficacy remain lacking. This study aimed to establish stage-specific glycation injury cell models and elucidate the stage-dependent molecular mechanisms of glycation-induced fibroblast damage, providing a standardized reference for anti-glycation efficacy assessment. Methods: Three glycation injury models were constructed in human foreskin fibroblasts (HFF-1): early-stage (glucose-induced), intermediate-stage (glyoxal-induced), and late-stage (advanced glycation end products (AGEs)-induced). Core biomarkers including Nε-(carboxymethyl)lysine (CML), collagen type I (Col I) and elastin (ELN) were used to optimize modeling conditions via Cell Counting Kit-8 (CCK-8) and enzyme-linked immunosorbent assay (ELISA). Untargeted metabolomics based on ultra-high-performance liquid chromatography (UHPLC)-Q Exactive Orbitrap was applied to identify differential metabolites and perturbed pathways, following Metabolomics Standards Initiative (MSI) Level 2 identification criteria. Results: Optimal conditions were determined as 50 mmol/L glucose for 48 h, 0.5 mmol/L glyoxal for 48 h, and 200 μg/mL AGEs for 24 h. A total of 319, 34 and 148 differential metabolites were identified in the three groups, respectively. Six key pathways were significantly perturbed. Early and intermediate models shared similar mechanisms (purine metabolism disturbance), while the late model showed distinct alterations in pyrimidine, nicotinate, arachidonic acid and steroid hormone metabolism. Conclusions: Three stable stage-specific glycation models were successfully established in HFF-1 cells. Significant differences in metabolic profiles and mechanisms exist across the three stages, providing a rational basis for model selection and theoretical support for anti-glycation efficacy evaluation. Full article

Introduction: Chronic non-specific neck pain (CNSNP) is a prevalent condition where active myofascial trigger points (A-MTrPs) are commonly detected in cervical muscles and may be associated with altered electromyographic activity (EMGact). However, their association with EMGact during functional tasks remains unclear. Objectives: This study aimed to explore this relationship, hypothesizing that A-MTrPs in cervical muscles would be associated with altered EMGact. Methods: An analytical cross-sectional exploratory study was conducted in 52 patients with CNSNP. Surface EMGact of the sternocleidomastoid (SCM), anterior scalene (AS), and upper trapezius (UT) muscles was recorded during the craniocervical flexion test (CCFT) and an isometric shoulder abduction task (ABD-90). Linear mixed-effects models were constructed to identify factors associated with EMGact. Age, pain intensity, pain duration, analgesic dose, anti-inflammatory dose, and kinesiophobia score were included as covariates, while gender, physical activity level, and the presence or absence of A-MTrPs were included as categorical factors. Results: At the 22 mmHg CCFT level, analgesic consumption was positively associated with peak EMGact and average AS activation (B = 0.791 and B = 0.223, respectively) and with SCM peak EMG act (B = 0.510). At the same level, kinesiophobia was associated with average SCM EMGact (B = 0.231). At the 26 mmHg CCFT level, average AS activation remained positively associated with analgesic consumption (B = 0.148) and SCM without A-MTrPs was associated with lower EMGact compared to SCM with A-MTrPs. At the 30 mmHg CCFT level, kinesiophobia was negatively associated with average EMGact of AS. In the UT muscle, during ABD-90, kinesiophobia was negatively associated with both peak (B = −0.378) and average EMGact (B = −0.132). Conclusions: The presence of A-MTrPs may be related to SCM EMGact during CCFT in individuals with CNSNP, while analgesic consumption and kinesiophobia also could be associated with cervical muscles EMGact during functional tasks. Full article

Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide, with exercise endorsed as first-line treatment and non-steroidal anti-inflammatory drugs (NSAIDs) among the most used pharmacologic options. These interventions are frequently combined in clinical practice, yet their synergistic effects remain unclear. To evaluate whether NSAID use modifies the association between physical activity (PA) and CLBP using nationally representative data from NHANES 2009–2010. Methods: We analyzed 988 adults aged ≥20 years with complete data on chronic low back pain, physical activity, medication use, and modeled covariates. Results: Among participants not using NSAIDs, moderate recreational physical activity was associated with lower odds of CLBP (adjusted OR = 0.47, 95% CI 0.25–0.91; p = 0.029). Active transport showed a similar direction but was not statistically significant (OR = 0.38, 95% CI 0.13–1.12; p = 0.074). In interaction models, active transport x aspirin was associated with higher odds of CLBP (OR = 2.24, 95% CI 1.02–4.90; p = 0.044), and moderate recreational PA x any NSAID use was also associated with higher odds of CLBP (OR = 2.26, 95% CI 1.01–5.06; p = 0.047). Subgroup analyses were exploratory and heterogeneous, including a significant potential protective interaction (OR ≈ 0.19, 95% CI 0.06–0.69; p = 0.015). Conclusions: In a nationally representative sample, NSAID use appeared to modify the association between physical activity and chronic low back pain. These findings are exploratory and hypothesis-generating. Therefore, longitudinal studies are needed to clarify the temporal and causal relationships and the potential influence of NSAIDs. Full article

Background/Objectives: Yes-associated protein 1 (YAP1) is a transcriptional cofactor that coordinates the complex interplay between cell proliferation, survival, differentiation, metabolism, biomechanics, and tissue regeneration. Previous studies have shown that YAP1 activity is reduced during aging, and replacing YAP1 function has been shown to rejuvenate old cells by mitigating senescence and its associated inflammation. Methods: As YAP1 is now confirmed to exert a profound regenerative influence on multiple organs, we wanted to gain more insight into the molecular signature of YAP1 expression relevant to brain cells. Since proteomics is a very powerful tool for discoveries, we generated SH-SY5Y cells stably expressing GFP-YAP1 and screened 8000 human proteins using multiplex arrays that utilize biotin-label-based antibody arrays. Results: We found YAP1 expression in astrocytes, microglia, neuronal and neuroblastoma cell lines, as well as human neurons. Importantly, YAP1 protein levels were significantly reduced selectively in the nuclear fractions of the brains of patients with Alzheimer’s disease (AD) relative to normal control (NC) subjects. The screen resulted in the identification of 283 differentially expressed proteins. In line with YAP1’s known role in the regulation of actin and cytoskeleton, we found a 2.53-fold upregulated level of Rho guanine nucleotide exchange factor 1 (ARHGEF1), a guanine nucleotide exchange factor (GEF) for the RhoA GTPase, which is crucial for dendritic spine regulation. A 6.19-fold upregulated level of NECAP endocytosis-associated 2 (NECAP2), the highest known increase for any protein in this screen, plays an essential role in clathrin-mediated endocytosis. Most importantly, another upregulated protein was Neudesin Neurotrophic Factor (NENF) (3.07-fold increase), also known as Neudesin, which primarily acts as a neurotrophic factor, and it promotes neuronal survival, enhances cell proliferation, and neurogenesis in neural progenitor cells. Neural Precursor Cell Expressed, Developmentally Down-Regulated 9(NEDD9) levels were also upregulated by 2.46-fold, and it affects neuronal cell number and synaptic connections through its role in neurite formation. However, it should be noted that these proteomic results are preliminary in nature as they are derived from single-sample data. The upregulated levels of ARHGEF1 and NEDD9 were confirmed by immunoblots. We also found a drastic reduction in the levels of p16INK4a, a marker of senescence. Conclusions: Thus, the anti-senescence effect of YAP1 may be mediated through p16INK4a, which in turn may be crucial for YAP1’s regenerative functions through NENF and NEDD9. Full article

The hypothesis that Group A beta-haemolytic Streptococcus (GAS) triggers an autoimmune cascade targeting basal ganglia dopaminergic circuits—producing obsessive–compulsive disorder (OCD), tic disorders, or chorea depending on the receptor subtype involved—is biologically compelling and supported by emerging molecular evidence. Yet PANDAS has remained a diagnostic conundrum since its original description in 1998, with ongoing uncertainty surrounding diagnostic criteria, the interpretation of streptococcal serology, and the distinction from primary neurodevelopmental disorders. This study aimed to review the diagnostic challenges of PANDAS, with focus on streptococcal serology interpretation, advances in dopamine receptor autoantibody biology, the genetic epidemiology of primary tic disorders, and the differential diagnosis of acute neuropsychiatric presentations in children. A structured narrative review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library for publications from 1998 to early 2025 addressing PANDAS, PANS, streptococcal antibodies, childhood movement disorders, autoimmune encephalitis, and the genetics of tic disorders. No currently available biomarker—including ASO, anti-DNase B, anti-basal-ganglia antibodies, or the Cunningham Panel—has demonstrated adequate individual-level diagnostic accuracy for PANDAS. Emerging molecular evidence identifies anti-D1R autoantibodies, acting via G protein-and beta-arrestin-mediated signalling, as candidate biomarkers for PANDAS/PANS neuropsychiatric phenotypes, and anti-D2R autoantibodies for Sydenham chorea movement phenotypes; independent replication in unselected populations is required. Primary tic disorders carry heritability estimates of 50–80% and first-degree familial risk ratios of approximately 18-fold in large population-based cohorts. Prospective blinded studies have not demonstrated a consistent population-level association between GAS infections and tic or OCD exacerbations: PANDAS and PANS remain diagnoses of exclusion. The high background prevalence of both GAS exposure and primary neurodevelopmental disorders in overlapping paediatric age ranges creates conditions for incidental temporal co-occurrence. In the absence of validated molecular biomarkers, diagnostic imprecision carries direct clinical consequences: children may be exposed to treatments with significant risk profiles—including IVIG, plasma exchange, and prolonged antibiotic prophylaxis—while evidence-based therapies are delayed. A stepwise diagnostic approach incorporating the full differential diagnosis is both an epistemological and a patient safety imperative. Full article

Background/Objectives: Congenital esophageal stenosis (CES) is a rare condition that may present with feeding difficulties in infancy, often becoming evident during weaning. We report a case of CES presenting with progressive dysphagia during the introduction of solid foods. Methods: Clinical evaluation, contrast esophagography, endoscopy, and magnetic resonance imaging were performed to characterize the stenosis and guide management. Results: Imaging revealed a fixed narrowing of the mid-distal esophagus with minimal passage of contrast and proximal dilatation. Endoscopy confirmed a non-traversable intrinsic stenosis with macroscopically normal mucosa. The patient underwent three endoscopic dilation sessions under general anesthesia using Savary-Gilliard bougies with progressive diameters (3–5 mm, 3–7 mm, and 7–11 mm). No major procedural complications occurred. At 2-month follow-up after the last dilation, feeding was appropriate for age, dysphagia had improved, and growth was regular. Conclusions: CES should be suspected in infants with feeding difficulties that worsen during weaning, particularly when symptoms are resistant to anti-reflux therapy. Endoscopic dilation can improve feeding tolerance, although repeated and staged sessions may be required. The role of adjunctive therapies such as topical budesonide remains uncertain. Full article

Ocular diseases like age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma and cataracts are major causes of visual impairment all over the world and are closely linked to oxidative stress, inflammation and mitochondrial dysfunction. This narrative review critically summarizes the available evidence on how various natural bioactive compounds, such as carotenoids, polyphenols, flavonoids, omega-3 fatty acids and botanical extracts, can affect important molecular pathways associated with ocular degeneration. Their antioxidant, anti-inflammatory, anti-angiogenic and neuroprotective properties are given particular emphasis, especially regarding the Nrf2, NF-κB and VEGF signaling pathways. This review is different from past reviews that simply discuss the potential of bioactives in the general nutritional context; rather, it unfolds the disease-specific mechanisms and compound-specific molecular actions and gives special attention to recent advances in nano-delivery systems and precision nutrition strategies to increase the bioavailability and therapeutic targeting of these nutrients in the eyes. Moreover, it offers a framework for a comparison of evidence between preclinical and clinical studies, as well as identifying current translational gaps, including limited bioavailability and a lack of long-term clinical trials, and suggesting future directions such as genotype-guided nutrition and microbiome-informed interventions. In general, this review provides a mechanistic and translational overview of how dietary bioactive compounds relate to eye health and offers the perspective of their possible use in prevention and complementary treatment for vision-related diseases. Full article

Plasminogen activator inhibitor-1 (PAI-1), encoded by SERPINE1, is the principal physiological inhibitor of tissue-type and urokinase-type plasminogen activators and a central regulator of fibrinolysis. Beyond its canonical hemostatic role, PAI-1 has emerged as a pleiotropic mediator of tissue remodeling, fibrosis, metabolic dysfunction, cancer progression, cellular senescence, and age-associated immune dysregulation. A central argument of this review is that PAI-1 should be understood not only as a downstream biomarker of aging-associated pathology, but also as an active effector linking senescence-associated secretory phenotype (SASP) signaling, chronic low-grade inflammation, impaired immune surveillance, fibrotic extracellular matrix remodeling, and a prothrombotic state. In this framework, PAI-1 may function as an immune-aging checkpoint: a molecular node through which senescent, stromal, malignant, and inflammatory cells reinforce immune evasion and tissue dysfunction. Structure-guided drug discovery has enabled the development of small-molecule PAI-1 inhibitors, including TM5275, TM5441, TM5509, and TM5614. Among these, TM5614 is an orally available investigational compound that has progressed to clinical evaluation. Preclinical studies support anti-thrombotic, anti-fibrotic, anti-inflammatory, anti-senescent, and tumor-microenvironment-modulating effects of PAI-1 inhibition, while early clinical studies have evaluated TM5614 in chronic myeloid leukemia, immune-checkpoint-refractory malignant melanoma, non-small-cell lung cancer, and COVID-19-associated pneumonia. This review summarizes the biology of PAI-1, expands the discussion of immunoaging, reviews representative preclinical and clinical data, compares available PAI-1 inhibitors, and discusses the translational opportunities and safety considerations for TM5614 and related compounds. Full article