Physicians React: 'Incompetence in Medicine Has No Age Limit'

 In their day-to-day work, doctors must utilize sophisticated cognitive skills and — depending on the specialty — fine-tuned manual dexterity. But these skills sometimes decline with age, leading to the conundrum of whether doctors can safely continue to practice medicine into their late sixties and beyond.

A recent Medscape commentary by bioethicist Arthur L. Caplan, PhD, tackled this question. In his commentary, which was inspired by an opinion piece in The New York Times entitled, "How Would You Feel About a 100-Year-Old Doctor?," Caplan notes that, unlike airline pilots, who are subject to mandatory retirement at age 65 because of the possiblity of cognitive or health decline, there is no mandatory retirement age for physicians.

Caplan recommends a "basic competency" recertification process, consisting of "a memory test, some sort of dexterity test, or a simple 20- or 30-minute examination annually or every other year" to "make sure that once you are older than 65, your skills have not slipped in a way that would harm patients or cause the risk of malpractice to increase."

Heated debate among Medscape readers ensued. One called the commentary "ageism at its finest," while another wrote, "Age and competency aren't directly correlated. Testing to maintain licensure based upon age is blatant discrimination."

Incompetence Has No Age Limit

One debate revolved around experience vs new technology. Many readers felt strongly that older physicians are not only competent but are actually superior to younger ones. "I would go to a 100-year-old doc in a heartbeat!" wrote one. "What they have observed and experienced is priceless. My favorite doc right now is 87 and he is my advisor on all things health." But "sadly, our society does not always respect the experience and wisdom that come with age," another said.

Younger physicians don't yet have the same amount of wisdom and experience, another noted. "They need to put in their time to reach that level." And a medical student "loves" older doctors because "they're compassionate, experienced, and highly intelligent — I'd trust many of them with my life over some younger physicians."

One reader said, "The young doctors might have some technical superiority to the older docs, but bedside manners and quality time is overwhelmingly better with older physicians." Not to mention experience: "If I know I need surgery, I want the old doctor who has done 1000 of them. If I want options and new treatment options, the young docs are better."

Several readers argued that aging and declining competency don't necessarily go hand in hand. "As Caplan suggested, there needs to be a way to screen for issues which should preclude practice, [but] age per se is not the issue; it's competence." Another agreed, adding, "incompetence can be found in clinicians of any age."

One respondent described physicians and other healthcare professionals she works with who are in their seventies and eighties. "You would be shocked to learn they are that old." On the other hand, she knows many in their fifties "who need to retire, due to physical and cognitive decline."

For this reason, "if this type of testing is to be done, it should be done at all ages and in a prospective manner to see what indicators there are that a physician is not able to practice well."

In the words of another reader: "If this agenda is going to continue to be pushed upon us then out of fairness, I think we should apply it to all ages."

More Experienced vs More Up to Date

But there were readers who preferred younger physicians. For example, "I wouldn't go [to a 100-year-old doctor]. The best doctors are between 5 and 15 years in practice, maybe 20 years. Medicine is a constantly-changing field, and we have to keep up to do our best for our patients." This reader has "seen too many senior partners treat patients with behind-the-times techniques and advice" despite advances in the field.

Others chimed in with similar perspectives. "There are some physicians who, despite their relative youth, are quite brilliant, skilled, kind, responsive to the patient's desires and needs, admired by their school's faculty and residents, and are charitable with their time as well. I met one at Johns Hopkins and I am grateful to have had him as my surgeon."

Is It Going Too Far to Test Competence?

Many readers balked at the idea of recertification testing beginning at age 65. For one thing, doctors are already subjected to a formidable number of tests and requirements, such as CME. One reader described taking a veritable alphabet soup of tests at regular intervals: CME, ACLS, ATLS, PALS, NRP, and the board exam every 10 years. "I don't believe another exam is necessary to demonstrate my competence," he wrote. "My competence is constantly being reviewed and I am nearly to that mandatory retirement age."

Others questioned what the exam would consist of and who would administer it. "I think in theory, it is good to test medical personnel — doctors, nurses, EMTs, etc, anyone who has hands-on care. But the rub is: who creates the tests, who audits the tests, how is it handled when someone falls into that category of 'not doing as well as he/she should?' Do we just accept the person's or panel's decision and retire? It's a slippery slope, but the idea is valid."

Another reader expressed similar concerns. "Testing? What are the tests and what will they actually tell us? For instance, does failure to remember a series of five words tell us much about clinical skills? And what happens after 'failure'? Supervision? Retraining? Reassignment? Loss of license? This idea is poorly thought out."

Where's the Evidence?

The practice of medicine should rest upon a solid evidence base informed by robust research, says one reader.

Another pointed out that, "before putting in new, non-evidence-based regulations," people should "think about doing a study looking at the signs and symptoms that predict the inability to practice medicine where the MD does not voluntarily give up practice. Bottom line: is it really a problem that there are a lot of physicians who, due to age, are not modifying their practice so that they are practicing within their capabilities? If so, let's see the studies."

Not All or Nothing

Some readers suggested that continuing to practice medicine into old age isn't an "all or nothing" proposition. "Why can't we create a system where professionals, such as surgeons or ICU staff, must pivot after a certain age to work in a consulting/mentor role?," a reader asked. "This could allow valuable expertise to be more widely disseminated to the next generation of doctors. Is the current system, to work just full-force until you must then not work at all, really the best possible system?"

And specialty mattered to several readers. "A 100-year-old surgeon is out of the question," one wrote. "As we age, our reaction time to external stimuli slows, but this isn't the same as cognitive decline. Maybe I'd go for a consult in non-surgical specialties."

For the surgeon to desist from performing surgery after his or her manual dexterity has declined does not mean that the surgeon should leave the field of medicine entirely. A reader described an older orthopedic surgeon who — after realizing he could no longer perform complex orthopedic surgeries safely — remained with his group instead of retiring. He continued to use his diagnostic skills to the benefit of patients and fellow surgeons. "I believe he was in his late eighties when I last saw him. He noted a fracture which had been missed by radiology and, more importantly, helped me avoid complications from the related crush injury."

Already having a historical relationship with the doctor might affect the decision as well. "If it was a physician I knew and trusted, then I would still see them. If it was a new physician to me, then probably not," a reader commented.

https://www.medscape.com/viewarticle/987837

Firefighters warn a Tesla fire is 'one of our worst nightmares'

 Firefighters trying to keep America’s roadways safe are reporting higher difficulties in putting out blazes involving Teslas and other electric vehicles, with a first responder in Michigan calling them "one of our worst nightmares." 

The concerns come as electric vehicle sales are trending upward in the U.S., with automakers selling 807,180 of them last year to increase market share to 5.8%, compared to 3.2% in 2021, according to a recent report by The Wall Street Journal. 

Fire departments in states such as California and Massachusetts say electric vehicle fires are taking hours to put out, with one in recent weeks needing more than 20,000 gallons of water to extinguish. The challenges are being blamed in part on the batteries found inside electric vehicles. 

"It can take four to five hours to extinguish a battery fire and after that, once it gets to a tow yard, they have had those fires reignite -- even two to three days afterward," Lt. Robert Muylaert of Shelby Township Fire in Michigan told Fox2 Detroit. 

A Tesla vehicle fire on Jan. 19, 2023 along Interstate-95 in Massachusetts that took firefighters more than 20,000 gallons of water to extinguish. (Wakefield Fire Department)

"Once they start to burn, it goes into what is called thermal runaway," he added. "So in that one battery, [it] puts out enough heat and fire to light the battery next to it on fire." 

Capt. Parker Wilbourn of the Sacramento Metropolitan Fire District in California told ABC 10 after a Tesla caught fire on Highway 50 near Sunrise Boulevard last week "Electric vehicle fires are just a whole different beast." 

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"On last week’s incident, [the] driver... noticed smoke billowing from the undercarriage of the vehicle. Thankfully, she was able to pull off the side of the road and exit the vehicle safely, but that fire just continued to grow and ended up actually burning through the hood," he said. 

"These fires burn very hot and it is dangerous because there are different chemicals that are being produced," Wilbourn also told the station. "On a standard internal combustion engine, I can generally put that fire out if that vehicle is fully involved with my 700-gallon water tank on any fire engine that we have, not so much for our EV vehicles. We've had three that have burned in Metro Fire’s jurisdiction, and all of them have taken thousands of gallons of water to extinguish." 

Firefighters used about 6,000 gallons of water to extinguish a Tesla electric vehicle fire near Sacramento, California on Jan. 28, 2023. (Metro Fire of Sacramento  / Fox News)

In mid-January in Massachusetts, the Wakefield Fire Department outside of Boston said "more than 20,000 gallons of water were used" to extinguish a fire involving a Tesla vehicle that crashed along Interstate-95. 

"As sales of electric and hybrid vehicles increase, the fire service is continuing to modify our tactics to properly respond, protect property and firefighters as well as control these types of fires," said Wakefield Fire Provisional Chief Purcell. "Fire companies on the scene of an electrical vehicle fire should expect longer time frames to manage and control EV vehicle fires, ensure that large, continuous, sustainable water supply is established, as well as maintain heightened situational awareness and prepare for secondary fires." 

Crews used jacks to lift the Tesla Model S and to put out the fire on Jan. 28 and cool the battery from underneath the vehicle. (Metro Fire of Sacramento  / Fox News)

Fire Engineer Matt Halleck, who works are a training officer in Hillsdale, Michigan, told the Hillsdale Daily News that "electricity and water do not mix." 

https://www.foxbusiness.com/economy/firefighters-tesla-electric-vehicle-fires-worst-nightmares

Big Philanthropy Advances as Big Player in Private Funding of Public Elections

 Echoing the private financing of public elections that critics saw as heavily favoring Democrats in 2020, some of America’s richest foundations are pouring money into a similar effort again, in the face of more organized conservative resistance.  

A nonprofit group called the Audacious Project, whose supporters include the Gates and MacArthur foundations and the Bridgespan Group, a consultant whose clients include Planned Parenthood, has committed $80 million to a progressive organization, the Center for Tech and Civic Life, to provide grant funding to run local elections.   

As part of its review process, the CTCL is sending operatives to local elections offices, examining practices and equipment, and acquiring the sorts of data coveted by political campaigns. Despite public claims of transparency, the center has refused to provide basic information about its operations.  

The CTCL became a focus of controversy in 2020 when it helped direct hundreds of millions of dollars donated by Facebook founder Mark Zuckerberg and his wife Priscilla Chan to help run elections during the pandemic, which prompted ad hoc changes to rules minimizing in-person voting. Many objected to that as unlawful. While the outside assistance was touted as nonpartisan, post-election analysis found that the so-called “Zuckerbucks” or "Zuck Bucks" were distributed on a partisan basis that favored Democrats.  

In response to concerns about the private money, 24 states and 12 counties have prohibited elections offices from accepting it. Democratic governors in three of the states selected to be part of the CTCL’s initial membership group – Wisconsin, North Carolina, and Michigan – overrode legislation banning private funding of elections, stoking more concern that the grants are a ruse for partisan infiltration of elections offices.   

The U.S. Alliance for Election Excellence expects that not all will welcome its help. Above, from its FAQs.

U.S. Alliance for Election Excellence

The CTCL in April created a consortium called the U.S. Alliance for Election Excellence, whose six partner groups include the CTCL, and are intertwined to specialize in different aspects of elections. For an annual fee, the consortium offers assistance to elections offices, providing online tutorials, consulting, and other services on an as-needed basis. A basic alliance membership costs a municipality $1,600 a year; a premium membership runs $4,800 annually.   

Both subscriptions offer consulting, coaching, and conferencing, and belonging obligates the member to “make non-monetary (but highly significant) contributions to the broader activities of the Alliance.” 

These include attending events put on by the CTCL-created alliance and the sharing of materials. Virtual conferences began in January, one described as a “debrief” of elections officials from the 2022 election designed to “inform preparation” for the 2024 elections.   

In May, the CTCL reached out to elections officials, inviting them to apply to join the alliance, which would bring together “election officials, designers, technologists, and other experts to help local election departments improve operations.” It received inquiries from over 90 jurisdictions in 31 states.   

The approved applicants were visited by CTCL representatives, a contingent that included Jennifer Morrell and Noah Praetz, leaders of The Elections Group, which works on election issues alongside progressive stalwarts such as Protect Democracy and the Brennan Center for Justice.   

Jennifer Morrell and Noah Praetz of the Elections Group, which has progressive ties. They do CTCL field visits.

The Elections Group

Ultimately, 10 elections offices, including several in swing states, were selected after on-site visits by the CTCL. Of the elections offices selected by the center, voters in six of them supported Joe Biden for president in 2020.   

Officials in one of the chosen towns, Greenwich, Conn. – a former GOP stronghold that has become a Democratic enclave -– had concerns about working with the CTCL. When residents heard that its elections office was tapped to receive $500,000 in grant money from the CTCL, a member of the town’s legislative council sent an email to the center seeking more information, including audits of the group’s books, a copy of the group’s annual report, and its conflict-of-interest policy.   

The CTCL declined to provide the documents, insisting that its audited financials and conflict policies “are not publicly filed documents,” Sophie Lehman, the group’s associate director, said in an email – even though the CTCL on its 2021 tax return claims financial statements and its conflict of interest policy are “available to the public on request.”  

The refusal by Lehman, who also didn’t respond to a request for the materials from RealClearInvestigations, prompted some residents to unsuccessfully rally against accepting the money, which was approved in a town meeting this month with a 104-101 vote.   

“I would be against the money even if it were the Koch brothers giving it,” said Michael Spilo, a Republican member of the town’s council who voted against taking the grant, referring to the billionaire brothers long associated with support for libertarian and conservative causes. “I don’t think private money should be involved at all. It seems like a really bad idea.”  

But that failed resistance has shed light on the CTCL’s practices. Emails obtained by RCI through an open records request show that before its September visit, the CTCL emailed the town’s voting registrars asking them to prepare certain materials.  

Doug Lewis, elections veteran: “Even if this all starts with the right intentions, there’s too much opportunity for manipulation.” 

U.S. Election Assistance Commission/YouTube

“We are collecting data on your operations, setup, and equipment to help Alliance partners better understand who you are and how you operate,” the email read.    

Greenwich registrar Fred DeCaro sent an email to an assistant asking her to prepare materials for the CTCL team to review, including sample ballots, maps of polling places, voting books, trouble reports from poll moderators, and electronic poll books.  

While some of the material involved is in the public record, “I would be a little worried about turning over poll books and voting software to anybody that wasn’t actually hired by an elections office,” said Doug Lewis, former executive director of the Elections Center (not The Elections Group), also known as the National Association of Election Officials. “Even if this all starts with the right intentions, there’s too much opportunity for manipulation.”  

The approach of the CTCL-created alliance has raised other concerns from recipients.   

“By participating in this program and becoming a member of Alliance, we have to pay money to continue to be part of it,” said Tim Tsujii, director of elections at the Forsyth County, N.C., Board of Elections. “We will pay an annual membership fee to be accredited by this alliance. There is all this talk about the money going to elections offices and the counties, but what about the money going from the counties to the alliance?”  

Tim Tsujii, North Carolina county elections director: “We were upfront about not getting any grant money.” 

Forsyth County

Tsujii, a member of the CTCL advisory board, supports the alliance, but says his jurisdiction will not take any money from it, since it has enough financial resources to run effective elections. The office also didn’t take any money in 2020, Tsujii noted.   

He joined the alliance to share approaches and practices to conducting elections, rather than seeking a grant, and “we were upfront about not getting any grant money.”  

In a Dec. 1 contract obtained by RCI, Kane County, Ill., received $2 million in grants – $650,000 in December 2022 and $1.35 million in December 2023 – and promised to spend the money on personnel, technology, and voting locations; but it is also allowed to use it for sub-grants to local political subdivisions or local governments. The contract is the same as the one used to give grants in 2020.    

Also accepting $2 million in CTCL grant money is Contra Costa County, Calif., where President Biden took 71% of the vote in 2020. Progressive stronghold Madison, Wis., took a $1.5 million grant.   

Another alliance member, Republican-tilting Brunswick County, N.C., signed on to be part of the alliance but will not take any grant money. But as part of its alliance membership, Elections Director Sara LeVere said in an email, she is attending an in-person convening of members, the first of which is scheduled to be in Chicago this week.   

 “I plan to ask for reimbursement from the Alliance for travel costs (flight, hotel, etc.),” LeVere said, adding, “I currently do not have plans to take in any direct funding that would not be offsetting an expense we have for participation.”   

Collegial connections to other offices and the sharing of ideas appeals to Ottawa County, Michigan, County Clerk Justin Roebuck. But the money is not for him.  

Justin Roebuck, Republican county clerk: "[W]e asked for the stats they were using. And there was no clear answer provided to us.” 

justinroebuck.com

“In 2020, after the money was released, and because of FOIA, and because the election community is a small world, I saw that some communities got significantly more money than others,” Roebuck, a Republican who has held office since 2014, told RCI.  After the election, he questioned the CTCL, asking what the criteria for the funding was.  

“The answer they gave is that it was population- and resource-driven,” Roebuck said. “Then we asked for the stats they were using. And there was no clear answer provided to us.”  

Roebuck said Ottawa County was offered grant money this time around – he didn’t give the amount – but said he will refuse it. Like the people in Greenwich, Roebuck is concerned about the lack of transparency on the part of the CTCL.   

“I believe the intentions of the alliance are sound, though, and remain excited about an effort to partner with non-profits that can offer services,” he said.   

CTCL co-founder Tiana Epps-Johnson did not respond to an email and text message requesting an interview for this story.   

Last year, Epps-Johnson told the website Afrotech.com that her push to privately fund elections works because “we know there are election departments in all types of communities that don’t have the basic technology they need to keep the process secure. … Our work at the center is focused on how we can make sure no matter what community you live in, your government is ready to provide access to democracy in a way that truly works for every voter.”  

Much of the work done with CTCL grant money in 2020, though, focused on rallying voters to cast ballots, designing absentee ballots, and allowing elections offices to work directly with progressive activist groups in several states. Emails show that CTCL relied on progressive consultants in advising elections administrators in Wisconsin, including the Brennan Center.  

Some municipalities used the money to produce videos and ads to drive voters to cast mail-in ballots, while others used the cash to pay attorneys to vet public information requests.   

For voters to have faith that the grants are being awarded with nonpartisan intentions, “the process for awarding the money should be more transparent,” said Hayden Ludwig, a researcher at the conservative Capital Research Center, which has been critical of the CTCL’s funding of elections offices.   

The grant-making, political foes contend, is a politically biased process that favors Democrats. If this new alliance and the CTCL were interested in helping elections offices, Ludwig said, “they would be advocating through democratic channels to expand budgets, going into state legislatures to support infrastructure. But they don’t and they have millions of dollars at their disposal.” 

https://www.realclearinvestigations.com/articles/2023/01/31/big_philanthropy_advances_as_a_big_player_in_the_private_funding_of_public_elections_877615.html

Italy Hit With Nationwide Internet Outage

 Network data from NetBlocks shows widespread disruption to internet service across Italy on Sunday. It's been reported that the telecommunications blackout might stem from leading operator Telecom Italia.

NetBlocks' real-time network data shows that national connectivity plunged from around 100% to 26% this morning

Another internet disruption tracking website shows a heatmap of the outages that appear to be nationwide. 

https://www.zerohedge.com/geopolitical/italy-hit-nationwide-internet-outage

Antibody candidate for treating serious liver disease IDd

 There is currently no drug for treating non-alcoholic fatty liver disease, which affects many people with type 2 diabetes and which can result in other serious liver diseases. A study led by researchers from Karolinska Institutet has now identified a drug candidate for the treatment of fatty liver. The preclinical study, published in the Journal of Hepatology, indicates that an antibody that blocks the protein VEGF-B presents a possible therapeutic option for fatty liver disease.

Fatty liver is associated with several serious and sometimes fatal diseases," says the study's first author Annelie Falkevall, researcher at the Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Sweden. "With the therapeutic principle that we've developed, it might be possible to prevent fatty liver and hopefully lower the risk of liver failure and terminal liver cancer."

For decades, obesity and overweight have been a common global disease that, amongst other problems, has caused a sharp rise in the incidence of type 2 diabetes. According to the Swedish Diabetes Association, there are 500,000 cases of diabetes in Sweden alone, of which 85 to 90 percent are type 2.

Significant rise in liver cancer risk

Chronic overweight and type 2 diabetes increase the risk of non-alcoholic fatty liver disease (NAFLD), which is the most common cause of chronic liver diseases, such as liver failure and liver cancer, in Europe and the U.S.

White adipose tissue has a remarkable ability to store energy in the form of lipids, but in the case of chronic obesity, and often type 2 diabetes, it is not enough and the concentration of fatty acids in the blood increases. They are therefore stored elsewhere, including in the liver. Not only does the accumulation of fat in the liver interfere with the secretion of glucose and lead to insulin resistance, but it also increases the danger of permanent damage to one of the body's most important organs.

NAFLD affects over 100 million adults, and previous research indicates a 17-fold higher risk of liver cancer in people with NAFLD. In people with type 2 diabetes, the incidence of NAFLD is 25 to 29 percent. There are at present no approved drugs for treating NAFLD.

Antibody blocks the release of fatty acids

Researchers at Karolinska Institutet, CIBERDEM and CIBEROBN in Spain, CSL Behring in the U.S., and CSL Innovation in Australia have now studied a new method for limiting the development of fatty liver.

For the study, the researchers had access to a drug candidate in the form of an antibody to the protein VEGF-B (Vascular Endothelial Growth Factor B), which controls the release of fatty acids from white adipose tissue.

"We've identified a new method of treating fatty liver disease that involves keeping the fatty acids in the adipose tissue so that they don't leak out and accumulate in the liver," says the study's corresponding author Ulf Eriksson, professor at Department of Medical Biochemistry and Biophysics, Karolinska Institutet. "Our results show that the pharmacological blocking of the VEGB-B signal pathway in mice prevents the accumulation of fat in the liver and reduces the risk of NAFLD."

The study was conducted on normal and genetically modified mice that received different diets and were treated with the drug candidate. The researchers also studied adipose tissue from 48 patients due to have bariatric surgery. One half of the group had NAFLD, one half did not. Their results reveal a clear correlation between the level of VEGB-B signaling in white adipose tissue and the presence of NAFLD.

"The next step in taking this exciting drug candidate further is to include it in a clinical development program," says Professor Eriksson.

More information: Annelie Falkevall et al, Inhibition of VEGF-B signaling prevents non-alcoholic fatty liver disease development by targeting lipolysis in the white adipose tissue, Journal of Hepatology (2023). DOI: 10.1016/j.jhep.2023.01.014

https://medicalxpress.com/news/2023-02-antibody-candidate-liver-disease.html

Therapeutic target in macrophages for treatment of obesity-related diseases

 Macrophages are cells of the immune system that, in addition to playing an essential role in the early response to microbial infection, also regulate tissue function and inflammation. Inflammation is a physiological response that helps to repair damaged tissue, but if not correctly resolved it can become chronic inflammation, which lies at the origin of many conditions, including the metabolic syndrome associated with obesity, type 2 diabetes, and cardiovascular disease.

Now, a team at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) has discovered that the metabolic requirements of macrophages differ depending on the organ in which they reside. In other words, these cells adapt to the needs of the organ in which they are located.

The discovery "gives us a better understanding of how macrophages regulate their metabolism according to the organ in which they reside. In addition, our results reveal a vulnerability of macrophages that contributes to chronic inflammatory diseases and that could be exploited therapeutically for the treatment of conditions associated with obesity and metabolic syndrome, such as cardiovascular disease," said study leader Dr. David Sancho, who heads the CNIC Immunobiology group. The study is published today (February 3) in an article in the journal Immunity.

Macrophages are immune cells that are normally distributed throughout the body and help to cleanse organs of all types of biological material that needs to be removed, from harmful particles such as mineral crystals or viruses to proteins or larger complexes that arise during development. Macrophages are also important for removing dead cells, thus contributing to tissue renewal. The new study reveals that macrophages adapt their metabolism and function to the organ in which they reside.

"In tissues with abundant extracellular fat and cholesterol, such as the lungs and spleen, macrophages adapt their metabolism to degrade these fats through mitochondrial respiration," explained first author Dr. Stefanie Wculek. "Using genetic or pharmacological methods to disrupt mitochondrial respiration, mitochondria can be eliminated from lung and spleen, whereas the macrophages in other organs, which don't depend on mitochondrial respiration, survive."

Another example is provided by the macrophages located in body fat, or adipose tissue. "Macrophages residing in the body fat of a person of normal weight are unaffected by mitochondria-disrupting treatments because their metabolism is less dependent on mitochondrial respiration. This is because the fat cells, called adipocytes, are fully functional, leaving the macrophages in a resting state," said Dr. Sancho. "However, in obese individuals, the excess fat surpasses the capacity of the adipocytes, and the resident macrophages become activated, converting into inflammatory cells that promote the development of insulin resistance, type 2 diabetes, and fatty liver."

But this change in adipose tissue macrophages also makes them vulnerable. "The activated macrophages depend on mitochondrial respiration to process the excess fat, and this makes them vulnerable to therapeutic interventions, including pharmacological inhibitors of mitochondrial respiration," explained Dr. Sancho.

The Immunity study shows that inhibition of mitochondrial respiration killed these proinflammatory macrophages, preventing the progression of obesity, type 2 diabetes, and fatty liver (the key components of metabolic syndrome) in an experimental mouse model. The investigators conclude that this finding opens the way to new treatments for conditions linked to obesity and metabolic syndrome, like cardiovascular disease.

More information: David Sancho & colleauges, Oxidative phosphorylation selectively orchestrates tissue macrophage homeostasis, Immunity (2023). DOI: 10.1016/j.immuni.2023.01.011. www.cell.com/immunity/fulltext … 1074-7613(23)00021-3

https://medicalxpress.com/news/2023-02-scientists-therapeutic-macrophages-treatment-obesity-related.html