{"publication_id":"873ff54a-3a1e-4c35-b4ff-b2bb5ab68649","screening":{"identified":37,"screened":37,"excluded":0,"included":37,"included_or_retained":37,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"37 candidate receipts retained after source retrieval, deduplication, and topic filtering. This is an evidence-map screening trace, not a PRISMA full-text exclusion audit.","exclusion_reasons":["No PRISMA full-text exclusion-stage filter was applied."]},"limitations":["This is an agent-assisted evidence map, not a PRISMA-complete systematic review or clinical guideline.","It is not PROSPERO-registered and should not be read as medical advice.","Public sidecars expose citation traces and extraction status; empty fields mean not extracted, not assumed absent."],"contradictions":["What does the current evidence establish about Colchicine Inflammaging and human geroscience? This paper synthesizes colchicine inflammaging as an aging-related intervention across 37 included source papers and 1511 high-confidence extracted claims. The evidence profile contains 3 direct clinical sources, 18 adjacent clinical sources, and no sources classified primarily as mechanistic or model-system evidence, with 113 cross-study disagreements across the evidence base. Positive study-level signals concentrate in the dosing and pharmacokinetics, longevity and immune outcome classes, null signals in the contextual adjacent evidence, cardiometabolic and dosing and pharmacokinetics outcome classes, and negative signals in the contextual adjacent evidence and longevity outcome classes. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect. The conclusion is that colchicine inflammaging remains a bounded geroscience case: mechanistic plausibility and selected clinical signals justify further targeted testing, while mixed and null findings limit any unqualified anti-aging claim. This conservative interpretation is especially important in aging research because endpoints often differ across model systems, human trials, and observational cohorts. A signal in one domain does not automatically establish the same signal in another.","Quantitative findings across these sources present a mixed picture. Cares 2026 reported null findings for diet and exercise interventions on cardiometabolic disease risk markers in the pediatric cancer survivor population reviewed, though no specific p-values were provided for pooled estimates.","Within the cardiometabolic corpus, tensions arise not from direct scientific disagreement but from differences in study context and intervention type. Cares 2026's null systematic review findings in pediatric cancer survivors further illustrate that the cardiometabolic inflammaging evidence remains fragmented across populations and intervention modalities, with no single source providing definitive mechanistic confirmation in a chronic aging context.","Mechanistically, colchicine's anti-inflammatory actions are well-characterized: it inhibits neutrophil chemotaxis, NLRP3 inflammasome activation, and microtubule-dependent cellular processes (Deftereos 2020; Imanishi 2026). These pharmacological properties provide biological plausibility for effects on inflammaging pathways. However, direct evidence that colchicine attenuates inflammaging biomarkers in human aging populations remains sparse, with most clinical data originating from cardiovascular event trials rather than aging-specific endpoints.","Within the corpus, notable tensions exist between sources reporting positive cardiovascular signals and those reporting null findings. Samuel 2025 and Wang 2025 both indicate beneficial effects of colchicine on recurrent vascular events, while Mohammadnia 2025b, Maes 2026, and Shchendrygina 2023 report null or non-significant results in their respective analyses. These disagreements likely reflect differences in population selection, outcome definitions, follow-up duration, and colchicine dosing (0.5 mg/day in most RCTs) rather than fundamental contradictions, as many comparisons involve different clinical contexts or subgroups.","Within this corpus, some tensions arise from differences in study design, endpoint selection, and effect direction attribution. Samuel 2020 reports no primary efficacy data of its own but frames the COLCOT findings within a cost-effectiveness analysis. Pan 2023's positive peri-operative findings contrast with the null safety signals reported by Broekhoven 2022, reflecting the different biological contexts — acute surgical inflammation versus chronic stable disease — under which colchicine was administered.","The evidence base for colchicine's effects on inflammaging-related immune biomarkers is limited in this corpus. Only one source, Mathiesen 2025, directly addresses colchicine in a diabetes population, describing an investigator-initiated, randomized, double-blind, placebo-controlled phase 2b trial (REC1TE) evaluating low-dose colchicine (0.5 mg/day) in individuals with type 1 diabetes to reduce residual inflammatory risk. However, this study is described in terms of its design and rationale, with no primary endpoint results reported, leaving the effect direction on immune markers as unclear. Ramuth 2026 provides observational data from an older adult cohort but examines cardiometabolic index rather than colchicine, yielding a null overall effect direction.","Mechanistically, colchicine's well-characterized anti-inflammatory actions — including inhibition of the NLRP3 inflammasome, tubulin polymerization disruption, and neutrophil chemotaxis suppression — provide a plausible basis for inflammaging modulation. However, the corpus contains no direct human mechanistic RCT data for colchicine on inflammaging biomarkers. Li 2025b's cocoa extract trial, which targets overlapping inflammatory pathways via flavanol-mediated reductions in hsCRP, offers indirect support that sustained anti-inflammatory intervention can alter inflammaging markers over a 2-year period. The absence of comparable colchicine-specific RCT data in this corpus means that mechanistic plausibility remains unconfirmed by human experimental evidence.","However, this tension is tempered by the fact that Li 2025b evaluated a non-colchicine intervention; it does not constitute direct evidence against colchicine but rather highlights that inflammaging biomarker modulation is achievable under certain intervention conditions. Mathiesen 2025's REC1TE trial, once completed, is positioned to resolve whether colchicine's anti-inflammatory profile translates to measurable biomarker changes in a diabetes population. The current evidence landscape for colchicine and immune outcomes in inflammaging is therefore characterized by mechanistic rationale without confirmed human RCT data, and the boundary conditions for efficacy remain to be established.","The synthesis identified two observational cohorts examining colchicine's impact on inflammatory and immune biomarkers. Shi 2026 was an observational pilot study in adults with heart failure with preserved ejection fraction (HFpEF) who received colchicine 0.5 mg once daily, with inflammatory markers reassessed after two weeks of outpatient treatment. Pourkarim 2025 described a study protocol for a randomized, double-blind, placebo-controlled trial examining colchicine in sepsis, a life-threatening condition with high mortality rates of up to 40% due to multiple organ dysfunction, enrolling a total of 44 patients aged 18 to 80 years. Both sources contributed to the immune inflammation outcome class, though neither constituted a completed clinical RCT with hard endpoints. The evidence base for this outcome class therefore rests on indirect directness assessments and observational designs.","Quantitative findings from Shi 2026 demonstrated statistically significant reductions in inflammatory cytokines and symptom improvement in HFpEF patients treated with colchicine. These results reflected a mixed effect direction, with multiple inflammatory endpoints reaching significance. Table 2 presents the complete per-study endpoint evidence for these quantitative outcomes.","Within the immune inflammation outcome class, a substantive tension exists between Shi 2026 and Pourkarim 2025. Shi 2026 reported mixed positive findings with multiple significant p-values across inflammatory endpoints in HFpEF, whereas Pourkarim 2025 yielded a null overall effect direction in the sepsis context despite individual p-values reaching significance. This disagreement carries a severity rating of 4 in the cross-study disagreement map, reflecting a meaningful difference in outcome patterns. The divergence may partly reflect the distinct clinical contexts — chronic low-grade inflammation in HFpEF versus acute hyperinflammation in sepsis — rather than an inherent contradiction in colchicine's anti-inflammatory mechanism. However, this context-dependency underscores that the inflammatory outcome evidence remains insufficient to establish a uniform anti-inflammaging effect across populations.","Despite the consistent gastrointestinal safety signal, the overall benefit-risk profile appears favorable for specific cardiovascular indications. These substantial efficacy signals in cardiometabolic endpoints suggest that the gastrointestinal risks, while statistically significant, may be clinically manageable in appropriately selected patient populations."]}