Association of composite dietary antioxidant index with high risk of prostate cancer in middle-aged and elderly men: insights from NHANES

Objectives

In the US, the most common type of cancer and the second leading cause of cancer-related death in men is prostate cancer (PCa). Food and lifestyle factors may influence the risk of developing prostate cancer. Therefore, research on dietary components associated with prostate cancer is essential for its prevention. Data from the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2010 was used for this cross-sectional investigation involving 5,658 middle-aged and older American men.

Methods

Dietary antioxidant vitamins A, C, E, total carotenoids, zinc, and selenium were subtracted from the total mean, divided by the standard deviation, respectively, and then summed to become the CDAI. Participants were categorized as high risk for PCa if they had tPSA greater than 10 ng/mL or tPSA levels between 4 and 10 ng/mL with f/t PSA ratios of 25% or below; the remaining subjects were classified as being at low risk for PCa.

Results

The sample represented approximately 75,984,602 American men. After multivariate logistic regression, dose-effect analysis and stratified analysis, CDAI was significantly and linearly negatively associated with a high risk of prostate cancer (OR=0.95, P=0.002, P for linear=0.0021). Age moderation analysis showed a significant effect on the inverse relationship between CDAI and prostate cancer risk (B = -0.0097, SE = 0.0034, t = -2.85, P = 0.004). Among the independent effects of CDAI components, zinc and selenium were more strongly negatively associated with prostate cancer (zinc, OR = 0.80, P = 0.008; selenium, OR = 0.78, P< 0.001).

Conclusions

CDAI serves as a dietary indicator of prostate cancer risk in middle-aged and older men, and high dietary antioxidant intake has a significant protective effect on prostate cancer risk, especially in the older population of men.

Protective Effect and Gut Microbiota Modulation of Grifola frondosa Antioxidant Peptides in Sodium Dextran Sulfate-Induced Ulcerative Colitis Mice

Grifola frondosa antioxidant peptides (GFAP) were prepared through trypsin enzymolysis and characterized. This study conducted a comprehensive assessment of clinical symptoms, colon pathological injuries, levels of inflammatory factors, expression of inflammation-related proteins, and alterations in gut microbiota composition in mice with ulcerative colitis (UC). The findings demonstrated that GFAP effectively mitigated UC, alleviated mucosal damage, and reduced inflammatory infiltration. Specifically, GFAP administration resulted in significant reductions in pro-inflammatory cytokines IL-6, IL-1β, and TNF-α, while enhancing the expression levels of tight junction proteins such as Occludin and ZO-1. Additionally, GFAP treatment led to decreased levels of Toll-like receptor 4 (TLR-4), inducible nitric oxide synthase (iNOS), and TNF-α. Noteworthy, GFAP also influenced the gut microbiota by decreasing the abundance of Proteobacteria and increasing Bacteroidetes and Firmicutes. Moreover, specific bacteria like Bacteroides uniformis and Alistipes exhibited elevated abundances following GFAP treatment. In summary, GFAP exhibited preventive and protective effects against UC in mice by effectively alleviating clinical symptoms and modulating gut microbiota composition.

Development and validation of a predictive model for the risk of symptomatic adjacent segmental degeneration after anterior cervical discectomy and fusion

Background

To investigate the risk factors for symptomatic adjacent segment degeneration (ASD) 5 years after anterior cervical discectomy and fusion (ACDF) and develop and evaluate predictive models.

Methods

A total of 655 patients who underwent ACDF were randomly assigned to the training set (n = 393) or validation set (n = 262) at a ratio of 6:4. Independent predictors of ASD were selected by LASSO regression and logistic regression analysis. A calibration curve, ROC curve and DCA curve were used to evaluate the model performance.

Results

LASSO regression combined with logistic regression analysis revealed that age, cervical canal stenosis, smaller T1S and smaller cervical lordosis (CL) were risk factors for ASD 5 years after surgery. Nomographic analysis using appeal factors was used to predict the risk of ASD. The area under the ROC curve was 0.711 (95% CI: 0.643-0.780) in the training set and 0.701 (95% CI: 0.618-0.785) in the validation set. The calibration curve showed no significant bias in either set. The DCA indicated that using the nomogram to predict the risk of ASD would be more accurate when the risk threshold probability was 12-53% in the training set and 6-43% in the validation set.

Conclusion

Age, cervical spinal stenosis, a smaller T1S, and a smaller CL are independent risk factors for ASD 5 years after ACDF surgery. Based on these four indicators, we constructed a new clinical prediction model that has a certain predictive effect and is conducive to clinical decision-making and treatment planning.

Interest of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Fever and Inflammatory Syndrome of Unknown Origin in Elderly Patients: A Retrospective Real-Life Single-Center Study from a University Referral Hospital

Background: Fever and inflammatory syndrome of unknown origin pose diagnostic challenges, particularly in elderly patients with atypical presentations. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) has proven useful in these cases, yet its role in geriatric populations remains underexplored. This study evaluates the impact of 18F-FDG PET/CT on the management of these conditions in elderly patients. Methods: A retrospective study of patients aged ≥75 years who underwent 18F-FDG PET/CT between 2013 and 2018 for unexplained fever or inflammatory syndrome was conducted. The primary outcome was the impact of 18F-FDG PET/CT on treatment decisions, defined as any change in treatment within 6 months of the scan request. Therapeutic changes included the initiation of new treatments or discontinuation of existing ones, regardless of the diagnosis. Results: Ninety-three patients (mean age: 82.2 years) were included. 18F-FDG PET/CT contributed to a definitive diagnosis in 30.8% of cases, with infections (19.8%), inflammatory diseases (19.8%), and malignancies (14.3%) being the most frequent diagnoses. Of the 61 patients who underwent further testing, 33 (39.3%) had targeted tests based on the 18F-FDG PET/CT findings. Histology was obtained for 28 patients, with 18 targeted biopsies. Therapeutic modifications occurred in 38.8% of cases, with new treatments initiated in 33.3% and treatment discontinued in 10%. False positives occurred in 15.2% of cases. Conclusions:18F-FDG PET/CT is a valuable tool in managing elderly patients with unexplained fever or inflammatory syndrome, aiding diagnosis and therapeutic decisions. Its use should be considered in the elderly population but must be carefully weighed against the patient's frailty and the available treatment options.

The new definition of metabolic syndrome including hyperuricemia improves its prognostic value: results from NHANES database

BACKGROUND

Metabolic syndrome (MetS) is a significant global health issue that is strongly associated with an increased risk of cardiovascular disease (CVD). While MetS was initially proposed to identify more high-risk individuals and facilitate early management, hyperuricemia has not yet been included in its definition, despite its strong association with MetS. This study aims to explore the prognostic value of incorporating hyperuricemia into the definition of MetS.

METHODS

Data derived from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018 were analyzed. The old version of MetS (MetSold) aligned with NCEP-ATP III criteria, whereas the new version of MetS (MetSnew) included hyperuricemia as a sixth criterion. Baseline characteristics were compared between participants with and without MetS, and outcomes were assessed by multivariate analyses.

RESULTS

Among the 36,363 participants analyzed, 12,594 (34.6%) and 14,137 (38.9%) met MetSold and MetSnew criteriarespectively. Compared to MetSold, MetSnew identified additional 1534(4.24%) participants at metabolic risk. Both MetSold and MetSnew were significantly associated with long-term all-cause and CVD mortality (all P < 0.001). Furthermore, the additional participants identified by MetSnew exhibited a similar risk of all-cause and CVD mortality as those meeting MetSold criteria. MetSnew demonstrated enhanced identification and reclassification abilities compared to MetSold, as evidenced by improvement in C-index, NRI and IDI.

CONCLUSIONS

The inclusion of hyperuricemia in the MetS criteria could identify a larger proportion of individuals at metabolic risk, thereby facilitating early management to prevent long-term adverse events.

Safety assessment and exploration of the mechanism of toxic effects of diallyl trisulfide: Based on acute and subacute toxicity and proteomics experiments

ETHNOPHARMACOLOGICAL RELEVANCE

Garlic (Allium sativum L.) is a widely consumed spice and condiment around the world, applied both as a food and as a traditional medicine, and is a natural strengthening agent for the body's circulatory and nervous systems. Diallyl trisulfide (DATS) is the major volatile organosulfur phytochemical found in garlic, with antithrombotic, anticoagulant, and antiplatelet activities as well as antioxidant, anti-infective, and other pharmacological effects. However, the safe dose and the underlying mechanisms of its toxic effects remain elusive.

AIM OF THE STUDY

DATS, an important pharmacologically active compound found in garlic, has garnered attention for its ability to fight cancer, antioxidant, anti-infective, and cardioprotective. The aim of this study was to evaluate the safety of DATS and to elucidate the potential mechanisms of its toxicity.

MATERIALS AND METHODS

In this study, ICR mice were selected for acute and subacute toxicity experiments according to OECD guidelines. The toxicity profile of DATS was analyzed by computer prediction software. Also, key differential proteins in spleen and serum were analyzed by proteomics. The binding stability of DAST to differential proteins was analyzed by molecular docking. Additionally, the regulatory relationship between DATS and differential proteins was verified by Western blot and ELISA experiments.

RESULTS

The results showed that the LD50 value of DATS in acute toxicity was 188.67 mg/kg. In subacute toxicity, water consumption and food intake were reduced in both male and female mice. In addition, the spleen and small intestinal organ coefficients were significantly elevated in male mice at the high dose of DATS; the blood biochemical indices ALB and TP were also significantly elevated. HE staining results showed significant damage to the spleen, liver, small intestine, and kidney of mice at high doses of DATS. Spleen and serum proteomics analyses showed that DATS significantly inhibited ZBP1 expression and upregulated TEC. ADMETlab 2.0 software predictions identified DATS as having potential genotoxicity, dermal sensitization, carcinogenicity, and respiratory and ocular toxicity. Docking results showed that the binding energies between DATS and TEC protein (PDB: 6F3F) and ZBP1 protein (PDB: 4KA4) were -3.7 kcal/mol, -2.4 kcal/mol, respectively. Western blot results showed that DATS-H significantly inhibited the expression of ZBP1 (only in male mice) and Bcl-2 proteins. ELISA results showed that DATS-H significantly increased the level of TEC protein both in male and female mice.

CONCLUSIONS

Long-term administration of high-dose DATS may carry some risk of toxicity. Based on the amount of DATS in garlic, it is recommended that adults should not take more than 359 mg of DATS and 84.5 g of garlic per day. The mechanism of toxicity may be related to the fact that DATS significantly inhibits ZBP1 expression, upregulates TEC, and promotes apoptosis. This study provides valuable toxicological data for the effective evaluation of the long-term toxicity of DATS and offers an additional experimental basis for developing DATS as a healthy food or drug.

Association between the expression of specific microRNAs and prostate cancer progression- a systematic review and meta-analysis

Background

This systematic review and metanalysis aimed to summarize the evidence supporting the significance of particular MiRNAs in PrCa progression and to thoroughly examine the body of prior research.

Methods

In accordance with the PRISMA guidelines, this review was conducted using a specifically design data extraction protocol and searching several online databases for relevant articles. The protocol was registered in the PROSPERO database (CRD42023428460).

Results

8 studies were ultimately included in this review. MiRNAs significantly reduced PrCa proliferation, with an odds ratio (OR) of 0.28 (95% CI: 0.21-0.39) and a risk ratio (RR) of 0.51 (95% CI: 0.43-0.61), though moderate heterogeneity was observed (I² = 57%). For two studies investigating MiRNAs as biomarkers for predicting metastasis, the pooled OR was 0.60 (95% CI: 0.47-0.76) and the RR was 0.72 (95% CI: 0.62-0.84), both demonstrating significant predictive value with low heterogeneity (I² = 0%).

Conclusion

The results emphasize the potential of miRNAs as biomarkers for predicting PrCa metastasis and demonstrate that miRNAs have a discernible effect on PrCa proliferation. However, to improve our comprehension of MiRNA's function in this condition, additional studies are required to address the limitations and investigate how MiRNA acts in many areas of PrCa.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023428460.

Remnant cholesterol and its variability independent of low density lipoprotein cholesterol predict metabolic dysfunction associated steatotic liver disease

This study aimed to determine whether remnant cholesterol (RC) and its variability can predict the onset of metabolic dysfunction-associated steatotic liver disease (MASLD) independently of low-density lipoprotein cholesterol (LDL-C) levels. A longitudinal cohort study involving 43,065 participants who underwent at least two physical examinations was conducted. This study used Cox proportional hazards models to assess the relationships among RC quartile levels (Q1-Q4), visit-to-visit variability, and the risk of MASLD. This variability was quantified using several metrics: standard deviation (SD), logSD, average real variability (ARV), logARV, mean absolute deviation (MAD), and logMAD. Concurrently, this study utilized a combined analysis of RC and LDL-C groups to assess the independent risk of MASLD associated with RC. During a mean visit-to-visit of 3.19 years (SD 2.06 years), 8374 patients (19.45%) developed MASLD. Compared with Q1, Q4 was associated with a significantly greater risk of MASLD (hazard ratio [HR] 1.309, 95% confidence interval [CI] 1.220-1.403, P < 0.001). The fully adjusted Cox model revealed that the HRs of SD, logSD, ARV, logARV, MAD and logMAD were 1.400 (95% CI 1.305-1.502), 1.278 (95% CI 1.188-1.374), 1.152 (95% CI 1.079-1.229), 1.183 (95% CI 1.140-1.227), 1.578 (95% CI 1.433-1.737) and 1.263 (95% CI 1.175-1.358), respectively. In both LDL-C subgroups (≥ 3.4 mmol/L and < 3.4 mmol/L), high baseline RC was associated with elevated MASLD risk (HR 1.208, 95% CI 1.148-1.270, P < 0.001; HR 1.246, 95% CI 1.129-1.374, P < 0.001). RC levels were independently associated with MASLD in healthy individuals, irrespective of LDL-C level. The variability of RC during visit-to-visit periods provides a predictive marker for identifying individuals at heightened risk of MASLD.

Post-transplant diarrhea in pediatric kidney transplant recipients

Diarrhea is a common complication after pediatric kidney transplantation. While mycophenolate mofetil is an important and common cause of post-transplant diarrhea, diarrhea can result from infectious and other non-infectious causes. Many complications can result from severe diarrhea including acute kidney injury from dehydration. Other unique complications in transplant recipients include tacrolimus toxicity and acute rejection (from changes in immunosuppressive pharmacokinetics or dosing in response to the diarrhea). Therefore, a thorough evaluation is recommended for all pediatric patients with severe diarrhea to ensure that appropriate interventions are instituted, and risks of complications minimized. Our review describes the scope of the morbidity of diarrheal illness after transplantation, common causes, and newer insights in the management of diarrhea, both supportive and targeted to the underlying cause.

Genetically predicted basal metabolic rate and infectious diseases: a Mendelian randomization study

BACKGROUND

The causal relationship between basal metabolic rate (BMR) and infectious diseases remains elusive. This study aims to clarify this association.

METHODS

This study analyzed genome-wide association studies (GWASs) data from the UK Biobank and FinnGen cohorts to investigate the association between BMR and infectious diseases in European populations. Mendelian randomization (MR) analysis was initially employed, followed by multivariable Mendelian randomization (MVMR) to account for potential confounders. Mediation analysis further confirmed significant relationships. Sensitivity analyses were conducted to validate the study findings.

RESULTS

Using two sample MR, genetically predicted BMR was positively linked to skin and soft tissue infections (SSTIs) (OR: 1.31, 95% CI: 1.18-1.47, P < .001), osteomyelitis (OR: 1.95, 95% CI: 1.36-2.80, P < .001) (1.36 ± 2.80), all-cause infections (OR: 1.36, 95% CI: 1.26-1.48, P < .001) and sepsis (OR: 1.36, 95% CI: 1.23-1.51, P < .001). MVMR analysis confirmed BMR's direct causal effect on SSTIs, osteomyelitis, all-cause infections, and sepsis, except for BMI and other factors affecting osteomyelitis. Mediation analysis revealed VAT as a mediator in the linkage between BMR and SSTIs and all-cause infections. HbA1c mediated the path from BMR to osteomyelitis, while CRP and BMI exhibited mediation effects in the BMR-all-cause infections relationship.

CONCLUSION

The study revealed a significant link between increased BMR and elevated risks of SSTIs, osteomyelitis, and bacterial infections, highlighting the intricate BMR-immune connection and its implications for disease control. Key message What is already known on this topic:  High BMR is positively correlated with COVID-19 and associated with proinflammatory and immunological activation, but the relationship between BMR and other infectious diseases remains largely unexplored. What this study adds:  Higher BMR significantly raises the risk of SSTIs, osteomyelitis, all-cause infections, and sepsis. VAT, HbA1c, CRP, and BMI may mediate the BMR-infection relationship. How this study might affect research, practice, or policy:  A higher BMR may be a valuable indicator associated with an increased risk for SSTIs, osteomyelitis, and sepsis. Modulating BMR might hold promise as a clinically relevant intervention to prevent specific infectious diseases.

Cigarette Smoke Contributes to the Progression of MASLD: From the Molecular Mechanisms to Therapy

Cigarette smoke (CS), an intricate blend comprising over 4000 compounds, induces abnormal cellular reactions that harm multiple tissues. Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic liver disease (CLD), encompassing non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC). Recently, the term NAFLD has been changed to metabolic dysfunction-associated steatotic liver disease (MASLD), and NASH has been renamed metabolic dysfunction-associated steatohepatitis (MASH). A multitude of experiments have confirmed the association between CS and the incidence and progression of MASLD. However, the specific signaling pathways involved need to be updated with new scientific discoveries. CS exposure can disrupt lipid metabolism, induce inflammation and apoptosis, and stimulate liver fibrosis through multiple signaling pathways that promote the progression of MASLD. Currently, there is no officially approved efficacious pharmaceutical intervention in clinical practice. Therefore, lifestyle modifications have emerged as the primary therapeutic approach for managing MASLD. Smoking cessation and the application of a series of natural ingredients have been shown to ameliorate pathological changes in the liver induced by CS, potentially serving as an effective approach to decelerating MASLD development. This article aims to elucidate the specific signaling pathways through which smoking promotes MASLD, while summarizing the reversal factors identified in recent studies, thereby offering novel insights for future research on and the treatment of MASLD.

Sensitive and Deep Coverage Phosphoproteome Detection Method Reveals Spleen as a More Sensitive Organ than Liver in Early Detection of Liver Fibrosis-Related Signaling Protein Dysregulation

Although cathepsin S is transported from the spleen to the liver, where it cleaves collagen XVIII to produce endostatin and plays a critical role in the onset of early liver fibrosis, the relationship between liver fibrosis and spleen function remains underexplored. Given the roles of phosphorylation in disease, understanding its regulatory mechanism in early liver fibrosis is crucial. Despite advances in mass spectrometry enhancing phosphoproteomics, its application is limited by small clinical samples and subtle protein changes. We optimized a phosphoproteomic workflow, adjusting the protein amounts and using different enrichment beads and varied mass spectrometers, achieving deep phosphoproteomic coverage from minimal samples. We identified over 46,000 phosphosites in HepG2 cells and over 29,000 phosphosites in mouse liver samples using just 500 μg of proteins. Even with as little as 50 μg of 293T proteins, we detected over 11,000 phosphosites, 1.2 times more than the recently reported RUPE-phospho. Using the Sensitive and Deep Coverage Phosphoproteome Detection method, abbreviated as SDC-PhosDet, we demonstrated that in early liver fibrosis, the spleen exhibits more rapid and sensitive phosphorylation changes than the liver, affecting proteins closely linked to signaling and metabolism such as STAT1, JUN, CBL, ATP7B, and PTPN2. These findings highlight the spleen's role and offer new avenues for investigating the molecular mechanisms of early liver fibrosis, diagnosis, and intervention beyond the liver itself. Moreover, this method holds promise for applying phosphoproteomics to early-stage liver fibrosis using clinical microsamples.

Visceral obesity augments prescription use: An analysis of the cross-sectional study of NHANES 2011-2018

BACKGROUND

Visceral obesity (VATob) increases the risk for many diseases. Central obesity has been associated with an augmented prescription use; however, there is a paucity of research focused on VATob. Here, the aim was to evaluate the association between VATob and prescription use.

METHODS

Data was collected from the NHANES dataset (2011-2018). Visceral adipose tissue was measured using dual x-ray absorptiometry, and VATob was defined as ≥100 cm2. Prescription use was collected from the RXQ_RX files and classified according to Vademecum. Association between VATob and prescription use was determined with logistic regression and reported as odds ratios (ORs) with 95% confidence intervals (95%CIs).

RESULTS

10,952 participants (weighted: 121,090,702) were included, in which 41.8% were VATob and 52.0% of them had ≥1 prescription. Overall, VATob demonstrated an augmented rate of prescription use when compared to non-VATob (52.0% versus 36.7%, p<0.001), specifically with metabolic (4.5-fold increase), cardiovascular (3.9-fold increase), gastrointestinal (2.5-fold increase), and hematopoietic agents (2.3-fold increase). This was associated with increased the risk for overall prescription use (ORoverall = 1.9, 95%CI: 1.7-2.1, p<0.001). Similar results were observed with metabolic and cardiovascular agents. However, when stratified by BMI, normal weight participants (ORmetabolic = 10.4; 95%CI: 6.5-16.6 & ORcardiovascular = 7.0; 95%CI: 4.4-11.1, p<0.001) had a greater risk than the overweight (ORmetabolic = 4.1; 95%CI: 3.0-5.6 & ORcardiovascular = 3.4; 95%CI: 2.5-4.7, p<0.001) or obese participants (ORmetabolic = 3.5; 95%CI: 2.3-5.3 & ORcardiovascular = 3.5; 95%CI: 2.5-4.9, p<0.001).

CONCLUSION

VATob is associated with augmented prescription use, particularly with cardiovascular and metabolic agents. This association was higher for normal weight participants.

How do probiotics alleviate constipation? A narrative review of mechanisms

Constipation is a common gastrointestinal condition, which may occur at any age and affects countless people. The search for new treatments for constipation is ongoing as current drug treatments fail to provide fully satisfactory results. In recent years, probiotics have attracted much attention because of their demonstrated therapeutic efficacy and fewer side effects than pharmaceutical products. Many studies attempted to answer the question of how probiotics can alleviate constipation. It has been shown that different probiotic strains can alleviate constipation by different mechanisms. The mechanisms on probiotics in relieving constipation were associated with various aspects, including regulation of the gut microbiota composition, the level of short-chain fatty acids, aquaporin expression levels, neurotransmitters and hormone levels, inflammation, the intestinal environmental metabolic status, neurotrophic factor levels and the body's antioxidant levels. This paper summarizes the perception of the mechanisms on probiotics in relieving constipation and provides some suggestions on new research directions.

CD300E+ macrophages facilitate liver regeneration after splenectomy in decompensated cirrhotic patients

Liver cirrhosis is prognostically associated with poor life expectancy owing to subsequent liver failure. Thus, understanding liver regeneration processes during cirrhotic injury is highly important. This study explored the role of macrophage heterogeneity in liver regeneration following splenectomy. We collected detailed clinical information from 54 patients with decompensated cirrhosis before and after splenectomy. Obvious liver regeneration was observed after splenectomy in cirrhotic patients. Single-cell RNA sequencing (scRNA-seq) was performed on three paired liver tissues from patients before and after surgery to explore the immune microenvironment map and the characteristics of liver regeneration-associated macrophages (RAMs). scRNA-seq analysis revealed that the composition of hepatic immune cells changed after splenectomy; among these changes, the proportion of CD300E+ RAMs significantly increased after surgery, and high expression levels of functional genes associated with cell proliferation promoted liver regeneration. Moreover, a mouse model of carbon tetrachloride-induced cirrhosis and a coculture system consisting of primary bone marrow-derived macrophages and hepatocytes were established for validation. We observed a similar phenomenon of liver regeneration in cirrhotic mice and further confirmed that CD300E+ monocyte-derived macrophages facilitated hepatocyte NAD+ synthesis via the secretion of NAMPT, which subsequently promoted hepatocyte proliferation. This study characterized the hepatic immune microenvironment in patients with cirrhosis following splenectomy. Our findings demonstrated that CD300E+ macrophages play a crucial role in remodeling the hepatic immune microenvironment after splenectomy, thereby promoting liver regeneration in patients with decompensated cirrhosis. CD300E+ macrophages are anticipated to emerge as a novel therapeutic strategy for the treatment of liver cirrhosis.

What is normal age-related thigh muscle composition among 45- to 84-year-old adults from the UK Biobank study

A loss of skeletal muscle mass and an increase in intramuscular fat are known to occur as we enter middle and older age, but the expected changes or normative values have remained unknown. The primary reason for this is that imaging studies are difficult and expensive to conduct, and consequently, the sample sizes have remained small. The development of the UK Biobank which provides access to a large magnetic resonance imaging (MRI) data set of more than 50,000 participants provides an opportunity to finally address this question of normative values for each age group. The study's primary aim was to determine the age-related changes in thigh muscle composition (e.g., thigh fat-free muscle volume and intramuscular fat) between the ages of 45 and 84 years. The second aim was to analyse associations between thigh fat-free muscle volume and intramuscular fat with lifestyle behaviours (smoking, alcohol consumption, and physical activity), leg pain, and bone mineral density. Fifty thousand three hundred thirty-two participants were included in the study. Total fat-free thigh muscle declined between the ages of 45 and 84 years, while intramuscular fat of the thigh continued to increase. The changes were stable between these age groups. The mean volume of fat-free muscle ranged from 11.16 (SD: 1.40) to 13.26 L (SD: 1.85) in adult males and 7.60 (SD: 0.97) to 8.80 L (SD 1.29) in females between the ages of 45 and 84 years. For intramuscular fat, the change among women was from 6.94% (SD: 1.59) in the 45 to 54 years age bracket to 8.83% (SD: 1.92) in the 75 to 84 age bracket, while for men, it was 5.83% (SD: 1.30) in the 45 to 54 age bracket to 7.85% (SD 1.89) in the 75 to 84 age bracket. The total fat-free muscle volume and intramuscular fat percentage provided can be used for the purpose of reference standards or normative values for adults in the age groups provided. Fat-free muscle and intramuscular fat were found to be associated with a range of health, activity, and leg pain outcomes, and these should be investigated in a follow-up longitudinal imaging study.

Association of clinical and laboratory variables with risk of venous thromboembolism in high-grade serous ovarian cancer

OBJECTIVES

This study aimed to assess the incidence and time course of venous thromboembolism and to survey clinical and laboratory features predicting the risk for these complications in patients with high-grade serous ovarian cancer.

METHODS

Patients with high-grade serous ovarian cancer treated in a prospective ovarian cancer study at the Turku University Hospital between 2009 and 2020 were retrospectively analyzed for the incidence of venous thromboembolism. This diagnosis was based on the International Classification of Diseases, 10th Revision Coding, and confirmed from hospital electronic health records. Analyses combined multiple variables including treatment strategies and laboratory variables.

RESULTS

Among the 146 patients with high-grade serous ovarian cancer, 24 (16.4%) had a confirmed venous thromboembolism. In 5 patients (3.4%), venous thromboembolism preceded the cancer diagnosis. The median time from cancer diagnosis to the venous thromboembolism event was 12.8 months. Patients with venous thromboembolism had shorter median survival (30.6 versus 41.6 months, p = .014), but age, disease stage at diagnosis, and co-morbidities were similar. In a multivariable analysis, short platinum-free interval (p < .005) and increased leukocyte (p = .004) and neutrophil (p = .013) counts both indicated an increased probability of venous thromboembolism event. Conversely, longer carbohydrate antigen 125 doubling time (p = .036), along with higher hemoglobin (p < .0001) and albumin levels (p = .015), were linked to a reduced risk of venous thromboembolism.

CONCLUSIONS

The combination of these findings in high-grade serous ovarian cancer patients could be incorporated into their venous thromboembolism risk stratification. Given the reduced overall survival in patients with venous thromboembolism, future studies should prioritize proactively targeted thromboprophylaxis.

High preoperative D-dimer increases the risk of venous thromboembolism after gynecological tumor surgeries: a meta-analysis of cohort studies

The role of preoperative D-dimer in the prediction of postoperative venous thromboembolism (VTE) with gynecological tumor remains unclear. This meta-analysis sought to assess the association between preoperative D-dimer and the risk of VTE after gynecological tumor surgeries and to identify prognostic significance of D-dimer in the prediction of postoperative VTE. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Eight electronic databases were searched for cohort studies from the date of inception to April 2024. The Newcastle-Ottawa Scale scoring tool and the Risk of Bias in Non-Randomized Studies-Intervention tool were used to assess the quality of the literature and the risk of bias in cohort studies, respectively. The relative risk and 95% CIs of the highest vs the lowest category and per milligram per liter of D-dimer were pooled relative to the VTE risk after gynecological tumor surgeries. Fifteen studies that met the criteria were included. Among these studies, D-dimer was considered as a continuous variable in 8 studies. The random-effect model results showed that the VTE risk was increased by 42% (15%-69%) per milligram per liter increase in D-dimer. Furthermore, based on the cutoff thresholds of D-dimer, 7 studies that reported the effect estimates of postoperative VTE in women with gynecological tumor by D-dimer were categorized as binary variables. Compared with the reference levels, the pooled relative risk of VTE after gynecological tumor surgeries for the higher level was 2.58 (95% CI, 1.49-4.47). Elevated preoperative D-dimer was associated with higher VTE risks after gynecological tumor surgeries.

Lubiprostone Reduces Fat Content on MRI-PDFF in Patients With MASLD: A 48-Week Randomised Controlled Trial

BACKGROUND AND AIMS

The laxative lubiprostone has been shown to decrease intestinal permeability. We aimed to assess the safety and efficacy of lubiprostone administered for 48 weeks in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

APPROACH AND RESULTS

A randomised placebo-controlled trial was conducted in a specialised MASLD outpatient clinic at the National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. The recruited patients had radiological evidence of MASLD along with other criteria for diagnosis. Eligible patients were randomly assigned to receive either placebo or lubiprostone 24 μg orally twice daily for 48 weeks. The liver fat content was quantified by magnetic resonance imaging estimated proton density fat fraction (MRI-PDFF). Between November 2020 and February 2023, 176 patients were screened, of whom 116 were eligible. Fifty-nine patients were randomised to receive placebo, while 57 patients were randomised to receive lubiprostone. Due mostly to patient dropout (i.e., loss to follow-up), complete data were available for 40 patients in each group. Compared with placebo group, 48-week lubiprostone treatment significantly reduced fat quantity (p = 0.04). Despite a significant reduction in body weight in the control group, no significant difference was found between both groups regarding fibrosis score by transient elastography or in serum ALT levels. One patient in the lubiprostone group developed severe diarrhoea requiring treatment stoppage. No other serious adverse events occurred.

CONCLUSION

Lubiprostone was well tolerated and reduced liver fat content as measured by MRI-PDFF in patients with MASLD over 48 weeks. Lubiprostone appears promising to treat MASLD and warrants more extensive studies to confirm such efficacy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05768334.

The Misdiagnosis and Underdiagnosis of Hepatic Encephalopathy

Patients with cirrhosis are at risk of developing hepatic encephalopathy (HE), which can present with a wide range of symptoms, including confusion, lethargy, inappropriate behavior, and altered sleep patterns. In addition to HE, patients with cirrhosis are at risk of developing mild cognitive impairment, dementia, and delirium, which have features closely resembling HE. Given the similar presentation of these conditions, misdiagnosis can and does occur. Mild cognitive impairment is common in individuals aged 50 years and older and can progress to dementia in those affected. Dementia and HE are both characterized by sleep disturbance and cognitive dysfunction, thus differentiating these conditions can be difficult. Furthermore, delirium can disrupt sleep patterns, and liver disease is recognized as a risk factor for its development. As HE is a cirrhosis-related complication, determining if a patient has undiagnosed cirrhosis is critical, particularly given the large number of patients with asymptomatic, compensated cirrhosis. Separately, underdiagnosis of minimal HE can occur even in patients with diagnosed liver disease, related, in part, to lack of testing. Given the availability of effective therapies for managing symptoms and preventing future episodes, accurate diagnosis of HE is essential.

Effects of exercise and nutrition in improving sarcopenia in liver cirrhosis patients: a systematic review and meta-analysis

Background

Sarcopenia is highly prevalent in patients with liver cirrhosis (LC), adversely affecting their quality of life and life expectancy. Exercise and nutrition represent common interventions to ameliorate sarcopenia in these patients, although there exists inconsistency in the reported effectiveness of these strategies. This study seeks to assess the impact of exercise and nutrition on sarcopenia in LC patients through a systematic review and meta-analysis.

Methods

The research protocol was preregistered on PROSPERO, and adherence to PRISMA reporting guidelines was maintained throughout the systematic review process. Controlled vocabularies via Emtree, MeSH, and CINAHL Subject Heading were searched in five databases without any language limitation. The final analysis included only studies with a randomized controlled trial (RCT) design published by December 2021. The quality of these studies was assessed by the Cochrane ROB 2.0 version, and the meta-analysis was conducted using Review Manager 5.4 version.

Results

A total of 262 studies were screened, and seven RCT studies involving 206 subjects were included in the meta-analysis. Exercise interventions encompassed muscle-strengthening, cardiopulmonary enhancement, and increased walking steps, while nutrition interventions included protein, branched-chain amino acids (BCAAs), carbohydrates, and vitamins. Most interventions had a duration of 8-12 weeks. Significant improvements in skeletal muscle index [mean difference (MD): 0.53, P=0.01, 95% confidence interval (CI): -0.10, 0.96, I2=0%] and albumin (MD: 0.16, P=0.04, 95% CI: 0.01, 0.31, I2=0%) were observed in the experimental group when interventions extended for 12 months. Various indicators, such as thigh circumference, midarm circumference, and sit-to-stand, showed significant improvements within the experimental groups following interventions.

Conclusions

Exercise and nutrition interventions demonstrate efficacy in improving sarcopenia in LC patients, with more pronounced effects observed with interventions lasting 12 months or longer. Skeletal muscle index and albumin levels in patients with LC can be positively influenced by exercise and nutrition strategies. Emphasizing a healthy diet and regular exercise is crucial for preventing sarcopenia in patients with LC.

Recent advances and therapeutic applications of PPARγ-targeted ligands based on the inhibition mechanism of Ser273 phosphorylation

PPARγ functions as a master ligand-dependent transcription factor that regulates the expressions of a variety of key genes related to metabolic homeostasis and inflammatory immunity. It has been recognized as a popular and druggable target in modern drug discovery. Similar to other nuclear receptors, PPARγ is a phosphoprotein, and its biological functions are regulated by phosphorylation, especially at Ser273 site which is mediated by CDK5 or ERK. In the past decade, the excessive level of PPARγ-Ser273 phosphorylation has been confirmed to be a crucial factor in promoting the occurrence and development of some major diseases. Ligands capable of inhibiting PPARγ-Ser273 phosphorylation have shown great potentials for treatment. Despite these achievements, to our knowledge, no related review focusing on this topic has been conducted so far. Therefore, we herein summarize the basic knowledge of PPARγ and CDK5/ERK-mediated PPARγ-Ser273 phosphorylation as well as its physiopathological role in representative diseases. We also review the developments and therapeutic applications of PPARγ-targeted ligands based on this mechanism. Finally, we suggest several directions for future investigations. We expect that this review can evoke more inspiration of scientific communities, ultimately facilitating the promotion of the PPARγ-Ser273 phosphorylation-involved mechanism as a promising breakthrough point for addressing the clinical treatment of human diseases.

Causal relationship between circulating inflammatory cytokines and the risk of hernia: a bidirectional Mendelian randomization study

OBJECTIVE

Observational studies suggest a link between hernia and inflammatory cytokines, but randomized trials are limited by ethical and cost constraints. In this study, we used bidirectional Mendelian randomization (MR) to investigate the causal relationship between inflammatory cytokines and five types of hernia, aiming to inform preventive and therapeutic strategies.

METHODS

We selected 41 inflammatory factors and five types of hernia as instrumental variables, using data from the IEU Open GWAS database including individuals of European descent. The primary analysis used the inverse variance weighted method with false discovery rate (FDR) adjustment. Additional MR methods and sensitivity analyses ensured robustness. Reverse MR was used to assess potential reverse causality.

RESULTS

After FDR adjustment, stem cell growth factor beta (SCGFb) was causally associated with diaphragmatic hernia (odds ratio = 0.884, 95% confidence interval: 0.819-0.955). Reverse MR indicated that diaphragmatic hernia may increase interferon gamma-induced protein 10 (IP10) and monokine induced by interferon-gamma (MIG), and ventral hernia may elevate macrophage inflammatory protein-1b (MIP1b). Sensitivity analyses confirmed robustness.

CONCLUSION

SCGFb may protect against diaphragmatic hernia, and IP10, MIG, and MIP1b are involved in hernia development, suggesting the therapeutic potential of targeting these cytokines. Further studies are needed.

Innovative approaches to metabolic dysfunction-associated steatohepatitis diagnosis and stratification

The global rise in Metabolic dysfunction-associated steatotic liver disease (MASLD)/Metabolic dysfunction-associated steatohepatitis (MASH) highlights the urgent necessity for noninvasive biomarkers to detect these conditions early. To address this, we endeavored to construct a diagnostic model for MASLD/MASH using a combination of bioinformatics, molecular/biochemical data, and machine learning techniques. Initially, bioinformatics analysis was employed to identify RNA molecules associated with MASLD/MASH pathogenesis and enriched in ferroptosis and exophagy. This analysis unveiled specific networks related to ferroptosis (GPX4, LPCAT3, ACSL4, miR-4266, and LINC00442) and exophagy (TSG101, HGS, SNF8, miR-4498, miR-5189-5p, and CTBP1-AS2). Subsequently, serum samples from 400 participants (151 healthy, 150 MASH, and 99 MASLD) underwent biochemical and molecular analysis, revealing significant dyslipidemia, impaired liver function, and disrupted glycemic indicators in MASLD/MASH patients compared to healthy controls. Molecular analysis indicated increased expression of LPCAT3, ACSL4, TSG101, HGS, and SNF8, alongside decreased GPX4 levels in MASH and MASLD patients compared to controls. The expression of epigenetic regulators from both networks (miR-4498, miR-5189-5p, miR-4266, LINC00442, and CTBP1-AS2) significantly differed among the studied groups. Finally, supervised machine learning models, including Neural Networks and Random Forest, were applied to molecular signatures and clinical/biochemical data. The Random Forest model exhibited superior performance, and molecular features effectively distinguished between the three studied groups. Clinical features, particularly BMI, consistently served as discriminatory factors, while biochemical features exhibited varying discriminant behavior across MASH, MASLD, and control groups. Our study underscores the significant potential of integrating diverse data types to enable early detection of MASLD/MASH, offering a promising approach for non-invasive diagnostic strategies.

The impact of the age-adjusted Charlson comorbidity index as a prognostic factor in patients with early gastric cancer after endoscopic submucosal dissection

BACKGROUND

The Charlson Comorbidity Index (CCI) and prognostic nutritional index (PNI) have proven to be valuable tools in predicting prognosis based on comorbidities and nutritional status in the context of surgical procedures and endoscopic resections. The age-Adjusted CCI (ACCI) has also shown utility in surgical settings, but its application to early gastric cancer (EGC) remains unexplored. Consequently, we aimed at clarifying the prognostic factors for EGC treated with endoscopic submucosal dissection (ESD).

METHODS

Patients who underwent ESD for EGC at the First Affiliated Hospital of Dalian Medical University from January 2015 to February 2023 were included. The overall survival (OS) and prognostic predictive ability were evaluated based on patients and lesion characteristics.

RESULTS

During a median follow-up period of 50 months, 15 patients died, but none from the gastric cancer. The 5-year survival rate was 90.0%. In univariate and multivariate analyses, a high ACCI (>4.5) was the only significant prognostic factor (Hazard ratio, 27.78; 95% confidence interval, 3.62-213.40; p < 0.01). The 5-year survival rates for patients with low ACCI (<4.5) and high ACCI were 98.9% and 72.9%, respectively (p < 0.01).

CONCLUSIONS

A high ACCI is a significant prognostic indicator for 5-year survival and the risk of mortality caused by other comorbidities. EGC suitable for ESD is unlikely to serve as a prognostic factor, and ACCI should be considered as an important reference when considering additional surgical procedures in high-ACCI patients after ESD with endoscopic curability (eCura) C-2 for EGC.

The systemic immune inflammation index is a reliable and novel risk factor for metabolic dysfunction-associated fatty liver disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) can trigger inflammation, hepatocellular damage, cirrhosis, and hepatocellular carcinoma. There is a need for non-invasive, cost-effective diagnostic markers for MAFLD, as current methods like liver biopsy are invasive. This study investigates the potential of the systemic immune inflammation index (SII) as a useful tool in diagnosis of MAFLD.

METHODS

A cohort of 806 individuals, including 426 with MAFLD and 380 controls, was analyzed. SII values, along with various biochemical and inflammatory markers, were compared between groups.

RESULTS

The MAFLD group exhibited significantly higher SII values, which correlated with key markers of liver inflammation and function. Median SII levels of the MAFLD patients (581 (45-4553)) were significantly higher than that of the control group (423 (112-2595)) (p <0.001). SII showed moderate sensitivity (72%) and specificity (56%) in detecting MAFLD. Logistic regression analysis identified SII as an independent risk factor for MAFLD, with a unit increase in SII increasing the risk by 1.21 times.

CONCLUSIONS

These findings suggest that SII could serve as a useful, noninvasive marker for diagnosing and monitoring MAFLD, warranting further longitudinal studies to explore its role in disease progression and treatment response.

A critical overview of systematic reviews and meta-analyses of intra-articular injection of platelet rich plasma versus hyaluronic acid for knee osteoarthritis

This study is to summarize and evaluate the available evidence for the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) for knee osteoarthritis (KOA). Eight databases were searched from inception to September 15, 2024. All systematic reviews (SRs)/meta-analyses (MAs) treated with PRP versus HA for KOA were collected. Literature screening and data extraction were independently performed by two reviewers. The methodological quality, reporting quality, risk of bias, evidence quality, and evidence overlap rate of the included studies were evaluated by using AMSTAR 2, PRISMA 2020, ROBIS, GRADE, and GROOVE systems. Seventeen SRs were included. The results showed that the effectiveness and safety of PRP in the treatment of KOA may be superior to HA. The methodological quality of all 17 documents was extremely low quality. Sixteen of them had poor reporting quality, and there were relatively serious information deficiencies. All SRs were determined to be at high risk. Among the 221 outcome indicators, there were two medium-quality evidences, 30 low-quality evidences, and 189 extremely low-quality evidences. It was found that there was a very high overlap among the included articles. Currently, the quality of SRs on the treatment of KOA with PRP versus HA is relatively low. Future authors of SRs should adhere to quality assessment tool criteria, expand sample sizes to reduce overlap, and evaluate the quality of evidence for merged study results, in order to provide more reliable and rigorous evidence-based support for clinical practice.

Which one is a better predictor of prognosis in COVID-19: analytical biomarkers or PaO2/FiO2?

BACKGROUND

The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.

METHODS

Retrospective cohort study with data on patients collected from March 1st, 2020 to March 1st, 2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (<100 vs. 100-200 vs. 200-300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.

RESULTS

Higher in-hospital mortality was found in the groups with PAFI < 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, P < .001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI > 300 and 4-5 high-risk criteria presented higher mortality than the patients with PAFI 200-300 and only 1-2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age [OR = 1.06 (1.05-1.06)], moderate [OR = 1.87 (1.49-2.33)] and severe [OR = 2.64 (1.96-3.55)] degree of dependency, dyslipidemia [OR = 1.20 (1.03-1.39)], higher Charlson index [OR = 1.19 (1.14-1.24)], tachypnea on admission [2.23 (1.91-2.61)], the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender [OR = 0.77 (0.65-0.90)] and the use of RDSV [OR = 0.72 (0.56-0.93)] were found to be protective factors.

CONCLUSIONS

The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.

Microbiome-centered therapies for the management of metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant global health issue, affecting over 30% of the population worldwide due to the rising prevalence of metabolic risk factors such as obesity and type 2 diabetes mellitus. This spectrum of liver disease ranges from isolated steatosis to more severe forms such as steatohepatitis, fibrosis, and cirrhosis. Recent studies highlight the role of gut microbiota in MASLD pathogenesis, showing that dysbiosis significantly impacts metabolic health and the progression of liver disease. This review critically evaluates current microbiome-centered therapies in MASLD management, including prebiotics, probiotics, synbiotics, fecal microbiota transplantation, and emerging therapies such as engineered bacteria and bacteriophage therapy. We explore the scientific rationale, clinical evidence, and potential mechanisms by which these interventions influence MASLD. The gut-liver axis is crucial in MASLD, with notable changes in microbiome composition linked to disease progression. For instance, specific microbial profiles and reduced alpha diversity are associated with MASLD severity. Therapeutic strategies targeting the microbiome could modulate disease progression by improving gut permeability, reducing endotoxin-producing bacteria, and altering bile acid metabolism. Although promising, these therapies require further research to fully understand their mechanisms and optimize their efficacy. This review integrates findings from clinical trials and experimental studies, providing a comprehensive overview of microbiome-centered therapies' potential in managing MASLD. Future research should focus on personalized strategies, utilizing microbiome features, blood metabolites, and customized dietary interventions to enhance the effectiveness of these therapies.

Systematic pharmacology and experimental validation to elucidate the inflammation-associated mechanism of Huanglian Wendan (HLWD) decoction in the treatment of MAFLD associated with atherosclerosis

ETHNOPHARMACOLOGICAL RELEVANCE

Metabolic-associated fatty liver disease (MAFLD) and atherosclerosis are very common disorders that frequently coexist. The therapeutic efficacy of Huanglian Wendan (HLWD) decoction, a traditional Chinese medicine (TCM) prescription, is satisfactory in treating MAFLD associated with atherosclerosis. However, the underlying mechanisms through which HLWD exerts its effects need to be elucidated. Given the complex composition of HLWD and its multiple therapeutic targets, pharmacological investigation is challenging.

AIM OF THIS STUDY

This study aimed to identify the effective compounds in HLWD and elucidate the mechanisms involved in its therapeutic effect on MAFLD associated with atherosclerosis.

MATERIALS AND METHODS

We used a systematic pharmacology method to identify effective compounds present in HLWD and determine the mechanism by which it affects MAFLD associated with atherosclerosis. The effective components of HLWD were identified through ultrahigh-performance liquid chromatography-q exactive-orbitrap high resolution mass spectrometry (UHPLC-Q-Orbitrap HRMS). Next, a comprehensive in silico method was used to predict potential related targets and disease targets for these compounds to establish corresponding pathways. The accuracy of our assumed systemic pharmacology results was determined by conducting follow-up experiments.

RESULTS

By conducting UHPLC-Q-Orbitrap HRMS combined with network analysis, we identified 18 potentially active components of HLWD and assessed the inflammatory regulatory mechanism by which it affects MAFLD associated with atherosclerosis on the basis of 52 key targets. We used a high-fat, high-cholesterol (HFHC)-induced mice model of MAFLD associated with atherosclerosis to confirm our results. We found that administering HLWD significantly improved the appearance of their liver and reduced their body weight, liver weight, blood lipids, hepatic damage, and hepatic pathology. HLWD also decreased atherosclerotic lesion areas, foam cells, and inflammatory cells in the aorta. HLWD showed anti-inflammatory effects, suppressed M1 polarization, and promoted M2 polarization in the liver and aorta. HLWD might also regulate peroxisome proliferator-activated receptor-γ (PPARγ)/nuclear factor kappa-B (NF-κB) signaling to influence macrophage polarization and inflammation.

CONCLUSIONS

Our results showed that HLWD protected against HFHC diet-induced MAFLD associated with atherosclerosis by regulating PPARγ/NF-κB signaling, thus adjusting macrophage polarization and inflammation. Additionally, pharmacochemistry research, network pharmacology analysis, and experimental verification can be combined to form a comprehensive model used in studies on TCM.

Water-Soluble Cellulose Acetate Changes the Intestinal Microbiota in Mice with Non-Alcoholic Steatohepatitis

Objectives: Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic disorder of the liver and affects many people worldwide. Intestinal bacteria are thought to be involved in the pathological progression of NAFLD; therefore, improving the intestinal microbiota may be important in controlling NAFLD. In this study, we assessed the effects of water-soluble cellulose acetate (WSCA) on the intestinal microbiota in a non-alcoholic steatohepatitis (NASH) mouse model. Methods: NASH model (STAM mice) was created by streptozotocin injection and feeding the mice a high-fat diet. The serum biochemical parameters were analyzed. Intestinal bacterial populations were analyzed using paired-end sequencing of 16S rRNA, 18S rRNA, and internal transcribed spacer gene. Results: Our findings indicated that WSCA administration tends to improve the serum alanine aminotransferase and glucose levels in STAM mice and decreased the alpha diversity and altered the beta diversity of their intestinal microbiota. Additionally, WSCA intake resulted in an increase in the abundance of Coriobacteriaceae_UCG-002 and a decrease in the abundance of Enterobacter. Conclusions: WSCA intake can alter specific microbial compositions to improve blood glucose levels and liver functions and may improve the pathogenesis of NAFLD.

Effect of alpha-lipoic acid and Silybum marianum supplementation with a Mediterranean diet on metabolic dysfunction-associated steatosis

BACKGROUND

The treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) has focused on the control of comorbidities. Silybum marianum (SM) and alpha-lipoic acid (ALA) have shown antioxidant and adjuvant effects on the control of metabolic disorders.

AIM

To evaluate whether the SM-ALA formulation (LUDLEV®), in combination with the Mediterranean diet (MD), could improve MASLD-related liver injury.

METHODS

A randomized, double-blind clinical trial was conducted on patients with MASLD. Administration of SM-ALA plus MD (group A) vs placebo plus MD (group B) was compared for 24 weeks. At baseline and weeks 12 and 24, anthropometric measurements, metabolic parameters, and liver function were analyzed. Clinical effectiveness was evaluated through transient elastography.

RESULTS

Fifty patients aged 54 ± 10 years were included, and the majority (74%) were female. Reduced visceral fat and umbilical circumference were reported in both groups, with significance in group A (P = 0.045 and 0.003, respectively). The decrease in controlled attenuation parameter was gradual and maintained at 12 and 24 weeks in group A (P = 0.026), whereas in group B the decrease was greater at week 12 and remained unchanged at week 24 (∆controlled attenuation parameter: -27 dB/m). Mild adverse effects were reported in 4 patients in group A (16%) and 4 patients in group B (16%), with no significant differences between groups (P = 0.641).

CONCLUSION

SM-ALA (LUDLEV®) combined with the MD can promote the improvement of metabolic parameters, reducing visceral fat and hepatic steatosis in Mexican patients with MASLD.

Factors Associated with Potentially Inappropriate Prescribing in Patients with Prostate Cancer

Background/Objectives: Drug prescribing in elderly people with chronic diseases carries certain risks. The desire to treat several different diseases at the same time increases the risk of inadequate drug prescribing. Prostate cancer is a disease of older men and occurs in most men over the age of 65. With age, the risk of prostate cancer increases, but so does the risk of the inadequate prescription of drugs. Our research aimed to highlight the potential inadequate prescription of drugs in patients with prostate cancer, considering that it is mostly a population of older men in whom a greater number of comorbidities is expected, followed by the use of a greater number of drugs. Methods: Our investigation was designed as an observational, cross-sectional study of 334 male patients who presented at the Multidisciplinary Tumor Board (MDT) for urological cancers at the University Clinical Center Kragujevac, Kragujevac, Serbia, from 1 September to 15 December 2023. Our primary outcome was obtaining the MAI score. Results: Our study showed that a significant number of drugs per patient with a prostate cancer diagnosis were prescribed potentially inadequately. The factors associated with greater risk for PIP were the initial level of PSA, ADT meta (intermittent), and several prescribed drugs; on the other hand, secondary hormonal therapy was the reason for less frequent PIP. Conclusions: In conclusion, patients with prostate cancer are under increased risk of inappropriate prescribing when they are prescribed more medication, have high PSA, and have ADT meta (intermittent). To stop the incidence of inappropriate prescribing and its serious economic and health consequences, clinicians should take special care when prescribing new drugs to such patients.

Self-assembled hyaluronic acid nanoparticles delivered by polymeric microneedles for targeted and long-acting therapy of psoriasis

Psoriasis is an autoimmune-driven inflammatory skin disease, clinically characterized by skin thickening, erythema, and scaling, significantly impacting patients' life quality and mental health. Clinically, oral pill or injection of methotrexate (MTX) formulation is a common route for psoriasis therapy, while both methods often cause undesired toxicity due to systemic administration, and limit patient compliance because of the frequent-dosing requirement. Here, we introduce a dissolvable microneedle (MN) patch made of polyvinyl alcohol (PVA) that incorporates self-assembled hyaluronic acid (HA) nanoparticles (NPs) conjugating MTX, which is designed for treating skin diseases, offering reduced adverse effects and improved patient adherence through its targeted and long-acting properties. Upon transdermal delivery via polymeric MNs, the HA-based therapeutic NPs actively target to the inflammatory skin cells via the interaction of HA group with CD44 protein that is highly expressed on the cell membrane in the psoriatic skin. Moreover, the HA-based NPs undergo slow dissociation, thereby achieving sustained release of the MTX drug at the lesion site over 7 days. Due to the favorite features, in the imiquimod (IMQ)-induced psoriatic mouse, only one application of the polymeric MN patch achieves diminished epidermal hyperplasia, and reduced inflammatory factors expression, ultimately improving the psoriasis-like skin condition in vivo.

Diagnostic Value of Glycosylated Extracellular Vesicle microRNAs in Gastric Cancer

Introduction

Early diagnosis is crucial for improving the prognosis of patients with gastric cancer (GC). However, the currently used biomarkers for diagnosing GC have limited sensitivity and specificity. This study aimed to develop a novel diagnostic model based on miRNAs from glycosylated extracellular vesicles and evaluate its effectiveness in diagnosing gastric cancer.

Methods

GlyExo-capture technology was used to isolate glycosylated extracellular vesicles from serum samples. The signatures were screened in a discovery cohort of GC patients (n=55) and non-disease controls (n=46) using an integrated process, including high-throughput sequencing technology, screening using a complete bioinformatics algorithm, validation using RT-qPCR, and evaluation by constructing a diagnostic model. The diagnostic model was evaluated in an independent validation cohort (n=139).

Results

We developed a diagnostic model for GC based on five miRNA pairs. This diagnostic model demonstrated high sensitivity, specificity, and stable performance in distinguishing GC patients from non-cancer controls with AUC of 0.930 in the independent validation cohort, particularly in differentiating early-stage GC from benign patients. The markers also showed excellent performance in indicating perineural invasion status and lymph node metastasis in the testing cohort.

Discussion

The model demonstrated high sensitivity and specificity in diagnosing patients with GC, especially in differentiating early-stage GC from benign patients. The five miRNA pairs could also aid in making treatment decisions. Thus, miRNAs derived from glycosylated exosomes are promising biomarkers for cancer diagnosis.

The effect of healthy eating index-2015 in the associations of biological aging and non-alcoholic fatty liver disease: an interaction and mediation analysis

BACKGROUND

The present study explored the association between biological aging (BA), healthy eating index-2015 (HEI-2015) and non-alcoholic fatty liver disease (NAFLD) in the general population of the United States.

METHODS

We used data from the NHANES database between 2017-2018 years to conduct the study. Weighted multivariable logistic regression analysis, restricted cubic spline (RCS), and subgroup analysis were performed to analyze the association of BA and HEI-2015 with prevalence of NAFLD and the mediation effect of HEI-2015 was also discussed. Additionally, generalized additive model was conducted to investigate the association of BA and HEI-2015 with ZJU index, BARD score, and NAFLD fibrosis score.

RESULTS

There was a total of 2,421 individuals. RCS shown that BA was positively correlated with prevalence of NAFLD, while HEI-2015 was negative correlated with NAFLD risk. After adjusting for interfering factors, compared with the lowest quartiles of BA and HEI-2015, the odds ratios with 95% confidence intervals for NAFLD across the quartiles were (1.24 (0.84, 1.84), 2.07 (1.15, 3.73) and 2.49 (1.16, 5.38)) and (0.89 (0.66, 1.18), 0.87 (0.65, 1.16) and 0.64 (0.46, 0.87)), respectively. The BA was linear positive with ZJU index, BARD score and NAFLD fibrosis score. However, the linear negative correlation existed between HEI-2015 and ZJU index, BARD score and NAFLD fibrosis score. Mediation analysis showed that the positive correlation between BA and NAFLD could be mediated and weakened by HEI-2015.

CONCLUSIONS

The prevalence of NAFLD gradually increases with BA, but this positive association can be weakened by the healthy diet.

Supplementation with essential amino acids in the early stage of carbohydrate reintroduction after a very-low energy ketogenic therapy (VLEKT) improves body cell mass, muscle strength and inflammation

BACKGROUND

Although little is yet known about the long-term maintenance of very low-energy ketogenic therapy (VLEKT) effects on body composition, muscle strength and inflammation, it is plausible to assume that changes may occur, particularly during the steps following the ketogenic step, due to the loss of the protective effects of ketones and the concomitant reintroduction of carbohydrates. For this reason, the present study aimed to evaluate the effects of supplementation with 8 g per day of essential amino acids (EAAs) on these parameters.

METHODS

A total of 68 women of reproductive age and with grade I obesity who had completed 45 days of the ketogenic phase with VLEKT (KeNuT protocol) and 40 days of non-ketogenic phase of KeNuT protocol with VLEKT (phase 3, fruit reintroduction) were included in the study. Half of them (n = 34) followed this first step of the re-educational phase of KeNuT protocol with VLEKT with supplementation with EAAs (Aminotrofic®: 4 g twice daily). Anthropometric parameters, body composition via bioelectrical impedance analysis and high-sensitivity C-reactive protein (hs-CRP) levels were assessed at baseline, pre- and post both dietary interventions.

RESULTS

At the end of 45 days of ketogenic phase with VLEKT (before fruit reintroduction and EAA supplementation), the two groups did not differ in any of the parameters assessed. At the end of the fruit reintroduction phase, the supplemented group showed greater magnitudes of reduction in weight, waist circumference, fat mass (FM) and hs-CRP (p < 0.001 for all) and of increase in muscle strength (p < 0.001), phase angle (p < 0.001), body cell mass (BCM) (p = 0.001), and muscle mass (%) (p < 0.001).

CONCLUSION

These results underline the usefulness of supplementation with EAAs during the first transitional phase post VLEKT to improve body composition (specifically reduction in FM and increase in BCM), muscle strength, and inflammatory status.

Association between the composite dietary antioxidant index and non-alcoholic fatty liver disease: evidence from National Health and Nutrition Examination Survey 2005-2016

Importance

Oxidative stress contributes to the progression of non-alcoholic fatty liver disease (NAFLD). Antioxidants from food can reduce NAFLD incidence, and the Composite Dietary Antioxidant Index (CDAI) measures total antioxidant capacity (TAC). However, the relationship between CDAI and NAFLD in the US adult population remains unclear.

Objective

To assess whether CDAI is associated with NAFLD in US adults.

Design setting and participants

This population-based cross-sectional study used data on US adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 cycles. Data were analyzed from January to February 2024.

Exposures

CDAI obtained from the dietary intake questionnaire.

Main outcomes and measures

The main outcome was NAFLD which defined by the US fatty liver score (USFLI) ≥30. Sampling weights were calculated according to NHANES guidelines.

Results

Among 9,746 adults included in this study [mean age, 48.3 years; 4,662 (47.6%) males], 3,324 (33.0%) were classified as having NAFLD using USFLI. In the fully adjusted of multivariable logistic regression, CDAI was negatively associated with NAFLD (odds ratio [OR], 0.95; 95% CI, 0.93-0.98). Furthermore, individuals in the highest quartile of CDAI were 34% less likely to have NAFLD compared to those in the lowest quartile (OR, 0.66; 95% CI, 0.52-0.85). In subgroup analyses, CDAI was inversely associated with NAFLD among participants with a BMI <25 (OR, 0.89; 95% CI, 0.83-0.95) and without metabolic syndrome (OR, 0.93; 95% CI, 0.91-0.96). The interaction tests revealed significant differences in these subgroups (P for interaction = 0.04 for BMI and 0.003 for metabolic syndrome). Sensitivity analyses confirmed this association using the hepatic steatosis index (HSI) to define NAFLD, applying unweighted logistic regression, adjusting for physical activity or after excluding non-Hispanic Black participants, and after excluding medications known for their potential hepatotoxic effects.

Conclusions and relevance

In this cross-sectional study based on six cycles (2005-2016) of the NHANES, CDAI was negatively associated with NAFLD in US adult population. This association highlights the potential for dietary interventions to reduce NAFLD incidence and underscores the need for future research, including clinical trials and mechanistic studies, to further explore the role of dietary antioxidants in NAFLD prevention and management.

Effects of Selected Food Additives on the Gut Microbiome and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

The purpose of this article is to present selected food additives as disruptors of normal intestinal homeostasis with a potential impact on the development of metabolic dysfunction-associated steatotic liver disease (MASLD). A comprehensive literature search was conducted in three major electronic databases: PubMed, ScienceDirect, and Google Scholar. MASLD is a prevalent liver condition that is closely related to the global rise in obesity. Its pathogenesis is multifactorial, with genetic, environmental, and metabolic factors playing a key role. The "multiple-hit" hypothesis suggests that a Western-style diet, rich in ultra-processed foods, saturated fats, and food additives, combined with low physical activity, contributes to obesity, which promotes lipid accumulation in the liver. Recent studies underscore the role of impaired intestinal homeostasis in the development of MASLD. Food additives, including preservatives, emulsifiers, and sweeteners, affect gut health and liver function. Selected preservatives inhibit pathogenic microorganisms but disrupt the intestinal microbiota, leading to changes in intestinal permeability and liver dysfunction. Some emulsifiers and thickeners can cause inflammation and alter the gut microbiome, contributing to liver steatosis. Furthermore, the use of sweeteners such as sucralose and aspartame has been linked to changes in liver metabolism and intestinal microbial composition, which in turn promotes metabolic disorders.

LDL-C and TC Mediate the Risk of PNPLA3 Inhibition in Cardiovascular Diseases

CONTEXT

PNPLA3 is a promising target for the treatment of metabolic dysfunction-associated steatotic liver disease. ARO-PNPLA3 is a drug that efficiently lowers PNPLA3 expression in hepatocytes at the mRNA level, resulting in a significant reduction in liver fat in Phase I clinical trials. However, the long-term effects and potential side effects of ARO-PNPLA3 are not well understood.

OBJECTIVE

We conducted a 2-sample, 2-step Mendelian randomization analysis to investigate the association between PNPLA3 inhibition and 10 cardiovascular diseases (CVDs), as well as the role of lipid traits as mediators.

METHODS

We identified genetic variants near the PNPLA3 gene, which are linked to liver fat percentage, as instrumental variables for inhibiting PNPLA3. Additionally, positive control analyses on liver diseases were conducted to validate the selection of the genetic instruments.

RESULTS

Genetically predicted PNPLA3 inhibition significantly increased the risk of coronary atherosclerosis (1.14, 95% CI 1.06, 1.23), coronary heart disease (1.14, 95% CI 1.08, 1.21), and myocardial infarction (1.16, 95% CI 1.08, 1.26). Suggestive associations were observed for increased risk of heart failure (1.09, 95% CI 1.02, 1.17, P = .0143) and atrial fibrillation (1.17, 95% CI 1.00, 1.36, P = .0468). Blood low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) mediated approximately 16% to 25%, 16% to 30%, and 14% to 22% of the associations between PNPLA3 inhibition and coronary atherosclerosis, myocardial infarction, and coronary heart disease, respectively.

CONCLUSION

This study suggests that PNPLA3 inhibition increases the risk of major CVDs. Moreover, blood LDL-C and TC may mediate a significant proportion of the associations between PNPLA3 inhibition and coronary atherosclerosis, coronary heart disease, or myocardial infarction.

The atherogenic index of plasma is associated with an increased risk of diabetes in non-obese adults: a cohort study

Objective

This study aims to investigate the relationship between the atherogenic index of plasma (AIP) and diabetes risk in Chinese non-obese adults. This is important because the incidence of diabetes is significant in non-obese populations, and evidence regarding this association is limited.

Methods

We conducted a retrospective cohort study with 82,977 Chinese non-obese adults. We used Cox proportional hazards regression to assess the relationship between baseline AIP levels and diabetes incidence. We also employed cubic spline functions and smooth curve fitting to investigate potential nonlinear relationships. Sensitivity and subgroup analyses were conducted to validate our findings.

Results

The median follow-up duration for these participants was 3.10 years, during which 1,041 subjects (1.25%) were diagnosed with diabetes. Adjusted analyses demonstrated a strong positive association between AIP and the risk of diabetes onset (HR 2.07; 95% CI: 1.63-2.63; p < 0.001). The risk of diabetes increased with higher AIP quartiles, especially between the highest (Q4) and lowest (Q1) quartiles (adjusted HR 1.55; 95% CI: 1.27-1.89). We also identified a nonlinear relationship between AIP and diabetes risk. Sensitivity and subgroup analyses confirmed these findings. Furthermore, E-value analysis indicated that the results were robust against unmeasured confounding variables.

Conclusion

Our findings highlight a positive, nonlinear association between AIP and diabetes risk in Chinese non-obese adults. Lowering triglycerides (TG) or increasing high-density lipoprotein cholesterol (HDL-C) levels may help reduce this risk.

Association of exposure to multiple volatile organic compounds with ultrasound-defined hepatic steatosis and fibrosis in the adult US population: NHANES 2017-2020

Objective

Volatile organic compounds (VOCs) are pervasive environmental pollutants known to impact human health, but their role in liver steatosis or fibrosis is not fully understood. This study investigates the association of urinary VOC mixtures with the risk of liver steatosis and fibrosis in U.S. adult population.

Methods

Data of 1854 adults from the National Health and Nutrition Examination Survey (NHANES) from 2017.01 to 2020.03 were collected. Vibration Controlled Transient Elastography (VCTE) assessed hepatic steatosis and liver fibrosis via the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. The study examined the relationship between urinary exposure biomarkers for 20 VOCs and liver health outcomes using multivariate logistic regression and Bayesian Kernel Machine Regression (BKMR) to evaluate the effects of both individual and mixed VOC exposures.

Results

Multivariate logistic regression analysis revealed that exposure biomarkers for acrolein and crotonaldehyde were positively associated with hepatic steatosis. Conversely, biomarkers for styrene, ethylbenzene, and propylene oxide were negatively associated with hepatic steatosis. Furthermore, biomarkers for 1,3-butadiene and xylene were positively associated with liver fibrosis, while ethylbenzene was negatively associated with this condition. BKMR analysis identified a significant positive joint effect of VOC biomarkers on CAP. Notably, when other VOC-EBs were held at median levels, biomarkers for acrolein and 1,3-butadiene exhibited linear correlations with Ln CAP and hepatic Ln LSM, respectively.

Conclusion

The study highlights the potential hepatotoxic effects of VOC mixtures, particularly noting the roles of acrolein and 1,3-butadiene in exacerbating liver steatosis and fibrosis. These findings advocate for further research to explore the mechanistic pathways and conduct longitudinal studies to establish causality and enhance understanding of VOCs' impact on liver health.

Drug Advances in NAFLD: Individual and Combination Treatment Strategies of Natural Products and Small-Synthetic-Molecule Drugs

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease and is closely associated with metabolic diseases such as obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome. However, effective treatment strategies for NAFLD are still lacking. In recent years, progress has been made in understanding the pathogenesis of NAFLD, identifying multiple therapeutic targets and providing new directions for drug development. This review summarizes the recent advances in the treatment of NAFLD, focusing on the mechanisms of action of natural products, small-synthetic-molecule drugs, and combination therapy strategies. This review aims to provide new insights and strategies in treating NAFLD.

[Short-term effectiveness of Gamma 3 U-Blade system for osteoporotic intertrochanteric fractures in the elderly]

Objective

To compare the short-term effectiveness between Gamma 3 intramedullary nails and Gamma 3 U-Blade system in the treatment of osteoporotic intertrochanteric fractures in the elderly.

Methods

A retrospective analysis was conducted on the clinical data of 124 elderly patients with osteoporotic intertrochanteric fractures, who were admitted between February 2020 and February 2023 and met the selection criteria. The fractures were fixed with Gamma 3 intramedullary nails in 65 patients (control group) and Gamma 3 U-Blade systems in 59 patients (UB group). The differences between the two groups were not significant in age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, bone mineral density, time from injury to operation, fracture classification, and affected side ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded; the tip-apex distance, fracture reduction quality, and lag screw position were evaluated on X-ray films at immediate after operation; the lag screw sliding distance and change value of neck-shaft angle were measured on X-ray films at last follow-up. Harris hip score at 1 year after operation and the occurrence of internal fixation-related complications were compared between the two groups.

Results

The operation time, intraoperative blood loss, and hospital stay in the UB group increased compared to the control group, but the differences were not significant ( P>0.05). All patients in both groups were followed up 12-24 months (mean, 17.1 months). At 12 months after operation, there was no significant difference in the Harris hip score between the two groups ( P<0.05). Radiological examination showed that there was no significant difference between the two groups ( P>0.05) in terms of tip-apex distance, fracture reduction quality, and lag screw position. Fractures healed in both groups, and there was no significant difference in healing time ( P>0.05). At last follow-up, the change value of neck-shaft angle and lag screw sliding distance in the UB group were significantly lower than those in the control group ( P<0.05). During follow-up, no related complications occurred in the UB group, while 6 cases (9.2%) in the control group experienced complications, and the difference in the incidence was significant ( P<0.05).

Conclusion

For the osteoporotic intertrochanteric fractures in the elderly, the Gamma 3 U-Blade system fixation can achieve good short-term effectiveness, with better imaging results compared to Gamma 3 intramedullary nails fixation.

Ginsenoside, a potential natural product against liver diseases: a comprehensive review from molecular mechanisms to application

Liver disease constitutes a significant cause of global mortality, with its pathogenesis being multifaceted. Identifying effective pharmacological and preventive strategies is imperative for liver protection. Ginsenosides, the major bioactive compounds found in ginseng, exhibit multiple pharmacological activities including protection against liver-related diseases by mitigating liver fat accumulation and inflammation, preventing hepatic fibrosis, and exerting anti-hepatocarcinogenic effects. However, a comprehensive overview elucidating the regulatory pathways associated with ginsenosides in liver disease remains elusive. This review aims to consolidate the molecular mechanisms through which different ginsenosides ameliorate distinct liver diseases, alongside the pathogenic factors underlying liver ailments. Notably, ginsenosides Rb1 and Rg1 demonstrate significantly effective in treating fatty liver, hepatitis, and liver fibrosis, and ginsenosides CK and Rh2 exhibit potent anti-hepatocellular carcinogenic effects. Their molecular mechanisms underlying these effects primarily involve the modulation of AMPK, NF-κB, TGF-β, NFR2, JNK, and other pathways, thereby attenuating hepatic fat accumulation, inflammation, inhibition of hepatic stellate cell activation, and promoting apoptosis in hepatocellular carcinoma cells. Furthermore, it provides insights into the safety profile and current applications of ginsenosides, thereby facilitating their clinical development. Consequently, ginsenosides present promising prospects for liver disease management, underscoring their potential as valuable therapeutic agents in this context.

Triterpenoids from Chios Mastiha Resin Against MASLD-A Molecular Docking Survey

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease without an approved pharmacological approach for its prevention/treatment. Based on the modified Delphi process, NAFLD was redefined as metabolic dysfunction-associated steatotic liver disease (MASLD) to highlight the metabolic aspect of liver pathogenesis. Chios mastiha (Pistacia lentiscus var. Chia, Anacardiaceae) resin demonstrated promising results in MASLD treatment. In this paper, molecular docking was applied to test 16 compounds from Chios mastiha as potential ligands for the receptors GR, LXRα, LXRβ, PPARα PPARγ, MC4R, AMPK, and VEGFR2, whose up- and down-regulation interfere with MASLD development and progression. The observed compounds had moderate and high affinity for LXR, GR, MC4R, and PPARγ in comparison to proven ligands, while their affinity for PPARα, AMPK, and VEGFR was less pronounced. The combination of active compounds from Chios mastiha rather than a single molecule may have a superior ability to control the intertwined MASLD metabolic pathways.

Miniaturized Liver Disease Mimics to Gain Insights into MMP Expression during Disease Progression

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver conditions, ranging from hepatic steatosis to steatohepatitis, fibrosis, and severe outcomes such as cirrhosis or cancer. The progression from hepatic steatosis to fibrosis involves significant extracellular matrix (ECM) remodeling, characterized by increased collagen deposition and cross-linking of ECM proteins, causing increased tissue stiffness and altered MMP expression patterns. Dysregulated MMP expression and extracellular acidosis are key contributors to NAFLD progression. Unlike other MMPs, which may be relevant only at specific disease stages, MMP-9 serves as a universal marker, allowing for monitoring of its expression in relation to disease states and ECM parameters. Understanding dysregulated MMP-9 expression across different NAFLD stages can provide crucial insights into disease progression and serve as both a diagnostic and a prognostic biomarker, identifying potential therapeutic targets. This study introduces a three-dimensional (3D) collagen/alginate-based liver disease model designed to investigate how matrix collagen content, elasticity, and diseased cell conditions influence MMP expression and pH levels in situ using nanoprobes. The platform offered an understanding of the relationships between these factors and their role in NAFLD progression, offering valuable insights into disease progression and potential resolution. To examine how various physicochemical and biological factors, particularly MMP expression and collagen deposition, drive NAFLD progression, three 3D NAFLD models were developed, simulating healthy (HL), steatotic (SL), and fibrotic (FL) liver matrices. Additionally, the role of collagenase treatment in the FL matrix in enhancing MMP expression and potentially mitigating fibrosis was also explored. By employing dual-sensitive fluorescent nanoprobes to monitor real-time in situ changes in MMP-9 expression and pH levels, this platform offers a novel approach to understanding the in vitro roles of matrix stiffness, collagen deposition, and diseased cell conditions in NAFLD pathogenesis.

Submicron Dispersions of Phytosterols Reverse Liver Steatosis with Higher Efficacy than Phytosterol Esters in a Diet Induced-Fatty Liver Murine Model

Consumption of phytosterols is a nutritional strategy employed to reduce cholesterol absorption, but recent research shows that their biological activity might go beyond cholesterol reduction for the treatment of metabolic dysfunction-associated fatty liver disease (MAFLD), and novel phytosterol formulations, such as submicron dispersions, could improve these effects. We explored the therapeutic activity of phytosterols, either formulated as submicron dispersions of phytosterols (SDPs) or conventional phytosterol esters (PEs), in a mouse model of MAFLD. MAFLD was induced in mice by atherogenic diet (AD) feeding. The reversion of distorted serum and liver parameter values after a period of AD feeding was investigated after supplementation of the AD with SDPs, PEs, or a placebo (PT). Additionally, the metabolic parameters of fatty acid synthesis, fatty acid oxidation, and inflammation were studied to understand the mechanism of action of phytosterols. AD supplementation with SDPs was shown to reduce liver fat, along with showing a significant improvement in liver triglycerides (TGs), free fatty acids (FFAs), and liver cholesterol levels. These results were reinforced by the analyses of the liver steatosis scores, and liver histologies, where SDP intervention showed a consistent improvement. Treatment with PEs showed slighter effects in the same analyses, and no effects were observed with the PT treatment. Additionally, SDP intervention reversed, with a higher efficacy than PEs, the effect of AD on the serum levels of TGs, total- and LDL-cholesterol levels, and glucose levels. And, exceptionally, while SDP improved HDL-cholesterol serum levels, PEs did not show any effect on this parameter. We provide evidence for the therapeutical activity of phytosterols in MAFLD beyond the regulation of cholesterol levels, which is increased when the phytosterols are formulated as submicron dispersions compared to ester formulations.

Defining an NK Cell-enriched Rejection-like Phenotype in Liver Transplant Biopsies From the INTERLIVER Study

BACKGROUND

Initial analysis of liver transplant biopsies in the INTERLIVER study (ClinicalTrials.gov; unique identifier NCT03193151) using rejection-associated transcripts failed to find an antibody-mediated rejection state (ie, rich in natural killer [NK] cells and with interferon-gamma effects). We recently developed an optimization strategy in lung transplants that isolated an NK cell-enriched rejection-like (NKRL) state that was molecularly distinct from T cell-mediated rejection (TCMR). Here we apply the same strategy to a liver transplant biopsy population.

METHODS

We used this strategy to search for a molecular NKRL state in 765 consented liver transplant biopsies collected at participating international centers for gold-standard histology and molecular assessment by genome-wide microarrays. Validation through a training set-test set approach of an optimized selection of variables as inputs into unsupervised rejection classification identified an NKRL state in livers.

RESULTS

The full model classified 765 biopsies into the following molecular phenotypes, characterized by their gene expression: no-rejection 54%, TCMR 16%, NKRL 13%, and injury 16%. Top TCMR transcripts were expressed in effector T cells; top NKRL transcripts were almost exclusively expressed in NK cells; and both had increased interferon-γ-inducible transcripts, which were more pronounced in TCMR. Most TCMR biopsies had significant parenchymal injury, molecular fibrosis, and abnormal biochemistry. NKRL biopsies had no excess of injury, fibrosis, or biochemistry abnormalities.

CONCLUSIONS

Optimized rejection algorithms indicate that some liver transplants manifest an NKRL state that is well tolerated in the short term postbiopsy and with minimal injury and relatively normal biochemistry, while also underscoring the potential of TCMR to produce extensive parenchymal injury.