New drugs approved by European medicines agency during 2024

In 2024, the European Medicines Agency (EMA) recommended 114 new medicines for human use, including 48 with entirely novel active substances. These therapeutic agents span diverse areas such as oncology, neurology, infectious diseases, metabolic disorders, and vaccines. Notably, 16 (14 %) of these approvals received orphan drug designation for the treatment of rare diseases. Key milestones included the endorsement of the first drug proven to slow Alzheimer's disease progression and the first vaccine to protect adults against chikungunya virus. Regulatory advancements played a critical role, with accelerated pathways facilitating the approval of innovative medicines to address unmet medical needs, including novel antibiotics targeting multidrug-resistant bacterial infections and therapies for antimicrobial resistance. EMA also made significant strides in addressing medicine shortages by implementing the European Shortages Monitoring Platform (ESMP) and enhancing communication with stakeholders for critical drugs such as glucagon-like peptide-1 (GLP-1) receptor agonists. This review examines the synthesis and clinical applications of newly approved drugs by the EMA in 2024, with a focus on their development pathways and therapeutic impact. By analyzing these innovative medicines, the review aims to provide insights into modern drug synthesis strategies and regulatory frameworks, fostering further advancements in pharmaceutical research and development.

An updated and comprehensive review of the health benefits and pharmacological activities of hesperidin

OBJECTIVES

This review aims to comprehensively assess the health benefits and pharmacological activities of hesperidin, a flavonoid commonly found in citrus fruits. It consolidates recent research findings to provide insights into hesperidin's diverse health-promoting effects.

KEY FINDINGS

Hesperidin has gained significant attention recently for its notable pharmacological activities and potential health benefits. Studies reveal its antioxidant properties, protecting cells from oxidative damage, and its anti-inflammatory effects, inhibiting pro-inflammatory cytokines and enzymes. Also, hesperidin shows promise in cardiovascular health by reducing blood pressure and cholesterol levels and enhancing endothelial function. It also exhibits anticancer potential by hindering cell proliferation, inducing apoptosis, and suppressing tumour growth. Moreover, hesperidin demonstrates neuroprotective effects, potentially mitigating neuroinflammation and oxidative stress associated with neurodegenerative diseases. Furthermore, it displays beneficial effects in metabolic disorders such as diabetes, obesity, and fatty liver disease by influencing glucose metabolism, lipid profile, and insulin sensitivity.

SUMMARY

Hesperidin exhibits a wide range of health benefits and pharmacological activities, making it a promising candidate for therapeutic interventions in various diseases. Its antioxidant, anti-inflammatory, cardiovascular, anticancer, neuroprotective, and metabolic effects underscore its potential as a valuable natural compound for promoting health and preventing chronic diseases.

Effect of tomato, tomato-derived products and lycopene on metabolic inflammation: from epidemiological data to molecular mechanisms

The goal of this narrative review is to summarise the current knowledge and limitations related to the anti-inflammatory effects of tomato, tomato-derived products and lycopene in the context of metabolic inflammation associated to cardiometabolic diseases. The potential of tomato and tomato-derived product supplementation is supported by animal and in vitro studies. In addition, intervention studies provide arguments in favour of a limitation of metabolic inflammation. This is also the case for observational studies depicting inverse association between plasma lycopene levels and inflammation. Nevertheless, current data of intervention studies are mixed concerning the anti-inflammatory effect of tomato and tomato-derived products and are not in favour of an anti-inflammatory effect of pure lycopene in humans. From epidemiological to mechanistic studies, this review aims to identify limitations of the current knowledge and gaps that remain to be filled to improve our comprehension in contrasted anti-inflammatory effects of tomato, tomato-derived products and pure lycopene.

Tanshinone IIA + Osthole alleviates ferroptosis in LPS-induced acute lung injury by Keap1-Nrf2/HO-1 pathway

BACKGROUND

Acute lung injury (ALI) is associated with a high mortality rate and requires effective treatment. Tanshinone IIA (T) and Osthole (O) exhibit anti-inflammatory effects and have been used to protect against lipopolysaccharide (LPS)-induced lung injury in mice. However, the combined effects of T and O on lung injury protection and their potential protective mechanisms have not been studied.

OBJECTIVE

To assess the protective effects of TO on LPS-induced ALI in mice and BEAS-2B cell injury and to investigate the potential mechanisms underlying these protective effects.

METHODS

Models of ALI induced by LPS were established. The assessment encompassed the viability of BEAS-2B cells, cell count, myeloperoxidase (MPO) activity, protein content, as well as IL-6 and TNF-a levels in bronchoalveolar lavage fluid (BALF). Additionally, malondialdehyde (MDA), reactive oxygen species (ROS), and glutathione (GSH) levels in mouse lung tissue were measured. The effects of TO were assessed using immunofluorescence (IF), immunohistochemistry (IHC), Western Blot (WB), RT-PCR, and ELISA. Statistical analysis involved one-way ANOVA and t-test.

RESULTS

TO administration led to a significant reduction in lung edema (W/D), MDA, ROS, GSH, and superoxide dismutase (SOD) levels compared to the individual T or O groups, alleviating LPS-induced ALI. TO also significantly attenuated lung tissue damage, reduced inflammatory response, decreased Fe2+ and 4-HNE levels, and increased GPX4, SLC7A11, and Nrf2 gene expression in mice. Ultimately, TO alleviated ferroptosis in LPS-induced ALI by activating Nrf2 expression, and no markedly adverse reactions were observed.

CONCLUSION

TO alleviates LPS-induced ALI and effectively treats against LPS-induced ALI.

Metabolic crosstalk and therapeutic interplay between diabetes and hyperuricemia

Hyperuricemia and diabetes mellitus (DM) are prevalent metabolic disorders with high comorbidity, imposing a substantial global public health burden. Their coexistence is not merely additive but synergistic, exacerbating metabolic dysregulation through mechanisms such as insulin resistance and β-cell apoptosis, ultimately establishing a vicious cycle. Both disorders induce acute and chronic damage to vital organs, particularly the cardiovascular, renal systems. Hyperuricemia aggravates diabetic complications, notably diabetic cardiomyopathy, nephropathy and retinopathy via oxidative stress, inflammation, and metabolic dysregulation.Current urate-lowering therapies (ULTs), such as xanthine oxidase inhibitors and urate transporter 1 (URAT1, also known as SLC22A12) antagonists, demonstrate potential benefits in ameliorating diabetic complications but face challenges including safety concerns and dose adjustments. Similarly, several glucose-lowering drugs also exhibit the benefits of improving hyperuricemia. This review summarizes the metabolic crosstalk and therapeutic interplay between hyperuricemia and DM, examines the pathogenic role of uric acid in diabetic complications, and discusses the benefits and challenges of existing ULTs and glucose-lowering drugs in disrupting this cycle of metabolic dysregulation and concurrent organ damage. We hope our findings deepen the comprehension of the intricate metabolic crosstalk between glucose and urate homeostasis, providing novel therapeutic insights for patients with comorbid DM and hyperuricemia.

M084 causes cell cycle arrest and inhibits voltage-gated Na+ and K+ channels in neuronal N2A cells

The effects of M084, an inhibitor of transient receptor potential (TRP) channels TRPC4 and TRPC5, on cell proliferation, voltage-gated K+ (Kv) channels and voltage-gated Na+ (Nav) channels were investigated in mouse neuronal N2A cells. Cell proliferation was measured by MTT assay and trypan blue exclusion test. Mitochondrial membrane potential was measured using JC-1 as a fluorescent probe. Cell cycle and ion channel activities were studied, respectively, using flow cytometry and voltage-clamp method. M084 (10-100 μM) concentration-dependently suppressed cell proliferation; M084 at 100 μM also arrested cell cycle at the G1 phase, and caused a decrease in mitochondrial membrane potential. The anti-proliferative effect of M084 was not mitigated by dorsomorphine (AMPK inhibitor), sodium salicylate (NF-κB inhibitor) and SP600125 (JNK inhibitor), but was alleviated by SB203580 (p38 inhibitor). M084 (3-100 μM) suppressed Nav and Kv currents in a concentration-dependent fashion with IC50 values of 9.1 and 29.2 μM, respectively. M084 (30 μM) caused left-shifts in inactivation curves of both Nav and Kv currents, and diminished peak amplitude of current injection-triggered membrane potential overshoot. In conclusion, M084 suppressed neuronal cell growth and inhibited their Nav and Kv channels.

Association between urinary albumin-to-creatinine ratio and all-cause and cardiovascular-cause mortality among MASLD: NHANES 2001-2018

Background

Urinary albumin-to-creatinine ratio (UACR) is an established biomarker for assessing kidney damage, but recent studies suggest it may also reflect broader health risks. This study aimed to investigate the association between UACR and all-cause and cardiovascular disease (CVD)-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

In this prospective cohort study, we included sample of 3,412 MASLD enrolled in the National Health and Nutrition Examination Survey 2001-2018. The study population was divided into three different risk categories based on urinary UACR: low level (<4.67 mg/g), intermediate level (4.67-7.67 mg/g), and high level (7.68-30 mg/g). Cox proportional hazards models were used to estimate the hazard ratios (HR) for the association between UACR level and both all-cause and CVD-cause mortality. Restricted cubic spline (RCS) curve analysis was employed to assess the non-linear association between UACR and mortality. Kaplan-Meier (KM) survival curves were used to evaluate survival rates across UACR groups.

Results

The study found that higher UACR levels, even within the normal range, were independently associated with increased risks of both all-cause and CVD-cause mortality. Each 1 mg/g increase in UACR was associated with a 4% higher risk of all-cause mortality (HR 1.04, 95% CI 1.03-1.05) and a 5% higher risk of cardiovascular mortality (HR 1.05, 95% CI 1.02-1.08). Compared with the low UACR group, high UACR both showed an increased all-cause mortality risk [HR, 2.69 (95% CI, 2.07-3.50)] and CVD-cause mortality risk [HR, 2.97 (95% CI, 1.76-4.99)]. RCS curve analysis revealed a non-linear positive correlation between UACR and both all-cause and CVD-cause mortality, identifying UACR thresholds of 7.467 mg/g for all-cause mortality and 7.195 mg/g for CVD-cause mortality. The KM survival curves confirmed that participants with lower UACR levels had higher survival rates.

Conclusion

Elevated UACR levels within the normal range, are associated with increased all-cause and cardiovascular mortality in patients with MASLD. UACR may serve as a useful early biomarker for identifying individuals at higher risk of mortality, supporting more proactive clinical interventions to manage MASLD-related risks.

Cuproptosis-related genes and agents: implications in tumor drug resistance and future perspectives

In the field of tumor treatment, drug resistance remains a significant challenge requiring urgent intervention. Recent developments in cell death research have highlighted cuproptosis, a mechanism of cell death induced by copper, as a promising avenue for understanding tumor biology and addressing drug resistance. Cuproptosis is initiated by the dysregulation of copper homeostasis, which in turn triggers mitochondrial metabolic disruptions and induces proteotoxic stress. This process specifically entails the accumulation of lipoylated proteins and the depletion of iron-sulfur cluster proteins within the context of the tricarboxylic acid cycle. Simultaneously, it is accompanied by the activation of distinct signaling pathways that collectively lead to cell death. Emerging evidence highlights the critical role of cuproptosis in addressing tumor drug resistance. However, the core molecular mechanisms of cuproptosis, regulation of the tumor microenvironment, and clinical translation pathways still require further exploration. This review examines the intersection of cuproptosis and tumor drug resistance, detailing the essential roles of cuproptosis-related genes and exploring the therapeutic potential of copper ionophores, chelators, and nanodelivery systems. These mechanisms offer promise for overcoming resistance and advancing tumor precision medicine. By elucidating the molecular mechanisms underlying cuproptosis, this study aims to identify novel therapeutic strategies and targets, thereby paving the way for the development of innovative anti-cancer drugs.

New insights into pathogenisis and therapies of P2X7R in Parkinson's disease

Parkinson's disease (PD), a prevalent neurodegenerative disorder, is linked to genetics and environment, but its mechanisms remain unclear. Emerging evidence connects purinergic signaling-particularly ATP-sensitive P2X7 receptor (P2X7R)-to PD. P2X7R expression is elevated in PD patients, and its antagonist BBG mitigates 6-OHDA-induced dopaminergic neuron death. This review discusses P2X7R's structure, neural functions, PD-related mechanisms, and therapeutic potential as a targert.

Evaluating the effects of L-carnitine on albino rat's gingiva-derived stem cells (In-Vitro Study)

OBJECTIVE

Stem cells as therapy is currently a well-established scientific research topic. Poor maintenance and survival of cells supplied to the damaged tissue are barriers to improving the efficacy of regenerative medicine. Antioxidants such as L-carnitine are used to promote cell survival and maintenance properties. This study aims to assess the effects of L-carnitine on albino rat gingiva-derived mesenchymal stem cells proliferation.

DESIGN

Rat gingiva-derived mesenchymal stem cells were isolated and exposed to 0, 1, 3, and 10 Mm of L-carnitine. Flow cytometry was then utilized to measure gene and protein expression levels for CD90, CD105, CD45, and CD19. The MTT test was used to examine the proliferation of cells. The proportion of apoptosis was determined using the Annexin V/PI technique. Cell cycle investigations to assess cells and identify the percentages of cells in the G0/G1, S, and G2/M phases. Expression of TGF-β gene has been evaluated using Real time‑PCR analysis.

RESULTS

The results showed that gingiva-derived mesenchymal stem cells, including CD90 and CD105, consistently showed positive immunostaining, whereas CD45 and CD19 were weakly positive or negative. Concentration-dependent increase of growth proliferation, more rapid proliferation of the cells treated with the highest L-carnitine concentration (10 mM) after 72 h (0.934 ± 0.063). Cells treated with 10 mM L-carnitine showed considerably decreased percentages of necrotic (2.38 ± 0.55), late (1.23 ± 0.90), early apoptotic cells (1.18 ± 0.13), and increased the percentage of viable cells (95.13 ± 1.61).

CONCLUSION

Our findings suggest that adding L-carnitine to gingiva-derived mesenchymal stem cells during expansion enables efficient and viable cell production.

Tannic Acid as an Ion Channel Modulator: An Understanding of Its Pharmacological Spectrum

Tannic acid (TA) is a polyphenol present in many plant foods and beverages such as green tea and wines. As a food additive, it has been recognized by Food and Drug Administration as generally safe. As a candidate drug, its pharmacological effects cover a wide spectrum, ranging from antibacterial, anticancer, cardioprotection to neuroprotection. TA has been shown to modulate a number of ion channels such as Ca2+-activated Cl- channels (CaCC), voltage-gated K+ (Kv) channels and transient receptor potential (TRP) channels, producing effects such as analgesia, antihypertensive effects and reduction of airway hypersensitivity. In this review we focus on how ion channel modulation by TA may account for the pharmacological effects of TA in various cells and organ systems. Further emphasis should be paid to factors, such as dosage and routes of administration, before the pharmacological actions of TA could be translated into therapeutic applications.

Lycopene Protects Corneal Endothelial Cells from Oxidative Stress by Regulating the P62-Autophagy-Keap1/Nrf2 Pathway

Oxidative stress is a key mechanism in corneal endothelial damage-related diseases, which is induced by environmental factors and genetic mutations. Lycopene (LYC), one of the most potent natural antioxidants, has been shown to offer significant protection against various diseases. However, its role and mechanisms in corneal endothelial damage remain unclear. In this study, an oxidative stress-induced injury model was created using the B4G12 cell line, and a disease model for Fuchs' endothelial corneal dystrophy (FECD) was established using genetically edited mice, both of which were treated with LYC. The results demonstrated that lycopene effectively protected corneal endothelial cells and slowed the progression of FECD. The protective mechanism involves upregulating P62 and activating autophagy, leading to Keap1 degradation, Nrf2 nuclear translocation, and activation of downstream antioxidant proteins. This study broadens the potential application of lycopene in protecting the corneal endothelium and provides a new non-surgical approach for treating corneal endothelial damage-related diseases.

Assessment of Tanshinone IIA Derivatives for Cardioprotection in Myocardial Ischemic Injury

Tanshinone ⅡA (TSA), a component of traditional Chinese medicine, effectively protects against myocardial injury. However, its clinical application is limited by poor water solubility and a short half-life. In this study, we report on four TSA derivatives designed and synthesized by our research group. The protective activity against hypoxia-reoxygenation injury in cells was evaluated, and derivative Ⅰ-3 was selected for in vivo experiments to verify its myocardial protective activity in rats with myocardial infarction. The results demonstrated that these four compounds could protect neonatal rat cardiomyocytes from hypoxia-reoxygenation injury. Among the derivatives, Ⅰ-3 showing superior protective effects, we found that Ⅰ-3 has enhanced metabolic stability and an extended half-life. Ⅰ-3 exhibited superior biological activity, effectively reducing the heart infarction area, alleviating myocardial hypertrophy, and enhancing cardiac pumping function. Ⅰ-3 reported in the present work represents a novel and effective derivative of TSA, showing great potential for the treatment of myocardial ischemia (MI).

Kinin B1 Receptor Agonist Enhances Blood-Brain Barrier Permeability in Healthy and Glioblastoma Environments

Background/Objectives: The low permeability of the blood-brain barrier (BBB) represents a significant challenge to effective systemic chemotherapy for primary and metastatic brain cancers. Kinin receptors play a crucial role in modulating BBB permeability, and their agonist analogs have been explored in preclinical animal models to enhance drug delivery to the brain. In this study, we investigated whether des-Arg9-bradykinin (DBK), a physiological agonist of kinin B1 receptor (B1R), acts as a brain drug delivery adjuvant by promoting the transient opening of the BBB. Methods: Human brain microvascular endothelial cells (HBMECs) were treated with DBK in the culture medium and in conditioned media from glioblastoma cell lines, namely T98G (CMT98G) and U87MG (CMU87). Immunofluorescence, RT-qPCR, in-cell Western assay, and proximity ligation assay (PLA) were performed to analyze BBB components, kinin receptors and TLR4, a receptor associated with the kinin pathway and inflammation. The effect of DBK on enhancing paracellular molecule transport was evaluated using Evans blue dye (EB) quantification in a cell culture insert assay and in an in vivo model, where mice with and without brain tumors were treated with DBK. To assess the functional impact of the transient BBB opening induced by DBK, the chemotherapeutic drug doxorubicin (DOX) was administered. Results: Treatment with DBK facilitates the presence of EB in the brain parenchyma by transiently disrupting the BBB, as further evidenced by the increased paracellular passage of the dye in an in vitro assay. B1R activation by DBK induces transient BBB opening lasting less than 48 h, enhancing the bioavailability of the DOX within the brain parenchyma and glioma tumor mass. The interaction between B1R and TLR4 is disrupted by the secreted factors released by glioblastoma cells, as conditioned media from T98G and U87 reduce TLR4 staining in endothelial cells without affecting B1R expression. Conclusions: These results further support the potential of B1R activation as a strategy to enhance targeted drug delivery to the brain.

Thinking Outside the Therapeutic Box: The Potential of Polyphenols in Preventing Chemotherapy-Induced Endothelial Dysfunction

The numerous side effects and adverse health implications associated with chemotherapies have long plagued the field of cancer care. Whilst in some cases a curative measure, this highly toxic intervention consistently scores poorly on quantitative measures of tolerability and safety. Of these side effects, cardiac and microvascular defects pose the greatest health risk and are the leading cause of death amongst cancer survivors who do not succumb to relapse. In fact, in many low-grade cancers, the risk of recurrence is far outweighed by the cardiovascular risk of morbidity. As such, there is a pressing need to improve outcomes within these populations. Polyphenols are a group of naturally occurring metabolites that have shown potential vasoprotective effects. Studies suggest they possess antioxidant and anti-inflammatory activities, in addition to directly modulating vascular signalling pathways and gene expression. Leveraging these properties may help counteract the vascular toxicity induced by chemotherapy. In this review, we outline the main mechanisms by which the endothelium is damaged by chemotherapeutic agents and discuss the ability of polyphenols to counteract such side effects. We suggest future considerations that may help overcome some of the published limitations of these compounds that have stalled their clinical success. Finally, we briefly explore their pharmacological properties and how novel approaches could enhance their efficacy while minimising treatment-related side effects.

Induction of apoptosis and hypoxic stress in malignant melanoma cells via graphene-mediated far-infrared radiation

BACKGROUND

Malignant melanoma (MM) is a highly aggressive skin tumor with a rising incidence and poor prognosis. Although current clinical treatments, including surgery, targeted therapy, immunotherapy, and radiotherapy, have shown some efficacy, therapeutic options remain limited for elderly patients and those with metastatic disease, highlighting the urgent need for novel therapeutic strategies. In recent years, the unique far-infrared radiation (FIR) properties of graphene have demonstrated potential applications in cancer treatment. However, the mechanisms underlying FIR's effects in MM therapy remain poorly understood.

METHODS

This study systematically evaluated the inhibitory effects of FIR on MM through in vitro cell experiments, animal models, and molecular mechanism analysis. First, the B16F10 melanoma cell line was used as the experimental model. The effects of FIR on cell proliferation, apoptosis, and the cell cycle were assessed using CCK-8 assays and flow cytometry, while RNA sequencing was conducted to analyze the associated signaling pathways. Second, specific caspase inhibitors were employed to further validate the mechanisms of FIR-induced apoptosis. Finally, a syngeneic tumor transplantation model in C57BL/6J mice was established to comfirm the anti-tumor efficacy of FIR in vivo, thereby comprehensively elucidating its anti-cancer mechanisms.

RESULTS

The results demonstrated that FIR significantly inhibits MM. In vitro experiments revealed that FIR treatment markedly suppressed B16F10 cell proliferation, induced apoptosis, caused G0/G1 phase cell cycle arrest, and downregulated the expression of hypoxia-related proteins such as HIF-1α. In animal studies, FIR significantly inhibited tumor growth. RNA sequencing revealed that FIR exerts its anti-cancer effects through multiple signaling pathways. Notably, the use of caspase inhibitors Z-DEVD-FMK and Z-LEHD-FMK, which specifically inhibit caspase-3 and caspase-9, respectively, can rescue cells from apoptosis induced by FIR treatment.

CONCLUSION

This study systematically elucidated that FIR exerts anti-tumor effects through multiple mechanisms, including inducing MM cell apoptosis, exacerbating hypoxic stress, and causing cell cycle arrest. The findings provide new insights and approaches for MM treatment and establish a theoretical foundation for the clinical application of FIR in cancer therapy.

Natural polyphenols as novel interventions for aging and age-related diseases: Exploring efficacy, mechanisms of action and implications for future research

Natural polyphenols are a group of components widely found in traditional Chinese medicines and have been demonstrated to delay or prevent the development of aging and age-related diseases in recent years. As far as we know, the studies of natural polyphenols in aging and aging-related diseases have never been extensively reviewed. In the present paper, we reviewed recent advances of natural polyphenols in aging and common age-related diseases and the current technological methods to improve the bioavailability of natural polyphenols. The results showed that natural polyphenols have the potential to prevent or treat aging and common age-related diseases through multiple mechanisms. Nanotechnology, structural modifications, and matrix processing could provide strong technical support for the development of natural polyphenols to prevent or treat aging and age-related diseases. In conclusion, natural polyphenols have important potential in the prevention and treatment of aging and age-related diseases.

Regulatory effects of resveratrol on nitric oxide signaling in cardiovascular diseases

Cardiovascular illnesses are multifactorial disorders and represent the primary reasons for death worldwide, according to the World Health Organization. As a signaling molecule, nitric oxide (NO) is extremely permeable across cellular membranes owing to its unique molecular features, like its small molecular size, lipophilicity, and free radical properties. Some of the biological effects of NO are vasodilation, inhibition in the growth of vascular smooth muscle cells, and functional regulation of cardiac cells. Several therapeutic approaches have been tested to increase the production of NO or some downstream NO signaling pathways. The health benefits of red wine are typically attributed to the polyphenolic phytoalexin, resveratrol (3,5,4'-trihydroxy-trans-stilbene), which is found in several plant species. Resveratrol has beneficial cardiovascular properties, some of which are mediated through endothelial nitric oxide synthase production (eNOS). Resveratrol promotes NO generation from eNOS through various methods, including upregulation of eNOS expression, activation in the enzymatic activity of eNOS, and reversal of eNOS uncoupling. Additionally, by reducing of oxidative stress, resveratrol inhibits the formation of superoxide and inactivation NO, increasing NO bioavailability. This review discusses the scientific literature on resveratrol's beneficial impact on NO signaling and how this effect improves the function of vascular endothelium.

Research Progress on the Role and Mechanism in the Change of Cardiac Structure and Function of Cardiac Fibrosis in the Elderly

Heart failure is closely related to aging. Elderly patients with heart failure are often able to retain normal systolic function, manifested by left ventricular hypertrophy with decreased diastolic function. Relevant studies have shown that age-related cardiac fibrosis plays an important role in the pathogenesis of cardiac diastolic heart failure. Activation of fibroblasts in the heart, the acquisition of a pro-fibrotic phenotype, and age-dependent accumulation of collagen can lead to progressive increases in myocardial stiffness and impaired diastolic function. The renin-angiotensin-aldosterone system, reactive oxygen species, and angiotensin II are closely related to fibrotic remodeling of the heart in the elderly, and their pro-fibrotic effects may be mainly mediated by transforming growth factor β. In this review, we summarize the research progress of the role and mechanism of cardiac fibrosis in the structural and functional changes of the elderly.

Transient angiotensin-converting enzyme inhibition confers sex-specific protection against angiotensin II-induced cardiac remodeling

Hypertension increases the prevalence of heart failure to a greater extent in women than men. The fibrotic remodeling of the left ventricle (LV) is a major contributor to increased myocardial stiffness and eventual decrease in cardiac function. Cardiac fibrosis can be prevented in the spontaneously hypertensive rat (SHR) by transient angiotensin-converting enzyme inhibitors (ACEi) in males. Whether transient ACEi also protects against fibrosis in females is not known. In the present study, we evaluated angiotensin II (Ang II)-induced cardiac fibrosis and related signaling in male and female SHR to determine how these responses are altered by prior transient ACEi treatment. Relative changes in blood pressure response to both ACEi and Ang II were similar between sexes, whereas Ang II-induced cardiac hypertrophy was attenuated by prior ACEi in males only. Ang II-induced changes in gene expression for collagens I, III, and IV were attenuated by prior ACEi in males but not females. Despite these sex-specific differences, prior ACEi-attenuated Ang II-induced increases in fibrogenic proteins [phosphorylated SMAD3/SMAD3, periostin, and lysyl oxidase (LOX)] and pro-oxidative proteins (NOX2 and NOX4), as well as hydroxyproline (HYP) content similarly in both sexes. Interestingly, a positive correlation between angiotensin II type 1 (AT1) receptor gene expression and Col1a1 in Ang II-treated males is absent in the female SHRs. The observed sex differences in the protection afforded by prior ACEi suggest altered signaling for collagen deposition that may lead to a greater understanding of the sex-dependent efficacy of antihypertensive drugs.NEW & NOTEWORTHY Here, we determine, for the first time that female spontaneously hypertensive rats are responsive to transient angiotensin-converting enzyme inhibitor (ACEi) treatment. Prior work showed that transient ACEi treatment induced persistent protection against a future stimulus in males. Here, Ang II-induced cardiac fibrosis was attenuated by transient ACEi treatment in both sexes. Notably, the underlying mechanism of action is sex-dependent. Specifically, changes in collagen deposition in male but not female hearts correlate with collagen gene expression.

Salvia miltiorrhiza Bunge root in the treatment of myocardial fibrosis: research progress and challenges

Myocardial fibrosis (MF) involves the activation and excessive proliferation of cardiac fibroblasts (CFs) in the extracellular matrix, leading to increased collagen expression that impairs cardiac function. Currently, there are no effective pharmacological treatments for MF. Traditional Chinese Medicine (TCM), particularly Salvia miltiorrhiza Bunge [Lamiaceae; Salviae miltiorrhizae radix et rhizoma], has gained attention for its potential in treating MF. Recent studies indicate significant therapeutic effects of its active metabolites, supporting its use in MF treatment and positioning it as a promising candidate for drug development.

AIM OF THE REVIEW

This article reviews the research and mechanisms of S. miltiorrhiza's effective metabolites and preparations in treating MF, providing a reference for future clinical treatments. A systematic literature search was conducted in PubMed, Web of Science, CNKI, and Google Scholar (January 2000-October 2024) using keywords: "myocardial fibrosis," "cardiac fibrosis," "Salvia miltiorrhiza Bunge," "extract," and "botanical drug."

RESULTS

The active metabolites of S. miltiorrhiza and its metabolite preparations exert anti-fibrotic effects through pleiotropic mechanisms, including suppression of ventricular remodeling, modulation of autophagy, inhibition of oxidative stress and cardiomyocyte apoptosis, and regulation of extracellular matrix homeostasis and immune-inflammatory responses.

CONCLUSION

Research indicates that S. miltiorrhiza is beneficial for managing MF, but further studies are needed to identify its chemical metabolites and regulatory mechanisms. Large-scale, multi-center clinical trials are also necessary to assess treatment safety. This review offers insights for developing new anti-MF pharmacotherapies.

Impact of Collaborative Empowerment Education on Psychological Distress, Quality of Life, and Nutritional Status in Esophageal Cancer Patients Undergoing Concurrent Chemoradiotherapy

Esophageal cancer (EC) patients undergoing concurrent chemoradiotherapy (CCRT) often face significant psychological distress, impaired quality of life (QoL), and poor nutritional status. This study evaluates the impact of multidisciplinary collaborative empowerment education (MCEE) in addressing these challenges. According to the inclusion criteria, 160 patients were recruited and randomly assigned to either the MCEE group (n = 80) or the control group (n = 80). The MCEE group received a tailored program consisting of psychological support, nutritional counseling, and educational interventions. Outcome measures, including psychological distress (using the Kessler Psychological Distress Scale), quality of life (using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), and nutritional status (using hemoglobin, serum protein, and albumin levels), were evaluated at baseline and after four cycles of concurrent chemoradiotherapy. Post-intervention, the MCEE group showed significant improvements in psychological distress. QoL improvements were noted across all functional domains, including physical, emotional, cognitive, and social functions (all Ps ≤ 0.001), with significant reductions in fatigue, insomnia, and pain. Nutritional status also improved, with higher levels of hemoglobin, serum protein, and albumin, as well as less weight loss in the intervention group (all Ps ≤ 0.001). MCEE effectively reduces psychological distress, improves QoL, and enhances nutritional status in EC patients undergoing CCRT. This patient-centered, multidisciplinary approach offers a promising strategy for improving treatment outcomes and overall well-being in cancer care.

Cardiac Telerehabilitation After Heart Attack Using E-Learning Platforms and Monitoring Cardiovascular Risk Factors: A Narrative Review of the Literature

This narrative review aims to evaluate the current evidence on the use of cardiac telerehabilitation (CTR) in patients after myocardial infarction, focusing on the effectiveness of e-learning platforms and remote monitoring for addressing cardiovascular risk factors, improving physical fitness, and enhancing patient adherence. The review also explores the limitations and gaps in the literature, highlighting the need for future research to optimize CTR approaches. A comprehensive literature search was conducted using PubMed and Scopus, focusing on specific keywords. The search yielded fifteen randomized controlled trials. Data from these studies were analyzed to evaluate the methodology, interventions, patient characteristics, and outcomes related to the use of CTR in managing cardiovascular risk factors and improving physical fitness. The included studies demonstrated that CTR interventions, delivered via online platforms, phone calls, and smart devices, were effective in improving cardiovascular risk factors, physical activity levels, and overall patient satisfaction. CTR appears to be associated with improvements in exercise tolerance, VO2 max, body composition, and adherence. While the outcomes were promising, there is still limited evidence regarding the long-term impact of CTR on cardiovascular risk factors and lifestyle interventions, particularly in non-exercise components like dietary management and psychological support. Cardiac telerehabilitation presents a feasible and effective alternative to traditional in-hospital rehabilitation programs for patients recovering from myocardial infarction. The integration of e-learning platforms and smart devices enhances patient adherence, improves cardiovascular risk factors, and increases access to rehabilitation services, particularly for those who face barriers to traditional care. However, further large-scale studies are needed to establish standardized protocols and best practices for CTR. Additionally, future research should address disparities in access to digital health technologies, especially among rural and underserved populations, to ensure equitable access to these innovative approaches.

Comprehensive Studies on the Regulation of Type 2 Diabetes by Cucurbitane-Type Triterpenoids in Momordica charantia L.: Insights from Network Pharmacology and Molecular Docking and Dynamics

Background/Objectives:Momordica charantia L. (M. charantia), a widely cultivated and frequently consumed medicinal plant, is utilized in traditional medicine. Cucurbitane-type triterpenoids, significant saponin components of M. charantia, exhibit hypoglycemic effects; however, the underlying mechanisms remain unclear. Methods: This study utilized comprehensive network pharmacology to identify potential components of M. charantia cucurbitane-type triterpenoids that may influence type 2 diabetes mellitus (T2DM). Additionally, molecular docking and molecular dynamics studies were performed to assess the stability of the interactions between the selected components and key targets. Results: In total, 22 candidate active components of M. charantia cucurbitane-type triterpenoids and 1165 disease targets for T2DM were identified through database screening. Molecular docking and molecular dynamics simulations were conducted for five key components (Kuguacin J, 25-O-methylkaravilagenin D, Momordicine I, momordic acid, and Kuguacin S) and three key targets (AKT1, IL6, and SRC), and the results demonstrated stable binding. The experimental results indicate that the interactions between momordic acid-AKT1 and momordic acid-IL6 are stable. Conclusions: Momordic acid may play a crucial role in M. charantia's regulation of T2DM, and AKT1 and IL6 seem to be key targets for the therapeutic action of M. charantia in managing T2DM.

Oroxylin A reverses SHP-2 oxidative inactivation in GPVI signaling to suppress platelet activation and thrombus formation

BACKGROUND

Arterial thrombotic events are the leading causes of death worldwide, and the therapeutic effects of current antiplatelet drugs are not fully satisfactory. Oroxylin A (OroA), a flavone compound extracted from Scutellaria radix, possesses cardioprotective and many other pharmacological effects. While platelets play a crucial role in the development of myocardial infarction, the direct effects of OroA on platelet activation and thrombosis have yet to be investigated.

METHODS

FeCl₃-induced arteriole thrombosis and whole-blood perfusion were used to assess the inhibitory effect of OroA on thrombus formation. A myocardial ischemia model was employed to evaluate the protective effect of OroA on myocardial injury. Multiple platelet function studies including platelet aggregation, platelet spreading, clot retraction were performed. Network pharmacology, flow cytometry, enzyme-linked immunosorbent assay, co-immunoprecipitation and western blot were utilized to explore the mechanism of OroA on platelet activation.

RESULTS

OroA inhibited thrombus formation with less bleeding risk compared with aspirin. OroA protected against myocardial injury by suppressing microvascular thrombosis and platelet infiltration. OroA suppressed different agonist-induced platelet activation in a concentration-dependent manner, showing greater antiplatelet activity against collagen-induced platelet aggregation compared to ADP or thrombin-induced aggregation. OroA decreased granule release, integrin αIIbβ3 activation, platelet spreading and clot retraction. As a flavone, OroA boosted superoxide dismutase (SOD) and glutathione (GSH) activities and decreased malondialdehyde (MDA), oxidized glutathione (GSSG) and ROS levels in platelets during oxidative stress. OroA binds to SHP-2 and prevents its oxidative inactivation, leading to the tyrosine dephosphorylation of Src, Syk and PLCγ2, as well as the reduction of Ca2+ influx and PKC phosphorylation in GPVI signaling.

CONCLUSIONS

OroA inhibits platelet activation, thrombus formation and myocardial injury via reversing SHP-2 oxidative inactivation thereby attenuating collagen-induced GPVI signaling. With minor bleeding risk and no obvious pharmacological toxicity, OroA holds promising therapeutic potential as an antithrombotic drug.

Infectious diseases, cardio-cerebrovascular health and vaccines: pathways to prevention

Cardiovascular and infectious diseases both feature among the leading causes of death among men and women in the world. The pathophysiological pathways of infection and cardiovascular disease intersect, and there is a bidirectional relationship between the two. Vaccines are available for the most common infectious diseases affecting older adults, such as influenza, pertussis, pneumococcal disease, herpes zoster, COVID and respiratory syncytial virus (RSV). In many countries, these vaccines are recommended systematically for older adults and any adults with comorbidities, who are also those most likely to suffer from cardiovascular disease. There is a large body of evidence attesting to the benefits of vaccination on cardio- and cerebrovascular health. The European Interdisciplinary Council for Aging (EICA) and the Italian Society for Cardiovascular Prevention (Società Italiana per la Prevenzione Cardiovascolare, SIPREC) convened a 2-day meeting in June 2024 to review the state of the evidence on the relationship between cardio- and cerebrovascular health and the most common infectious diseases, and the role of vaccines in preventing both infection and its adverse consequences in terms of cardiovascular and cerebrovascular outcomes. We present here the Executive Summary of the proceedings of this meeting.

Knowledge and attitudes of nurses towards telenursing in cardiac care in Al-Ahsa, Saudi Arabia: a cross-sectional study

Objectives

Telenursing in cardiac care leverages technology to support self-care and optimize outcomes for heart failure patients during and beyond the pandemic. This study aims to explore nurse's knowledge and attitudes towards telenursing in cardiac care, examine the correlation between knowledge and attitude, and associate knowledge levels with selected demographic variables.

Methods

A cross-sectional study was conducted, and 149 nurses from Prince Sultan Cardiac Care Center hospitals were randomly selected. The data were collected through a structured questionnaire, including socio-demographic characteristics, knowledge, and attitudes about telenursing.

Results

The mean age of the nurses was 36.17 ± 6.5 years. Most nurses (64.4%) held a bachelor's degree, with 71.8% working as staff nurses. Nearly half (47.6%) had 6-9 years of professional experience. Among them, 15.4% had good knowledge, 63.8% had average knowledge, and 20.8% had poor knowledge, with a total mean knowledge score of 14.92 ± 3.2. Overall, nurses had positive attitudes towards telenursing (p < 0.05). Knowledge scores were significantly associated with age, education, and professional experience (p < 0.05).

Conclusion

Strengthening nurse's understanding of telenursing is vital. Focused educational and training programs are imperative to enhance knowledge about telenursing in cardiac care and alleviate the healthcare system's economic burden.

Tannic Acid Modulates Voltage-gated K + Channels to Promote Neuritogenesis in Neuronal N2A Cells

ABSTRACT

In a previous report, we showed that voltage-gated K + (Kv) Kv1 and Kv2 channels are involved in cAMP-induced neuritogenesis of mouse neuronal N2A cells. In this report, we examined the effects of tannic acid (TA) on Kv channels and neuritogenesis in N2A cells. TA (15 μM) mildly enhanced Kv currents at -30 to -20 mV but strongly inhibited Kv currents at higher voltages, causing a preferential activation of currents at low voltages. When enhancement and suppression of Kv currents (at -20 and +70 mV, respectively) by different concentrations of TA were analyzed, TA at 4 μM produced strong enhancement at -20 mV with relatively mild suppression at + 70 mV. TA (4 μM) also promoted neuritogenesis; such promotion was suppressed by a Kv channel blocker tetraethylammonium ion, or a combination of hongotoxin-1 (blocker of Kv1.1), UK 78282 (blocker of Kv1.4) and guangxitoxin 1E (blocker of Kv2.1). Our results demonstrate, for the first time, TA at low concentrations could modulate Kv channels and thereby promote neuritogenesis.

Decoding TGR5: A comprehensive review of its impact on cerebral diseases

Currently, unraveling the enigmatic realm of drug targets for cerebral disorders poses a formidable challenge. Takeda G protein-coupled receptor 5 (TGR5), also known as G protein-coupled bile acid receptor 1, is a specific bile acid receptor. Widely distributed across various tissues, TGR5 orchestrates a myriad of biological functions encompassing inflammation, energy metabolism, fatty acid metabolism, immune responses, cellular proliferation, apoptosis, and beyond. Alongside its well-documented implications in liver diseases, obesity, type 2 diabetes, tumors, and cardiovascular diseases, a growing body of evidence accentuates the pivotal role of TGR5 in cerebral diseases. Thus, this comprehensive review aimed to scrutinize the current insights into the pathological mechanisms involving TGR5 in cerebral diseases, while contemplating its potential as a promising therapeutic target for cerebral diseases.

Impact of Estrogen on Purinergic Signaling in Microvascular Disease

Microvascular ischemia, especially in the heart and kidneys, is associated with inflammation and metabolic perturbation, resulting in cellular dysfunction and end-organ failure. Heightened production of adenosine from extracellular nucleotides released in response to inflammation results in protective effects, inclusive of adaptations to hypoxia, endothelial cell nitric oxide release with the regulation of vascular tone, and inhibition of platelet aggregation. Purinergic signaling is modulated by ectonucleoside triphosphate diphosphohydrolase-1 (NTPDase1)/CD39, which is the dominant factor dictating vascular metabolism of extracellular ATP to adenosine throughout the cardiovascular tissues. Excess levels of extracellular purine metabolites, however, have been associated with metabolic and cardiovascular diseases. Physiological estrogen signaling is anti-inflammatory with vascular protective effects, but pharmacological replacement use in transgender and postmenopausal individuals is associated with thrombosis and other side effects. Crucially, the loss of this important sex hormone following menopause or with gender reassignment is associated with worsened pro-inflammatory states linked to increased oxidative stress, myocardial fibrosis, and, ultimately, diastolic dysfunction, also known as Yentl syndrome. While there is a growing body of knowledge on distinctive purinergic or estrogen signaling and endothelial health, much less is known about the relationships between the two signaling pathways. Continued studies of the interactions between these pathways will allow further insight into future therapeutic targets to improve the cardiovascular health of aging women without imparting deleterious side effects.

Traditional Chinese medicine in lung cancer treatment

Lung cancer remains a major global health challenge and one of the leading causes of cancer-related deaths worldwide. Despite significant advancements in treatment, challenges such as drug resistance, side effects, metastasis and recurrence continue to impact patient outcomes and quality of life. In response, there is growing interest in complementary and integrative approaches to cancer care. Traditional Chinese medicine (TCM), with its long history, abundant clinical experience, holistic perspective and individualized approach, has garnered increasing attention for its role in lung cancer prevention and management. This review provides a comprehensive overview of the advances in TCM for lung cancer treatment, covering its theoretical foundation, treatment principles, clinical experiences and evidence supporting its efficacy. We also provide a systematic summary of the preclinical mechanisms, through which TCM impacts lung cancer, including the induction of cell death, reversal of drug resistance, inhibition of metastasis and modulation of immune responses. Additionally, future prospects for TCM in lung cancer treatment are discussed, offering insights into its expanded application and integration with modern medicine to address this challenging disease.

Molecular Mechanisms Underlying Heart Failure and Their Therapeutic Potential

Heart failure (HF) is a prominent fatal cardiovascular disorder afflicting 3.4% of the adult population despite the advancement of treatment options. Therefore, a better understanding of the pathogenesis of HF is essential for exploring novel therapeutic strategies. Hypertrophy and fibrosis are significant characteristics of pathological cardiac remodeling, contributing to HF. The mechanisms involved in the development of cardiac remodeling and consequent HF are multifactorial, and in this review, the key underlying mechanisms are discussed. These have been divided into the following categories thusly: (i) mitochondrial dysfunction, including defective dynamics, energy production, and oxidative stress; (ii) cardiac lipotoxicity; (iii) maladaptive endoplasmic reticulum (ER) stress; (iv) impaired autophagy; (v) cardiac inflammatory responses; (vi) programmed cell death, including apoptosis, pyroptosis, and ferroptosis; (vii) endothelial dysfunction; and (viii) defective cardiac contractility. Preclinical data suggest that there is merit in targeting the identified pathways; however, their clinical implications and outcomes regarding treating HF need further investigation in the future. Herein, we introduce the molecular mechanisms pivotal in the onset and progression of HF, as well as compounds targeting the related mechanisms and their therapeutic potential in preventing or rescuing HF. This, therefore, offers an avenue for the design and discovery of novel therapies for the treatment of HF.

Signaling pathways behind the biological effects of tanshinone IIA for the prevention of cancer and cardiovascular diseases

Tanshinone IIA (Tan IIA) is a well-known fat-soluble diterpenoid found in Salvia miltiorrhiza, recognized for its various biological effects. The molecular signaling pathways of Tan IIA have been investigated in different diseases, including the anti-inflammatory, hepatoprotective, renoprotective, neuroprotective effects, and fibrosis prevention. This article provides a brief overview of the signaling pathways related to anti-cancer and cardioprotective effects of Tan IIA. It shows that Tan IIAs anti-cancer ability has good expectation through multiplicity mechanisms affecting various aspects' tumor biology. The major pathways involved in its anti-cancer effects include inhibition of PI3/Akt, MAPK, and p53/p21 signaling which leads to enhancement of immune responses and increased radiation sensitivity. Some essential pathways responsible for cardioprotective effects induced by Tan IIA are PI3/AKT activation, MAPK, and SIRT1 promoting protection against ischemia/reperfusion injury in myocardial cells as well as inhibiting pathological remodeling processes. Finally, the article underscores the complex and specific signaling pathways influenced by Tan IIA. The PI3/Akt and MAPK pathways play critical roles in the anti-cancer and cardioprotective effects of Tan IIA. Particularly, Tan IIA suppresses the proliferation of malignancies in cancerous cells but stimulates protective mechanisms in normal cardiovascular cells. These findings highlight the importance of investigating molecular signaling pathways in evaluating the therapeutic potential of natural products. Studying about signaling pathways is vital in understanding the therapeutic aspects of Tan IIA and its derivatives as anti-cancer and cardio-protective agents. Further research is necessary to understand these complex mechanisms.

ATGL regulates renal fibrosis by reprogramming lipid metabolism during the transition from AKI to CKD

Acute kidney injury (AKI) can progress to chronic kidney disease (CKD) and subsequently to renal fibrosis. Poor repair of renal tubular epithelial cells (TECs) after injury is the main cause of renal fibrosis. Studies have shown that restoring damaged fatty acid β-oxidation (FAO) can reduce renal fibrosis. Adipose triglyceride lipase (ATGL) is a key enzyme that regulates lipid hydrolysis. This study, for the first time, demonstrated that ATGL was downregulated in the renal TEC in the AKI-CKD transition mouse model. Moreover, treatment with the ATGL inhibitor atglistatin exacerbated lipid accumulation and downregulated the FAO level and mitochondrial function, while it increased the level of oxidative stress injury and apoptosis, resulting in aggravated renal fibrosis. In contrast, ATGL overexpression suppressed lipid accumulation, improved the FAO level and mitochondrial function, and attenuated oxidative stress and apoptosis, thereby ameliorating fibrosis in vitro and in vivo. In summary, ATGL regulates renal fibrosis by reprogramming lipid metabolism in renal TECs. This study provided new avenues and targets for treating CKD.

Review on critical factor in monocyte adhesion: Nutrients

Endogenous and exogenous factors play a role in endothelial dysfunction. Inflammation, leukocyte adhesion-aggregation, abnormal vascular proliferation, atherosclerosis, and hypertension are among the endogenous factors. Another factor that affects endothelial dysfunction is exogenous factors such as drug treatments, smoking, alcohol, and nutrition. According various studies on nutrition and endothelial function, it is supported that fatty acids, proteins, and phenolic compounds modulate this function. In vitro studies show that nutrients change the adhesion of monocytes to the endothelium. The pathways that play a role in the adhesion process of monocytes are also affected by nutrients. Particularly among these pathways, mTORC1, S6 plaques, monocyte chemotaxis protein, monocyte integrins, monocyte cytokines are transferred to the lesional area selectin protein. In this article, the effects of various nutrients on monocyte adhesion are examined. It explains the changes and possible mechanisms of nutrients such as fatty acids, protein, phenolic compounds, and other dietary components on monocyte adhesion, and examines the relationship between nutrients and monocyte adhesion in our country and allows us to look at our profession from a different perspective. Although not all nutritional elements are included, it is thought that our profession will play a role in taking the first step towards cell studies.

Remote monitoring and heart failure

Heart failure (HF) represents one of the leading causes of morbidity and mortality worldwide. In recent years, remote monitoring (RM) and telemedicine have emerged as a promising strategy to improve the management of patients with HF, reducing hospitalizations and enhancing the quality of life. Through the integration of technologies such as implantable sensors, home monitoring devices, and mobile applications, it is possible to detect clinical changes early, enabling timely interventions. This article provides an overview of available technologies for RM in HF, analyses the clinical benefits observed in various studies, and addresses the remaining challenges, such as the need for standardization, long-term sustainability, and widespread adoption. Remote monitoring offers significant potential to improve clinical outcomes but requires further research and development to optimize its use in clinical practice.

Advancements in Managing Choledocholithiasis and Acute Cholangitis in the Elderly: A Comprehensive Review

The increasing elderly population has led to a rising prevalence of choledocholithiasis and acute cholangitis, presenting unique diagnostic and therapeutic challenges owing to age-related physiological changes and multiple comorbidities. This comprehensive review synthesizes current evidence and recent advances in managing these conditions in elderly patients, with a particular focus on diagnostic innovations, therapeutic strategies, and perioperative optimization. Recent advances in diagnostic modalities, including enhanced imaging techniques and AI-assisted systems, have improved early detection accuracy, whereas minimally invasive interventions, particularly endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), have demonstrated superior outcomes when combined with comprehensive perioperative care. The implementation of multidisciplinary approaches and personalized treatment strategies has significantly improved patient outcomes, with evidence supporting the critical role of early antibiotic intervention, careful surgical selection, and enhanced recovery protocols in reducing morbidity and mortality. The optimal management of elderly patients with choledocholithiasis and acute cholangitis requires a systematic, individualized approach incorporating advanced diagnostic techniques, minimally invasive interventions, and comprehensive perioperative care, while future research should focus on developing age-specific treatment algorithms and validating novel therapeutic approaches.

Risk Factors of Idiopathic Congenital Clubfoot in the South of Vietnam: A Hospital-Based Study

PURPOSE

To date, there are no comprehensive epidemiological studies exploring congenital clubfoot (CCF) within the Vietnamese population. This study aimed to identify potential risk factors associated with idiopathic CCF in infants and their mothers in southern Vietnam.

METHODS

A case-control study was conducted to compare the environmental and socio-demographic characteristics of mothers and infants between two groups: infants diagnosed with idiopathic CCF (cases) and those without any congenital deformity (controls). The study included 233 cases and 232 controls. All infants were born in 2002, and their mothers resided in the southern and highland provinces of Vietnam. Associations between maternal and infant characteristics and the occurrence of CCF were assessed using odds ratios and Fisher's exact test.

RESULTS

The prevalence of clubfoot was significantly higher in male infants compared to females (OR = 1.75; 95% CI: 1.17-2.61). The breech presentation was strongly associated with an increased risk of clubfoot (p = 0.001). Mothers living in the western, eastern, and highland regions of Vietnam had significantly higher odds of having infants with clubfoot compared to those residing in Ho Chi Minh City, with odds ratios of 2.22 (95% CI: 1.39-3.55), 1.97 (95% CI: 1.21-3.23), and 3.86 (95% CI: 1.74-7.79), respectively.

CONCLUSIONS

This study identified significant associations between CCF and infant sex, breech presentation, and maternal geographical location. Further, population-based studies are needed to explore these risk factors on a broader scale.

Promotion of nitric oxide production: mechanisms, strategies, and possibilities

The discovery of nitric oxide (NO) and the role of endothelial cells (ECs) in its production has revolutionized medicine. NO can be produced by isoforms of NO synthases (NOS), including the neuronal (nNOS), inducible (iNOS), and endothelial isoforms (eNOS), and via the non-classical nitrate-nitrite-NO pathway. In particular, endothelium-derived NO, produced by eNOS, is essential for cardiovascular health. Endothelium-derived NO activates soluble guanylate cyclase (sGC) in vascular smooth muscle cells (VSMCs), elevating cyclic GMP (cGMP), causing vasodilation. Over the past four decades, the importance of this pathway in cardiovascular health has fueled the search for strategies to enhance NO bioavailability and/or preserve the outcomes of NO's actions. Currently approved approaches operate in three directions: 1) providing exogenous NO, 2) promoting sGC activity, and 3) preventing degradation of cGMP by inhibiting phosphodiesterase 5 activity. Despite clear benefits, these approaches face challenges such as the development of nitrate tolerance and endothelial dysfunction. This highlights the need for sustainable options that promote endogenous NO production. This review will focus on strategies to promote endogenous NO production. A detailed review of the mechanisms regulating eNOS activity will be first provided, followed by a review of strategies to promote endogenous NO production based on the levels of available preclinical and clinical evidence, and perspectives on future possibilities.

Signalling pathways involved in urotensin II induced ventricular myocyte hypertrophy

Sustained pathologic myocardial hypertrophy can result in heart failure(HF); a significant health issue affecting a large section of the population worldwide. In HF there is a marked elevation in circulating levels of the peptide urotensin II(UII) but it is unclear whether this is a result of hypertrophy or whether the high levels contribute to the development of hypertrophy. The aim of this study is to investigate a role of UII and its receptor UT in the development of cardiac hypertrophy and the signalling molecules involved. Ventricular myocytes isolated from adult rat hearts were treated with 200nM UII for 48hours and hypertrophy was quantified from measurements of length/width (L/W) ratio. UII resulted in a change in L/W ratio from 4.53±0.10 to 3.99±0.06; (p<0.0001) after 48hours. The response is reversed by the UT-antagonist SB657510 (1μM). UT receptor activation by UII resulted in the activation of ERK1/2, p38 and CaMKII signalling pathways measured by Western blotting; these are involved in the induction of hypertrophy. JNK was not involved. Moreover, ERK1/2, P38 and CaMKII inhibitors completely blocked UII-induced hypertrophy. Sarcoplasmic reticulum (SR) Ca2+-leak was investigated in isolated myocytes. There was no significant increase in SR Ca2+-leak. Our results suggest that activation of MAPK and CaMKII signalling pathways are involved in the hypertrophic response to UII. Collectively our data suggest that increased circulating UII may contribute to the development of left ventricular hypertrophy and pharmacological inhibition of the UII/UT receptor system may prove beneficial in reducing adverse remodeling and alleviating contractile dysfunction in heart disease.

Molecular signaling pathways in doxorubicin-induced nephrotoxicity and potential therapeutic agents

Doxorubicin (DOX), an anthracycline chemotherapeutic agent, is extensively utilized in the clinical management of both solid and hematological malignancies. Nevertheless, the clinical application of this treatment is significantly limited by adverse reactions and toxicity that may arise during or after administration. Its cytotoxic effects are multifaceted, with cardiotoxicity being the most prevalent side effect. Furthermore, it has the potential to adversely affect other organs, including the brain, kidneys, liver, and so on. Notably, it has been reported that DOX may cause renal failure in patients and there is currently no effective treatment for DOX-induced kidney damage, which has raised a high concern about DOX-induced nephrotoxicity (DIN). Although the precise molecular mechanisms underlying DIN remain incompletely elucidated, prior research has indicated that reactive oxygen species (ROS) are pivotal in this process, triggering a cascade of detrimental pathways including apoptosis, inflammation, dysregulated autophagic flux, and fibrosis. In light of these mechanisms, decades of research have uncovered several DIN-associated signaling pathways and found multiple potential therapeutic agents targeting them. Thus, this review intends to delineate the DIN associated signaling pathways, including AMPK, JAKs/STATs, TRPC6/RhoA/ROCK1, YAP/TEAD, SIRTs, Wnt/β-catenin, TGF-β/Smad, MAPK, Nrf2/ARE, NF-κB, and PI3K/AKT, and to summarize their potential regulatory agents, which provide a reference for the development of novel medicines against DIN.

Pharmacology of Non-Psychoactive Phytocannabinoids and Their Potential for Treatment of Cardiometabolic Disease

The use of Cannabis sativa by humans dates back to the third millennium BC, and it has been utilized in many forms for multiple purposes, including production of fibre and rope, as food and medicine, and (perhaps most notably) for its psychoactive properties for recreational use. The discovery of Δ9-tetrahydrocannabinol (Δ9-THC) as the main psychoactive phytocannabinoid contained in cannabis by Gaoni and Mechoulam in 1964 (J Am Chem Soc 86, 1646-1647), was the first major step in cannabis research; since then the identification of the chemicals (phytocannabinoids) present in cannabis, the classification of the pharmacological targets of these compounds and the discovery that the body has its own endocannabinoid system (ECS) have highlighted the potential value of cannabis-derived compounds in the treatment of many diseases, such as neurological disorders and cancers. Although the use of Δ9-THC as a therapeutic agent is constrained by its psychoactive properties, there is growing evidence that non-psychoactive phytocannabinoids, derived from both Cannabis sativa and other plant species, as well as non-cannabinoid compounds found in Cannabis sativa, have real potential as therapeutics. This chapter will focus on the possibilities for using these compounds in the prevention and treatment of cardiovascular disease and related metabolic disturbances.

Recent advancements in drug delivery system of flavonoids with a special emphasis on the flavanone naringenin: exploring their application in wound healing and associated processes

Numerous flavonoids have been identified in citrus fruits which show potential to cure several complex diseases. These natural polyphenolic bioactive compounds are the secondary metabolites of various plants, among which naringenin has been explored in several pre-clinical research for its beneficial role in promoting health by modulating various biochemical processes. Its antioxidant, anti-inflammatory, and anti-microbial effects have been projected toward healing of wounds. Further, its application has also been shown to regrow vascular networks, which are known to facilitate the healing of chronic wounds. Thus, the potential of naringenin to modulate various molecular pathways aids in the healing process of wounds. Considering the recent literature, an update has been attempted to present the correlation between the healing mechanisms of wounds by the application of naringenin. Furthermore, the application of naringenin is challenging because of its properties of poor solubility and limited permeability, which can be overcome by the nanotechnology platform. Thus, several nanocarriers that have been employed for the improvement of naringenin delivery are highlighted. Thereby, it can be concluded that a suitable nanocarrier of naringenin could be an effective tool in treating wounds to improve the quality of life of such patients.

Effect of 17β-Estradiol on Endothelial Cell Expression of Inflammation- Related MicroRNA

BACKGROUND

Estrogen plays a protective role in vascular health due, in part, to its regulation of endothelial inflammation. However, the mechanism(s) by which estrogen negatively regulates inflammatory signaling pathways is not completely understood. MicroRNAs (miRNAs) are recognized as sensitive and selective regulators of cardiovascular function, inflammation, and disease, yet the effects of 17β-estradiol on the endothelial miRNA profile are largely unknown.

OBJECTIVE

The aim of this study was to determine the effect of 17β-estradiol on the expression of inflammation-associated miRNAs in endothelial cells in vitro.

METHODS

Human Umbilical Vein Endothelial cells (HUVECs) were treated with media in the absence (control) and presence of 17β-estradiol (100 nM) for 24 hr. Thereafter, endothelial cell release of cytokines (IL-6 and IL-8), the intracellular expression of the central protein inflammatory mediator NF-κB, and the levels of inflammatory-associated miRNAs: miR-126, miR-146a, miR-181b, miR-204, and miR-Let-7a, were determined.

RESULTS

17β-estradiol-treated cells released significantly lower levels of IL-6 (47.6±1.5 pg/mL vs. 59.3±4.9 pg/mL) and IL-8 (36.3±2.3 pg/mL vs. 44.0±2.0 pg/mL). Cellular expression of total NF-κB (26.0±2.8 AU vs. 21.2±3.1 AU) was not different between groups; however, activated NF-κB (Ser536) (12.9±1.7 AU vs. 20.2±2.2 AU) was markedly reduced in 17β-estradiol-treated cells as compared to untreated cells. Furthermore, cellular expressions of miR-126 (1.8±0.3 fold), miR-146a (1.7±0.3 fold), miR-181b (2.1±0.4 fold), miR-204 (1.9±0.4 fold), and miR-Let-7a (1.8±0.3 fold) were markedly increased in response to 17β-estradiol treatment.

CONCLUSION

These data suggest that the anti-inflammatory effect of 17β-estradiol in endothelial cells may be mediated by miRNAs.

The effects of the urotensin-II receptor antagonist palosuran treatment on the corpora cavernosa of streptozotocin-induced diabetic rats

Objective

This study aimed to investigate the effects of treatment with palosuran, a urotensin receptor blocker, on molecular changes in the corpora cavernosa (CC) in diabetic rats.

Methods

Streptozotocin-induced diabetic rats were treated with palosuran 300 mg/kg per day for 6 weeks. Contraction of CC induced by potassium chloride, phenylephrine, and NG-nitro-L-arginine methyl ester and relaxation of CC induced by electrical field stimulation (EFS) and sodium nitroprusside (SNP) (endothelium-dependent and endothelium-independent stimuli, respectively), and Y-27632 (Rho-kinase inhibitor) were examined in organ baths. Direct contraction or relaxation induced by palosuran and urotensin-II (U-II) were also evaluated. The expression levels of nitric oxide synthetases (NOSs), RhoA, oxidative stress regulators, and U-II were analyzed by Western blotting or immunohistochemistry.

Results

Induction of diabetes in rats resulted in the decreased relaxant response to SNP, decreased pD2 value of SNP, attenuated relaxant response to Y-27632 as well as the decreased RhoA expression in CC. Palosuran treatment of diabetic rats reversed all of these parameters; however, it further impaired the already weakened relaxation of diabetic CC in response to EFS. Although induction of diabetes did not change U-II expression in CC significantly, palosuran treatment reduced U-II expression in diabetic CC. The expression level of nNOS was lowered in diabetic CC; however, palosuran treatment did not change the decreased the neuronal NOS expression. In vitro exposure of diabetic CC strips to palosuran produced a direct relaxant response.

Conclusion

Palosuran treatment did not affect the expression of NOSs or reduce nitrergic conduction induced by EFS stimulation in diabetic CC. However, while directly triggering a relaxant response, it did not induce a prominent contraction either by decreasing U-II expression, or increasing the sensitivity of CC to nitric oxide which suggested that palosuran has the potential to support erectile function. Further and comprehensive studies are required to clarify this issue.

Non-Drug and Non-Invasive Therapeutic Options in Alzheimer's Disease

Despite the massive efforts of modern medicine to stop the evolution of Alzheimer's disease (AD), it affects an increasing number of people, changing individual lives and imposing itself as a burden on families and the health systems. Considering that the vast majority of conventional drug therapies did not lead to the expected results, this review will discuss the newly developing therapies as an alternative in the effort to stop or slow AD. Focused Ultrasound (FUS) and its derived Transcranial Pulse Stimulation (TPS) are non-invasive therapeutic approaches. Singly or as an applied technique to change the permeability of the blood-brain-barrier (BBB), FUS and TPS have demonstrated the benefits of use in treating AD in animal and human studies. Adipose-derived stem Cells (ADSCs), gene therapy, and many other alternative methods (diet, sleep pattern, physical exercise, nanoparticle delivery) are also new potential treatments since multimodal approaches represent the modern trend in this disorder research therapies.

Reactive oxygen species in hypertension

Hypertension is a leading risk factor for stroke, heart disease and chronic kidney disease. Multiple interacting factors and organ systems increase blood pressure and cause target-organ damage. Among the many molecular elements involved in the development of hypertension are reactive oxygen species (ROS), which influence cellular processes in systems that contribute to blood pressure elevation (such as the cardiovascular, renal, immune and central nervous systems, or the renin-angiotensin-aldosterone system). Dysregulated ROS production (oxidative stress) is a hallmark of hypertension in humans and experimental models. Of the many ROS-generating enzymes, NADPH oxidases are the most important in the development of hypertension. At the cellular level, ROS influence signalling pathways that define cell fate and function. Oxidative stress promotes aberrant redox signalling and cell injury, causing endothelial dysfunction, vascular damage, cardiovascular remodelling, inflammation and renal injury, which are all important in both the causes and consequences of hypertension. ROS scavengers reduce blood pressure in almost all experimental models of hypertension; however, clinical trials of antioxidants have yielded mixed results. In this Review, we highlight the latest advances in the understanding of the role and the clinical implications of ROS in hypertension. We focus on cellular sources of ROS, molecular mechanisms of oxidative stress and alterations in redox signalling in organ systems, and their contributions to hypertension.

Uric Acid and Atherosclerosis in Patients with Chronic Kidney Disease: Recent Progress, Mechanisms, and Prospect

Background

Chronic kidney disease (CKD) is a prevalent global health concern, significantly linked to increased cardiovascular morbidity and mortality. Among various risk factors, uric acid (UA) has emerged as a potentially modifiable contributor to cardiovascular complications in CKD patients.

Summary

Elevated serum uric acid levels frequently occur in individuals with CKD and are associated with the development of atherosclerosis (AS). Uric acid has been demonstrated to exacerbate inflammatory processes, promote oxidative stress, and cause endothelial dysfunction, which are critical factors that drive the formation of atherosclerotic plaques. Furthermore, high uric acid levels can worsen renal function, establishing a detrimental cycle that amplifies cardiovascular risk.

Key Messages

This review investigates the complex interconnection between UA and AS in patients with CKD, highlighting the underlying mechanisms and therapeutic considerations. A more profound comprehension of this relationship is essential for enhancing cardiovascular health and outcomes in this vulnerable population.

Isoorientin: Unveiling the hidden flavonoid's promise in combating cancer development and progression - A comprehensive review

Cancer remains one of the leading causes of mortality worldwide, characterized by uncontrolled cell growth and the ability of tumors to invade surrounding tissues and spread to distant organs. Despite significant advancements in early detection, diagnosis, and treatment, many cancers still present substantial challenges due to their heterogeneity, resistance to conventional therapies, and severe side effects of existing treatments. Consequently, there is an ongoing need for novel therapeutic agents to selectively target cancer cells, enhance the efficacy of current treatments, and minimize adverse effects. Isoorientin (ISO) is a naturally occurring flavonoid known for its anticancer properties. ISO has demonstrated the ability to influence several critical processes in cancer progression, such as cell proliferation, apoptosis, and metastasis. Due to the absence of clinical trials, we included only in vitro studies, reviewing 13 investigations. These studies covered diverse cancer types, including lung, brain, oral, liver, pancreatic, and gastric cancers, and assessed various outcomes related to cell viability, apoptosis, migration, and molecular pathway modulation. By synthesizing data from these investigations, our review seeks to provide a thorough understanding of ISO's anticancer effects, its mechanisms of action, and its potential as a therapeutic agent.

Modeling the contribution of cardiac fibroblasts in dilated cardiomyopathy using induced pluripotent stem cells

Fibrosis is implicated in nearly all forms of cardiomyopathy and significantly influences disease severity and outcomes. The primary cell responsible for fibrosis is the cardiac fibroblast, which remains understudied relative to cardiomyocytes in the context of cardiomyopathy. The development of induced pluripotent stem cell-derived cardiac fibroblasts (iPSC-CFs) allows for the modeling of patient-specific disease characteristics and provides a scalable source of fibroblasts. iPSC-CFs are invaluable for understanding molecular pathways that affect disease progression and outcomes. This review explores various aspects of cardiomyopathy, with a focus on dilated cardiomyopathy, that can be modeled using iPSC-CFs and their application in drug discovery, given the current lack of approved therapies for cardiac fibrosis. We examine how iPSC-CFs can be utilized to study heart development, fibroblast heterogeneity, and activation, with the ultimate goal of developing better therapies for patients with cardiomyopathies. SIGNIFICANCE STATEMENT: We explore how induced pluripotent stem cell-derived cardiac fibroblasts (iPSC-CFs) are used to study the fibrotic component of dilated cardiomyopathy. Most research has focused on cardiomyocytes, but iPSC-CFs serve as a valuable tool to elucidate molecular pathways leading to fibrosis and paracrine interactions with cardiomyocytes. Gaining insights into these events could aid in the development of new therapies and enable the use of patient-derived iPSC-CFs for precision medicine, ultimately improving patient outcomes.