Engineered bacteria as an orally administered anti-viral treatment and immunization system

The emergence of new viral pathogens necessitates innovative antiviral therapies and vaccines. Traditional approaches, such as monoclonal antibodies and vaccines, are often hindered by resistance, limited effectiveness, and high costs. Here, we develop an engineered probiotic-based antiviral platform using Escherichia coli Nissle 1917 (EcN), capable of providing both mucosal and systemic immunity via oral administration. EcN was engineered to display anti-spike nanobodies or express the Spike-Receptor Binding Domain on its surface. Our findings reveal that EcN with nanobodies effectively inhibits the interaction between spike protein-expressing pseudoviruses and the ACE2 receptor. Furthermore, we observed the translocation of nanobodies to distant organs, facilitated by outer membrane vesicles (OMVs). The oral administration of EcN expressing spike proteins induced a robust immune response characterized by the production of both IgG and IgA, antibodies that blocked the pseudovirus-ACE2 interaction. While SARS-CoV-2 served as a model, this versatile probiotic platform holds potential for developing customizable biotherapeutics against a wide range of emerging pathogens such as influenza virus or respiratory syncytial virus (RSV) by engineering EcN to express viral surface protein or neutralizing nanobodies demonstrating its versatility as a next-generation mucosal vaccine strategy.

Impact of FcRn antagonism on vaccine-induced protective immune responses against viral challenge in COVID-19 and influenza mouse vaccination models

Antagonism of the neonatal Fc receptor through an engineered antibody Fc fragment, such as efgartigimod, results in a decrease in immunoglobulin G levels. This approach is being evaluated as a therapeutic strategy for the treatment of IgG-mediated autoimmune diseases. Our goal was to evaluate the impact of mFc-ABDEG, a mouse-adapted antibody Fc fragment with a mode of action highly similar to efgartigimod, on vaccine-induced protective immune responses against viral infections. Therefore, mouse vaccination models for COVID-19 and influenza were employed, utilizing an mRNA COVID-19 vaccine (COMIRNATY) and an adjuvanted, inactivated quadrivalent influenza vaccine (Seqirus+AddaVax), respectively. In both models, vaccination induced robust humoral responses. As expected, animals treated with mFc-ABDEG had lower levels of virus-specific IgG, while virus-specific IgM responses remained unaffected. The COVID-19 vaccine induced a strong Th1-type T cell response irrespective of mFc-ABDEG treatment. Influenza vaccination resulted in a poor T cell induction, regardless of mFc-ABDEG treatment, due to the Th2-biased response that inactivated influenza vaccines typically induce. Importantly, mFc-ABDEG treatment had no effect on protective immunity against live viral challenges in both models. Vaccinated animals treated with mFc-ABDEG were equally protected as the non-treated vaccinated controls. These non-clinical data demonstrate that FcRn antagonism with mFc-ABDEG did not affect the generation of vaccine-induced protective humoral and cellular responses, or protection against viral challenges. These data substantiate the clinical observations that, although IgG titers were reduced, FcRn antagonism with efgartigimod did not impair the ability to generate new specific IgG responses, regardless of the timing of vaccination.

Artificial intelligence revolution in drug discovery: A paradigm shift in pharmaceutical innovation

Integrating artificial intelligence (AI) into drug discovery has revolutionized pharmaceutical innovation, addressing the challenges of traditional methods that are costly, time-consuming, and suffer from high failure rates. By utilizing machine learning (ML), deep learning (DL), and natural language processing (NLP), AI enhances various stages of drug development, including target identification, lead optimization, de novo drug design, and drug repurposing. AI tools, such as AlphaFold for protein structure prediction and AtomNet for structure-based drug design, have significantly accelerated the discovery process, improved efficiency and reduced costs. Success stories like Insilico Medicine's AI-designed molecule for idiopathic pulmonary fibrosis and BenevolentAI's identification of baricitinib for COVID-19 highlight AI's transformative potential. Additionally, AI enables the exploration of vast chemical spaces, optimization of clinical trials, and the identification of novel therapeutic targets, paving the way for precision medicine. However, challenges such as limited data accessibility, integration of diverse datasets, interpretability of AI models, and ethical concerns remain critical hurdles. Overcoming these limitations through enhanced algorithms, standardized databases, and interdisciplinary collaboration is essential. Overall, AI continues to reshape drug discovery, reducing timelines, increasing success rates, and driving the development of innovative and accessible therapies for unmet medical needs.

RNA production of IgG receptors is present in podocytes and varies depending on glycemia - preliminary results on Fc gamma receptor presence in kidney cells

Diabetes results from high blood glucose level and is one of the four main noncommunicable diseases. It is also a major cause of kidney failure. An inflammation of renal tissue during diabetic kidney disease (DKD) is aimed to resolve the ongoing homeostatic imbalance, however it leads to renal tissue injury. Because, the kidney glomerulus, where the blood filtration occurs, is an immunologically privileged place with very few leukocytes within, it was suspected that cells within the glomerulus possess immunological features and may initiate or increase the inflammation of renal tissue. One of the cell types in glomerulus, podocytes, are not only crucial for plasma filtration, but also can phagocytose and were described as professional antigen presenting cells. Due to an increased level of IgG-based immune complexes generated in the blood of diabetic patients and deposited in their kidneys, it was also proposed, that podocytes may express receptors for Fc fragment of IgG (FcγRs), which initiate phagocytosis. Many analyses point to that, but it has never been tested before. Thus, in the current study, we have analyzed mRNA expression levels of FcγR-coding genes in human podocytes, compared it to their expression levels in other non-immune epithelial cells (ovarian cells) and to leukocytes, as well as compared FcγR-coding genes' expression levels in podocytes cultured in a medium with standard versus high glucose concentration. The detection of FcγR expression in podocytes could help to understand the pathomechanism of renal tissue inflammation during DKD and subsequently help to prevent or minimize it.

Circadian clock regulation of myofibroblast fate

Fibrosis-related disorders represent an increasing medical and economic burden on a worldwide scale, accounting for one-third of all disease-related deaths with limited therapeutic options. As central mediators in fibrosis development, myofibroblasts have been gaining increasing attention in the last 20 years as potential targets for fibrosis attenuation and reversal. While various aspects of myofibroblast physiology have been proposed as treatment targets, many of these approaches have shown limited long-term efficacy so far. However, ongoing research is uncovering new potential strategies for targeting myofibroblast activity, offering hope for more effective treatments in the future. The circadian molecular clock is a feature of almost every cell in the human body that dictates the rhythmic nature of various aspects of human physiology and behavior in response to changes in the surrounding environment. The dysregulation of these rhythms with aging is considered to be one of the underlying reasons behind the development of multiple aging-related chronic disorders, with fibrotic tissue scarring being a common pathological complication among the majority of them. Myofibroblast dysregulation due to skewed circadian clockwork might significantly contribute to fibrotic scar persistence. In the current review, we highlight the role of the circadian clock in the context of myofibroblast activation and deactivation and examine its dysregulation as a driver of fibrogenesis.

Targeting endothelial cells: A novel strategy for pulmonary fibrosis treatment

Endothelial cells (ECs) are a monolayer of flat cells lining the inner surfaces of blood and lymphatic vessels. They play a key role in many physiological and pathological processes. Specifically, they maintain vascular permeability and structural stability and participate in immune responses, inflammation, coagulation, and other vital functions. ECs play a decisive role in various age-related diseases; however, their involvement in pulmonary fibrosis (PF) remains poorly understood. PF refers to a group of chronic interstitial lung diseases characterised by progressive scarring of the pulmonary parenchyma, primarily caused by aberrant tissue repair mechanisms. These changes lead to irreversible loss of lung function. Although the exact pathophysiological mechanism underlying PF has not yet been elucidated, recent studies have indicated that ECs may play a pivotal role in PF. This review outlines the involvement of pulmonary vascular ECs in PF, focusing on the regulation of vascular remodelling and endothelial barrier integrity and on the maintenance of angiogenesis through EC-specific markers, such as vascular endothelial growth factor. This review also explores processes such as endothelial-to-mesenchymal transition, immune cell interactions, anti-EC antibody reactions, metabolic dysregulation, and cellular senescence. By elucidating recent advancements in understanding the role of ECs in PF and examining drugs targeting ECs for the treatment of PF, this study provides novel insights into the pathological mechanisms of PF and the development of endothelium-based therapeutic agents.

Vitamin D: recent advances, associated factors, and its role in combating non-communicable diseases

The field of nutrigenomics has produced numerous studies indicating the impact of vitamin D on various disease conditions. Trace elements of this vitamin in the body play a significant role in the regulation of body metabolism. This immunomodulatory vitamin plays a role in management of both communicable (viz. respiratory illness like COVID-19 and Respiratory tract infections) and non-communicable diseases e.g., cancer, osteomalacia, diabetes, and cardiovascular diseases. Deficient levels, i.e., vitamin D deficiency in body can lead to the onset of chronic non-communicable illnesses. Vitamin D plays a direct and sometimes indirect role in the progression (when deficient) and prevention (when sufficient) of non-communicable diseases. This essential nutrient may be obtained through dietary intake or supplements. However, the absorption of it relies on various factors, including the presence of complementary nutrients, chemical forms, and external stimuli such as UV-B and a healthy gastrointestinal tract. This review discusses vitamin D absorption and its role in non-communicable diseases with updates on methods for evaluating and fortifying this vitamin in varied diets. We also briefly highlight recommended dietary allowances by age group, absorption difficulties, and its significance in non-communicable disorders.

Thioredoxin-interacting protein is associated with obesity-induced insulin resistance in PCOS patients: a large-scale case-control study

PURPOSE

Polycystic ovary syndrome (PCOS) is a common endocrine disorder often associated with obesity and insulin resistance (IR), though the role of thioredoxin-interacting protein (TXNIP) in obesity-induced IR in PCOS remains unclear. This study explores the relationship between TXNIP levels and obesity-associated IR in women with PCOS.

METHODS

A case-control study was conducted from January 2019 to December 2020, including 161 women with PCOS and 107 healthy controls. PCOS patients were categorized into insulin-resistant (IR) and non-IR subgroups, further divided by BMI into obese, overweight, and normal weight groups. The metabolic parameters such as cholesterol, triglycerides, fasting blood glucose, homocysteine, and serum TXNIP levels were measured. Logistic regression assessed the relationship between TXNIP expression and metabolic dysfunction.

RESULTS

TXNIP levels were significantly higher in the PCOS group compared to controls (67% increase), with a further 56% increase in the IR subgroup. The TXNIP levels were elevated in the obese group compared to overweight and normal weight groups (P < 0.05). TXNIP expression was negatively correlated with obesity (R = - 0.116, P = 0.007) and HDL cholesterol (R = - 0.196, P = 0.001), but positively associated with triglycerides (R = 0.181, P = 0.003) and homocysteine (R = 0.130, P = 0.034). After adjusting for confounders, TXNIP remained significantly associated with IR (P < 0.05). TXNIP demonstrated excellent diagnostic performance in distinguishing IR from non-IR PCOS patients, with an AUC of 0.89 (95% CI 0.84-0.94; P < 0.001).

CONCLUSIONS

TXNIP is significantly correlated with IR in women with PCOS, highlighting its potential as a biomarker for metabolic abnormalities. Further research is needed to fully understand its role in obesity-induced IR in PCOS.

Regulators and Conductors of Immunity: Natural Immune System in Health and Autoimmunity

Natural autoantibodies (nAAbs) recognize self-antigens and are an important component of the immune system, having evolved from invertebrates to vertebrates, and are viewed as stable byproducts of immune function and essential players in health and disease. Initially characterized by their conserved nature and multi-reactivity, primarily as IgM isotypes, nAAbs are now recognized for their adaptability in response to infections and vaccinations, bridging innate and adaptive immunity. The nAAbs and the cellular elements, such as γδ T, iNKT, and MAIT cells, of the natural immune system perform a primary defense network with moderate antigen-specificity. This comprehensive literature review was conducted to analyze the role of natural autoantibodies (nAAbs) in health and disease. The review focused on research published over the past 40 years, emphasizing studies related to infectious diseases, vaccinations, and autoimmune disorders. Recent studies suggest that nAAbs engage in complex interactions in autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and type 1 diabetes. Their roles in immunological processes, such as maternal tolerance during pregnancy, further underscore their complexity. Emerging evidence indicates that nAAbs and the cellular elements of the natural immune system may contribute to both disease pathogenesis and protective mechanisms, highlighting their dual nature. Continued research on nAAbs is vital for improving our understanding of immune responses and developing therapeutic strategies for autoimmune disorders and infectious diseases.

Social media in myositis care - an exploratory mixed-methods study among myositis patients (SociMyo)

Myositis is a rare autoimmune disease primarily affecting muscles, with potential involvement of the skin, heart, and lungs. Patients often experience delays in diagnosis, lack of adequate information, and limited support for disease management. Social media has emerged as a valuable tool to address these gaps by facilitating information exchange, peer support, and community building. However, its role in myositis care is not yet well understood. This study aims to explore how myositis patients use social media, focusing on shared content, perceived benefits and challenges, and the overall impact on disease management and emotional well-being. A mixed-methods approach was applied, including semi-structured interviews with 11 patients and a netnographic analysis of social media group dedicated to myositis care. Data were analyzed using Kuckartz's structured qualitative content analysis, with coding performed inductively, to identify key themes. Four key themes emerged: (I) Social media as a global platform for sharing experiential knowledge, particularly on symptom management, medication side effects, and coping strategies. (II) Peer support fostering a sense of belonging, emotional exchange, and mutual encouragement through structured discussions and community-driven moderation. (III) Perceived benefits, such as real-time access to patient-driven insights, shared decision-making support, and enhanced communication with healthcare providers. (IV) Perceived drawbacks, including misinformation, privacy concerns, and the absence of professional medical input. Participants emphasized the need for expert involvement to improve content reliability, while also valuing the autonomy and emotional support within these communities. Social media platforms, particularly closed groups, provide a complementary avenue to traditional care by offering support and knowledge exchange. To maximize their potential, privacy concerns and the integration of professional guidance must be addressed.

Treatment guidelines for idiopathic inflammatory myopathies in adults: a comparative review

Myositis, or idiopathic inflammatory myopathy, encompasses a group of autoimmune diseases with broad-spectrum clinical presentations, with a common presentation of muscle weakness and inflammation. The management of myositis presents significant challenges due to the rarity and variability of the disease and lack of large-scale, randomized controlled trials. Due to limited evidence available from smaller studies as well as variation in treatment practices across geographical regions and disease subtypes, available published treatment recommendations vary significantly. There is a need, therefore, to develop multidisciplinary consensus-driven guidelines that appropriately reflect the diverse and complex nature of the disease. This comparative review presents an in-depth analysis of existing myositis treatment guidelines from diverse organizations, highlighting similarities and key differences in diagnoses, treatment and management recommendations. We propose that there is a need for developing globally unified, consensus-driven standardized set of guidelines for effective myositis management.

The immune system in Hashimoto's thyroiditis: Updating the current state of knowledge on potential therapies and animal model construction

Hashimoto's thyroiditis (HT) is one of the most prevalent endocrine disorders worldwide, and it can occur in people of all ages, including children. HT has a multifactorial pathogenesis and develops after a combination of gene regulation, environmental modifiers, and infection triggers. Various coamplifying feedback chronic inflammatory systems are involved in immune mechanisms, including oxidative stress, lymphocyte infiltration, and thyroid cell death. Furthermore, there is no effective treatment for HT at their roots. Thus, this review systematically summarizes and updates the existing etiology and pathogenesis, potential malignant transformation, emerging therapeutic drugs and animal model construction, making it more convenient for researchers to obtain effective information about HT and better explore potential strategies for short-term treatment of the disease.

AI-driven approaches in therapeutic interventions: Transforming RNA-seq analysis into biomarker discovery and drug development

Pharmacotranscriptomics integrates transcriptomics and pharmacology to discover potential therapeutic targets for effective treatment. This review focuses on significant advancements in combining artificial intelligence (AI) with transcriptomic research, enabling the conversion of vast data sets into valuable knowledge for therapeutics. We provide detailed insights into implementing machine learning (ML) techniques for analyzing intricate transcriptomic data, facilitating a comprehensive understanding of disease mechanisms and the identification of key signature genes for biomarker and drug development. We further highlight the potential of ML to streamline the drug discovery process by revealing disease mechanisms and suggesting therapeutic interventions. This review presents a framework of AI models and their applications within pharmacotranscriptomics analysis. We also discuss the challenges and limitations needed to optimize AI models for enhanced therapeutic outcomes.

Cardiovascular impact of emerging and Re-emerging Viruses: Pathophysiological mechanisms, diagnosis, and management with a pediatric focus

Emerging and re-emerging viruses are currently known as a major public health issue. These viruses can cause various human complications such as cardiovascular diseases (CVDs), both in adults and pediatric populations. Although various CVDs have been previously reported for emerging and re-emerging viruses, the mechanisms underlying these complications remain relatively unknown. Children and infants, while commonly developing less severe symptoms, may experience notable cardiovascular manifestations during infections caused by emerging and re-emerging viral infections, which can result in both acute and long-term complications. The present review aims to discuss various cardiovascular complications linked to emerging and re-emerging viral pathogens (including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV)) such as arrhythmias, myocarditis, vascular disorders, and thromboembolic conditions, particularly among the pediatric population. This review also addresses the potential mechanisms by which SARS-CoV-2, DENV, ZIKV, and CHIKV may impact the cardiovascular system and their clinical implications. Moreover, it discusses the diagnostic challenges for viral-caused cardiovascular disorders in children, owing to their common subtle or atypical manifestations. Finally, it addresses the present therapeutic specifically used for pediatric cases.

A novel Harris Hawks Optimization-based clustering method for elucidating genetic associations in osteoarthritis and Diverse Cancer Types

Considering the high incidence of osteoarthritis (OA), especially of the knee and hip, this study explores the possible genetic associations between OA and cancer types, including cancers of the bladder, kidney, breast, and prostate. The objective of our study is to decipher the complex genetic connections among these common disorders, emphasizing potential correlations and underlying biological processes. However, the genetic connections between these diseases remain largely unexplored. It fills a vacuum in the literature by using a new clustering approach based on Harris Hawks Optimization (HHO-C), which is a first for applying machine learning methods to this particular set of genetic data. To address this gap, we introduce HHO-C, a novel machine learning-based clustering approach, for the first time in this specific genetic dataset. The work accomplishes three noteworthy firsts: firstly, it is the first to apply machine learning to the study of the genetic interactions between OA and these cancers. Second, it creates a flexible genetic dataset that will be very helpful for further studies in this field. Finally, it presents the novel HHO-C approach, showcasing how well it manages intricate genetic data and providing fresh perspectives on genetic data analysis. It is anticipated that the results of this investigation will clarify the genetic relationships between OA and these malignancies, which could result in novel understandings of medical genetics and the creation of fresh approaches to diagnosis and treatment.

The Role of Extracellular Vesicles in the Pathogenesis of Metabolic Dysfunction-Associated Steatotic Liver Disease and Other Liver Diseases

The increasing prevalence of liver diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD), presents considerable medical challenges, particularly given the absence of approved pharmacological treatments, which underscores the necessity to comprehend its underlying mechanisms. Extracellular vesicles (EVs), which are tiny particles released by cells, play a crucial role in facilitating communication and can transport harmful molecules that promote inflammation and tissue damage. These EVs are involved in the progression of various types of liver disorders since they aggravate inflammation and oxidative stress. Because of their critical role, it is believed that EVs are widely involved in the initiation and progression of MASLD, as well as in viral hepatitis, alcoholic liver disease, drug-induced liver injury, and hepatocellular carcinoma. This review emphasizes recent findings regarding the functions of EVs in the above liver pathologies and underscores their potential as new therapeutic targets, paving the way for innovative approaches to address those detrimental liver conditions.

The impact of a multi-species probiotic supplementation on clinical symptoms and biochemical factors in patients with irritable bowel syndrome: a randomised controlled trial

Background: Intestinal inflammation and oxidative stress contribute to the pathophysiology of irritable bowel syndrome (IBS). This clinical trial investigated the effects of a probiotic supplementation on symptom severity and quality of life (QOL) in IBS patients.

Methods: Forty-six IBS patients were randomised to receive either a multi-species probiotic or placebo for 8 weeks. Clinical symptoms were evaluated using the IBS Severity Scoring System (IBS-SSS) and IBS QOL questionnaire. Serum levels of IFN-γ, IL-1β, IL-10, IL-6, malondialdehyde (MDA), total antioxidant capacity (TAC), and nitric oxide (NO) were measured before and after the intervention.

Results: After 8 weeks, the probiotic group showed significant improvements in QOL scores, and reductions in IBS-SSS and MDA levels compared to placebo group. TAC levels were significantly higher in probiotic group. However, no significant differences were observed in cytokine or NO levels.

Conclusions: This multi-species probiotic supplement was safe and effective in reducing symptom severity and improved QOL of IBS patients.

Umbilical Cord-Derived Mesenchymal Stem Cells Infusion in Type 2 Diabetes Mellitus Patients: A Retrospective Cytopeutics' Registry Study

Background

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, leading to elevated blood glucose levels. Cellular therapies offer promise for improving hyperglycemia in T2DM. This retrospective study aimed to assess the clinical effectiveness of intravenous allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) infusion in T2DM patients through various clinical evaluations, focusing on systemic inflammation, metabolic dysfunction, and insulin resistance.

Methods

The data from a total of 218 T2DM patients who attended for follow-up after 6 months, and 83 patients after 12 months after receiving 50-100×10⁶ allogeneic UC-MSCs were analyzed. Blood and urine samples were collected at baseline and follow-up. Key evaluations included changes in anthropometry, diabetes indices, lipids, liver, renal, hormonal, and inflammatory markers.

Results

All patients demonstrated satisfactory outcomes, without adverse effects. Significant reductions in HbA1c levels were observed at 6-months (p<0.001) and 12-months (p=0.016). Insulin (p=0.048) and HOMA-IR (p=0.007) levels significantly reduced within 6-months, with same trend at 12-months. ALT and GGT levels significantly decreased (p<0.05), indicating a reduction in liver inflammation. hs-CRP level among patients with higher inflammation were also reduced at 6-months (p=0.073) and significantly at 12-months (p=0.016). Testosterone (p=0.050) and estradiol (p=0.043) levels increased in males and females, respectively, during 12-month follow-up. Additionally, estimated glomerular filtration rate (eGFR) and creatinine levels improved in stage 2 chronic kidney disease (CKD) at 6- and 12-month (p<0.05), indicating recovered renal function for those in early stage of CKD.

Conclusion

Allogeneic UC-MSCs infusion is safe for patients with T2DM and is associated with overall health outcomes, with sustained benefits up to 12 months. Notably, the treatment significantly improved metabolic indices including glycemic control, liver and renal profile and systemic subclinical inflammation. These findings provide a basis for further exploration of UC-MSCs in managing T2DM in proper randomized control trial, by addressing both metabolic dysregulation and inflammation.

Secondary Non-Response to Biologic Treatment in Patients with Severe Asthma

Biologic therapies have revolutionized the management of severe asthma (SA), offering significant symptom control and reduced exacerbations for many patients. However, up to 25% of individuals do not show satisfactory responses to these treatments and are categorized as non-responders. Definitions of response and primary non-response to biologics in SA are well-established. In secondary nonresponse, patients show initial response to biological treatment in the first 6-12 months but later lose asthma control, and in SA this phenomenon remains undefined and unstudied in literature. We present 4 cases of severe asthma treated with different biologic agents. All patients demonstrated significant clinical improvement during the first 12 months of therapy but followed by a gradual loss of asthma control, indicative of secondary nonresponse. We discuss the clinical features, potential mechanisms, and implications of secondary nonresponse to biologics in severe asthma, highlighting an unmet need for further research to define this phenomenon and guide future therapeutic strategies.

Integrative Metabolomic and Lipidomic Signatures of SARS-CoV-2 VOCs: Correlations with Hematological and Biochemical Markers

In the present study, we investigated biochemical, hematological, lipidomic, and metabolomic alterations associated with different SAR-CoV-2 variants of concern (VOCs), such as WT, α, β, γ, and δ, as well as their impact on COVID-19 severity. Across the first and second waves in India, a machine learning approach was used in 3134 COVID-19 patients, and nine critical biochemical and hematological parameters, namely, C-reactive protein (CRP), D-dimer, ferritin, neutrophil, WBC count, lymphocyte, urea, creatine, and lactate dehydrogenase (LDH), were identified. Furthermore, through metabolic and lipidomic profiles of lung and colon cells transfected with spike VOCs, notable dysregulation was exhibited by the delta variant correlated with characteristic pathways such as catecholamine and thyroid hormone synthesis. A corroborating meta-analysis also highlighted the involvement of urea and amino acid metabolism pathways. Overall, our study provides crucial insights into metabolic and biochemical disruptions caused by VOCs, contributing to a better understanding of COVID-19 pathogenesis and the development of targeted interventions.

Integration of network pharmacology, molecular docking and pharmacokinetic investigations of dandelion in rats for the treatment of diabetes mellitus

BACKGROUND

The dandelion is a medicinal and edible plant with various assumed properties, including hypoglycemic, antioxidative, anti-inflammatory, and anti-tumor effects. However, the underlying mechanism and metabolic behavior of dandelion that can be used in treating diabetes mellitus (DM) remain unclear.

AIMS

This study aimed to investigate the molecular mechanism of dandelion in the treatment of DM and the in vivo metabolic behavior of its bioactive components.

METHODS

Network pharmacology and molecular docking were used to identify the underlying mechanism of dandelion in treating DM. LC-MS/MS was used to analyze the pharmacokinetic behavior of the main active components in dandelion in rats.

RESULTS

The network pharmacology analysis demonstrated that the primary active components (hesperidin, protocatechuic acid, and syringic acid) of dandelion exert therapeutic effects on DM through multi-target interactions. These components regulated lipid and atherosclerosis pathways and the AGE-RAGE signaling pathway in diabetic complications via interactions with core targets including SRC, HRAS, and AKT1. The highest and lowest docking scores were - 8.55792 kcal·mol-1 and -4.18450 kcal·mol-1, respectively, indicating good binding activity between the compounds and the targets. Pharmacokinetic analysis revealed that all the analytes were detected in the plasma but their elimination within 24 h varied. Hesperidin, syringic acid and protocatechuic acid are abundant in rat plasma, characterized by extended long half-life and high bioavailability.

CONCLUSION

This work not only predicted the potential mechanism of dandelion in treating DM, but also revealed the pharmacokinetic profiles of its active components, a finding that is critical for advancing clinical applications of dandelion and related traditional Chinese medicine (TCM) formulae.

Nanobodies: From Discovery to AI-Driven Design

Nanobodies, derived from naturally occurring heavy-chain antibodies in camelids (VHHs) and sharks (VNARs), are unique single-domain antibodies that have garnered significant attention in therapeutic, diagnostic, and biotechnological applications due to their small size, stability, and high specificity. This review first traces the historical discovery of nanobodies, highlighting key milestones in their isolation, characterization, and therapeutic development. We then explore their structure-function relationship, emphasizing features like their single-domain architecture and long CDR3 loop that contribute to their binding versatility. Additionally, we examine the growing interest in multiepitope nanobodies, in which binding to different epitopes on the same antigen not only enhances neutralization and specificity but also allows these nanobodies to be used as controllable modules for precise antigen manipulation. This review also discusses the integration of AI in nanobody design and optimization, showcasing how machine learning and deep learning approaches are revolutionizing rational design, humanization, and affinity maturation processes. With continued advancements in structural biology and computational design, nanobodies are poised to play an increasingly vital role in addressing both existing and emerging biomedical challenges.

Evolving understanding of Guillain-Barré syndrome pathophysiology and the central role of the classical complement pathway in axonal injury

Guillain-Barré syndrome (GBS) is a rare, frequently postinfectious neuromuscular emergency and the leading cause of acute paralytic neuropathy worldwide. GBS incidence varies considerably across geographic regions, owing predominantly to different infectious exposures. In GBS, antecedent infection leads to production of immunoglobulin G and immunoglobulin M antibodies that cross-react with the myelin sheath and axons of peripheral nerves. These antibodies activate the classical complement pathway, which plays a key role in peripheral nerve injury regardless of autoantibody binding to myelin or axons as a target. The heterogeneous clinical presentation and progression of GBS symptoms have long been attributed to binary axonal and demyelinating neurophysiologic classifications; however, evolving evidence indicates that these pathophysiologic processes overlap. Intravenous immunoglobulin and plasma exchange, the current standard-of-care therapies in GBS, both reduce autoantibody levels and complement activation, thereby aiming to address this convergence of pathophysiology. However, these therapies only partially decrease antibody levels and complement activity and require extended courses of treatment (5 days for intravenous immunoglobulin and 7-14 days for plasma exchange), limiting their effectiveness in addressing acute neuronal damage during the active phase of disease. Given its evolutionary role in antibody binding and activating the classical complement pathway, the complement component C1q has been proposed as a therapeutic target in GBS. The clinical trial program of the C1q inhibitor ANX005, including placebo-controlled, double-blind phase 1b and phase 3 trials in GBS, provides insight into the pathophysiology of GBS and the efficacy of C1q inhibition regardless of neurophysiologic classification or geographic location.

Innovative Strategies in the Diagnosis and Treatment of Liver Cirrhosis and Associated Syndromes

Liver cirrhosis continues to be a major global health issue, contributing to high morbidity and mortality due to its progressive nature and associated complications. This review explores recent advancements in the diagnosis and treatment of liver cirrhosis and its related syndromes. Non-invasive diagnostic tools, such as elastography and serum biomarkers, have significantly improved early detection, reducing the need for liver biopsies. Advanced imaging techniques, including MRI and CT, further enhance diagnostic accuracy. In parallel, molecular and genomic research is providing new insights into the pathogenesis of the disease, paving the way for precision medicine. On the treatment front, pharmacological innovations, such as antifibrotic agents and targeted therapies, show promise in slowing disease progression. Endoscopic interventions like variceal banding are improving the management of complications, while advancements in liver transplantation and artificial liver support systems offer life-saving alternatives. Regenerative medicine, particularly stem cell therapy and tissue engineering, is emerging as a promising strategy for liver repair. Managing cirrhosis-related syndromes, including portal hypertension, ascites, hepatic encephalopathy, and hepatorenal syndrome, now involves evolving therapeutic approaches such as transjugular intrahepatic portosystemic shunt (TIPS) and novel pharmacotherapies. Prognostic scoring systems like the MELD and Child-Pugh are being refined with new biomarkers for better risk stratification. The future of cirrhosis care will likely involve the integration of artificial intelligence and machine learning for early diagnosis and personalized treatments, alongside emerging therapies currently under investigation. Despite these advancements, challenges such as costs, accessibility, and healthcare disparities remain barriers to widespread adoption. This review highlights the importance of incorporating innovative diagnostic and therapeutic strategies into clinical practice to improve the outcomes for patients with liver cirrhosis and its complications.

Computational and Experimental Investigation of Antidiabetic Drugs on Tofacitinib Metabolism: Molecular Docking, in vitro, and in vivo Studies

Background

Tofacitinib is an orally administered Janus kinase (JAK) inhibitor that has demonstrated significant efficacy in the treatment of rheumatoid arthritis. This study aimed to investigate the effects of gliquidone and linagliptin, two hypoglycemic agents on the pharmacokinetics of tofacitinib in vitro and in vivo.

Methods

The mechanism of drug-drug interaction was studied in vitro using a murine liver microsome incubation system and in vivo by administering gliquidone and linagliptin orally to rats pretreated with various concentrations of tofacitinib. This study used waters ACQUITY UPLC I-Class/Xevo TQD ultra-high performance liquid chromatography-tandem triple quadrupole mass spectrometer. Furthermore, molecular docking was performed to simulate the interaction using computer simulations.

Results

Gliquidone and linagliptin inhibited the metabolism of tofacitinib by heparanase in vitro with IC50 values of 1.140 μM and 4.064 μM, respectively. Co-administration of gliquidone significantly increased the AUC(0-t) of tofacitinib by approximately 43.3%, accompanied by a 45.1% increase in Cmax and a 27.5% reduction in clearance (CLz/F). In contrast, linagliptin exhibited a more potent inhibitory effect, raising the AUC(0-t) approximately 4.4-fold, enhancing the Cmax by 2.86-fold, and decreasing clearance to 25.8% of the control level. These findings suggest that while both gliquidone and linagliptin significantly enhance the systemic exposure of tofacitinib, linagliptin demonstrates a markedly more significant inhibitory effect on tofacitinib's metabolism and elimination.

Conclusion

Gliquidone and linagliptin significantly altered the pharmacokinetics of tofacitinib in vitro and in vivo. This study demonstrated the drug-drug interactions between linagliptin, gliquidone, and tofacitinib, highlighting the need for clinical attention to this possibility.

New insights into the phenomenon of remissions and relapses in autoimmune diseases and the puzzle of benign autoantibodies in healthy individuals

The onset and relapse of autoimmune diseases (AIDs) are triggered by autoimmune attacks on target tissues. However, symptoms are unlikely to appear if damaged cells are rapidly replaced. Addressing the implications of this premise, the present work examines the balance between target tissue destruction and recovery rates as a key factor in the mechanisms of remissions and relapses in AIDs. The theory, supported by published clinical data, suggests that remissions are improbable in AIDs characterized by slow target tissue recovery. Conversely, a high recovery rate is a necessary (though not sufficient) condition for cycles of remission and relapse in AIDs. A high recovery rate of target tissue explains the tendency for remitting-relapsing disease, the likelihood of detecting autoantibodies in healthy individuals and the responsiveness to immunosuppressive drug treatments. Analyzing specific AIDs through the balance of tissue destruction and recovery yields several insights. For example, the difference between androgenic alopecia, a non-remitting-relapsing disease and alopecia areata, a remitting-relapsing AID, is elucidated. A new mechanism underlying relapses and remissions in alopecia areata based on hair follicle regeneration rate is proposed. It is suggested that mild Graves' disease and remitting Hashimoto's thyroiditis would be responsive to corticosteroids or immunosuppressant treatment, unlike more severe forms of these diseases. Additionally, it is proposed that the transition from remitting-relapsing multiple sclerosis to secondary progressive multiple sclerosis is associated with the depletion of brain compensatory reserves. Notably, it is concluded that exercise will not play a neuroprotective role in secondary progressive multiple sclerosis.

Subjective cognitive decline in conjunction with cerebrospinal fluid anti-ATP1A3 autoantibodies and a low amyloid β 1-42/1-40 ratio: Report and literature review

BACKGROUND

Animal studies reveal the role of the sodium/potassium transporting ATPase α-3 subunit (ATP1A3) in maintaining the resting membrane potential and thus in synaptic information processing and potentially cognitive disorders. However, autoantibodies against AT1A3 have not previously been reported in patients with subjective cognitive decline.

CASE PRESENTATION

We report the case of a 57-year-old female who underwent neuropsychological testing, magnetic resonance imaging (MRI) and 18 F fluorodesoxyglucose positron emission tomography (FDG-PET) imaging, and cerebrospinal fluid (CSF) analysis. Neural autoantibodies were assessed in serum and CSF. We found a normal cognitive profile together with a self-reported cognitive decline, and such consistent with subjective cognitive decline (SCD). Analysis of the cerebrospinal fluid revealed anti-ATP1A3 autoantibodies. ATP1A3 autoantibodies were also detected in serum. Analysis of amyloid pathology markers in the CSF showed a slightly reduced amyloid β1-42/ amyloid β1-40 ratio. In view of the possible paraneoplastic autoantibodies, whole-body FDG-PET was performed, which did not reveal a malignancy-specific lesion. FDG-PET of the brain also showed no hypometabolism. We diagnosed SCD based on CSF-affirmed possible Alzheimer´s pathologic change with ATP1A3 autoantibodies in CSF and serum.

CONCLUSIONS

To our knowledge, this is the first report of CSF and serum ATP1A3 autoantibodies associated with SCD although an incidental finding cannot be fully excluded. In addition, amyloid pathology was detected via CSF biomarkers, suggesting that ATP1A3 autoantibodies are a potentially promising biomarker in SCD with an Alzheimer´s pathologic change if confirmed in large-scale studies.

Long-term outcomes of idiopathic inflammatory myopathies: a large-scale longitudinal cohort study

OBJECTIVES

To investigate mortality, patient-reported outcomes (PROs), and drug-free remission (DFR) in a large well-characterised cohort of idiopathic inflammatory myopathies (IIMs).

METHODS

This study retrospectively enrolled 1854 patients with IIMs. Follow-up lasted up to 20 years. Mortality was analysed using the standardised mortality ratio (SMR) and Kaplan-Meier survival analysis. PROs and DFR rates were examined in the survivors at the end of follow-up.

RESULTS

Of 1854 patients, 348 (18.8 %) died during follow-up, with an overall SMR of 6.82 (95 % confidence interval [CI] 6.11-7.54). Subgroup analysis revealed the highest SMRs in dermatomyositis (DM), followed by antisynthetase syndrome (ASS), and immune-mediated necrotising myopathy, while SMRs in patients with polymyositis indicated no significant mortality difference from general population. Patients with anti-MDA5-positive DM exhibited higher SMRs than those with other IIM serotypes. Respiratory failure was the leading cause of death among patients with IIMs. Patients with DM had the lowest survival rates within the initial nine years of disease duration, whereas patients with ASS exhibited significantly reduced survival after nine years. At the end of follow-up, 17.1 % of patients achieved DFR (cumulative 3-, 5-, and 10-year DFR rates of 6.1 %, 14.9 %, and 29.3 %, respectively). Patients with DM presented with better PROs and higher DFR rates than those with other IIM subtypes.

CONCLUSIONS

Our data indicated increased mortality in patients with IIM compared with the general population and provided an important foundational understanding of IIMs. These findings emphasise the heterogeneity in the long-term outcomes across IIM subtypes, DM's acute nature, and ASS's progressive course.

Association between the quality of plant-based diets and risk of thyroid dysfunction

Background: Plant-based diets are generally considered to be associated with a decreased risk of several chronic diseases. However, there is limited prospective evidence on the association between plant-based diet quality and thyroid dysfunction (TD) risk. Therefore, we aimed to explore the longitudinal associations between plant-based diets and TD (encompassing hypothyroidism and hyperthyroidism) risk. Methods: A total of 199 382 TD-free participants were enrolled in the UK Biobank. The three plant-based diet indices (PDIs), including the overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI), are calculated based on 17 major food groups from the Oxford WebQ questionnaire. Cox proportional hazard models were utilized to assess the associations of PDIs and their combinations with the risk of TD, hypothyroidism, and hyperthyroidism. Results: A total of 4283, 4086, and 935 cases of incident TD, hypothyroidism, and hyperthyroidism were documented over a median follow-up of 12.0 years. The multivariable-adjusted HRs (95% CIs) for the highest uPDI versus the lowest tertile of TD and hypothyroidism were 1.11 (1.03-1.20; P for trend = 0.014), and 1.14 (1.06-1.23; P for trend = 0.002), respectively, after adjusting for potential confounding factors. And lower risks of hyperthyroidism were linked to higher hPDI scores, with HRs (95% CIs) of 0.84 (0.72, 0.98; P for trend = 0.038). The associations between PDIs and TD were consistent in stratified analyses and several sensitivity analyses. Conclusions: The uPDI was associated with a higher TD and hypothyroidism risk, whereas the hPDI was associated with a lower risk of hyperthyroidism.

An inulin-type fructan from Codonopsis pilosula ameliorates cyclophosphamide-induced immunosuppression and intestinal barrier injury in mice

In the present study, an inulin-type fructan (ITF) with the degree polymerization (DP) of 21 was isolated from Codonopsis pilosula roots and its structure was characterized by FT-IR, MALDI-TOF-MS and NMR. The immunomodulatory and intestinal protective effects of ITF were investigated on immunosuppressive mice. Male BALB/c mice were pretreated with cyclophosphamide (Cy) for 3 days to establish an immunosuppressive model followed by ITF treatment. The results demonstrated that compared with the model group, ITF administration significantly increased immune organ index (P<0.05), alleviated intestinal villus damage, stimulated serum cytokine secretion including Ig G, IL-4, IL-6, IL-2, TNF-α, and INF-γ (P<0.05), upregulated the expression of Occludin and Claudin-1 (P<0.05), and increased CD4+ and CD8+ T cells of ileum in Cy-induced mice (P<0.05). Furthermore, ITF restored the intestinal microbiota dysbiosis caused by Cy by increasing the abundance of Muribaculaceae, Blautia, Odoribacter, Lactobacillus and decreasing the abundance of Lachnospiraceae_NK4A136_group (P<0.05). Meanwhile, ITF increased the production of short-chain fatty acids (SCFAs) including acetic acid, propionic acid and butyric acid (P<0.05). These results indicated that ITF can ameliorate cyclophosphamide-induced immunosuppression and intestinal barrier injury, and restore gut microbiota dysbiosis. This study provided important evidences for the immunomodulatory and intestinal protective effects of the ITF from C. pilosula.

Multifaceted roles of OCT4 in tumor microenvironment: biology and therapeutic implications

OCT4 (Octamer-binding transcription factor 4, encoded by the POU5F1 gene) is a master transcription factor for maintaining the self-renewal and pluripotency of pluripotent stem cells, as well as a pioneer factor regulating epigenetics-driven cell reprogramming and cell fate conversion. It is also detected in a variety of cancer tissues and particularly in a small subpopulation of cancer cells known as cancer stem cells (CSCs). Accumulating evidence has revealed that CSCs are a dynamic population, exhibiting shift between multipotency and differentiation states, or quiescence and proliferation states. Such cellular plasticity of CSCs is profoundly influenced by dynamic interplay between CSCs and the tumor microenvironment (TME). Here, we review recent evidence showing that OCT4 expressed in CSCs plays a multifaceted role in shaping the TME by interacting with the cellular TME components, including cancer-associated fibroblasts, tumor endothelial cells, tumor-infiltrating immune cells, as well as the non-cellular TME components, such as extracellular matrix (ECM), metabolites, soluble factors (e.g., growth factors, cytokines and chemokines), and intra-tumoral microbiota. Together, OCT4 regulates crucial processes encompassing ECM remodeling, epithelial-mesenchymal transition, metabolic reprogramming, angiogenesis, and immune responses. The complex and bidirectional interactions between OCT4-expressing CSCs and the TME create a supportive niche for tumor growth, invasion, and resistance to therapy. Better understanding OCT4's roles in such interactions can provide deeper insights into potential therapeutic strategies and targets for disrupting the supportive environment of tumors. The emerging therapies targeting OCT4 in CSCs might hold promise to resensitize therapeutic-resistant cancer cells, and to eradicate all cancer cells when combined with other therapies targeting the bulk of differentiated cancer cells as well as the TME.

Defining a normal reference range for B cells: A key to diagnosing humoral inborn errors of immunity

B cells are integral components of the adaptive immune response that develop in distinct stages, producing various subsets with specialized roles. Abnormal B cell subsets development is associated with humoral inborn errors of immunity (IEI) and so assessment of B cell subsets is a component of humoral IEI diagnosis and should be compared to a reference range which is age- and population-specific although relatively few studies on B-cell subsets have been published in Africa populations when compared with other populations and not all studies evaluate the same subsets or in the same age-groups. This highlights the need for local studies to establish locally relevant reference ranges.

An integrated transcriptomic cell atlas of human endoderm-derived organoids

Human pluripotent stem cells and tissue-resident fetal and adult stem cells can generate epithelial tissues of endodermal origin in vitro that recapitulate aspects of developing and adult human physiology. Here, we integrate single-cell transcriptomes from 218 samples covering organoids and other models of diverse endoderm-derived tissues to establish an initial version of a human endoderm-derived organoid cell atlas. The integration includes nearly one million cells across diverse conditions, data sources and protocols. We compare cell types and states between organoid models and harmonize cell annotations through mapping to primary tissue counterparts. Focusing on the intestine and lung, we provide examples of mapping data from new protocols and show how the atlas can be used as a diverse cohort to assess perturbations and disease models. The human endoderm-derived organoid cell atlas makes diverse datasets centrally available and will be valuable to assess fidelity, characterize perturbed and diseased states, and streamline protocol development.

Risk factors of COVID-19 related hospitalization of paediatric patients with rheumatic diseases: a systematic review and meta-analysis

OBJECTIVE

Among adults who develop coronavirus disease 2019 (COVID-19), those with rheumatic diseases (RDs) have similar hospitalization rates compared with those without RDs. Similar comparisons are lacking in children, due to the overall rarity of COVID-19-related hospitalization in this population. We aimed to examine the risk factors for COVID-19-related hospitalization in paediatric patients with RDs.

METHODS

We conducted a systemic literature search in MEDLINE, EMBASE, Web of Science and China National Knowledge Infrastructure from 1 December 2019, through 22 January 2024. We included observational studies based on inclusion and exclusion criteria. Odds ratios (ORs) with 95% CI were calculated.

RESULTS

Eight cohort studies capturing 1501 paediatric RD patients with SARS-CoV-2 and 118 COVID-19-related hospitalization were included. Odds of hospitalization was increased in children with RDs compared with healthy children. While the diagnosis of juvenile idiopathic arthritis (JIA) was associated with reduced odds of hospitalization overall (OR 0.43 [95% CI: 0.27, 0.68]), systemic JIA was associated with increased odds of hospitalization (OR 2.54 [95% CI: 1.01, 6.40]). The use of glucocorticoids (OR 5.36 [95% CI: 2.21, 13.04]), rituximab (OR 4.62 [95% CI: 1.87, 11.40]), mycophenolate mofetil (OR 4.17 [95% CI: 1.08, 16.16]), hydroxychloroquine (OR 2.97 [95% CI: 1.42, 6.21]), and IL-1 inhibitors (OR 2.28 [95% CI: 1.09, 4.78]) was associated with increased odds of hospitalization, while the use of TNFα inhibitors was associated with reduced odds (OR 0.35 [95% CI: 0.20, 0.66]).

CONCLUSION

Children with RDs are at risk of severe COVID-19 outcomes, while children with JIA taking TNFα inhibitors might be at a lower risk.

Rosmarinic acid-chondroitin sulfate nanoconjugate for targeted treatment of ulcerative colitis

Rosmarinic acid (RA) is an attractive candidate for ulcerative colitis (UC) application due to its bioactive properties, including antioxidant and anti-inflammatory functions, however, the poor water solubility and on-targeting hamper its therapeutic outcome. Therefore, this work reported the synthesis and preparation of novel water-soluble rosmarinic acid-chondroitin sulfate A (RA-CSA) nanoconjugate, which was used for the treatment of UC in dextran sulfate sodium (DSS)-induced acute colitis mouse model. RA was functionalized with CSA as confirmed by FTIR and 1H NMR, and self-assembled to form nanoassemblies with a diameter of 247.3 ± 2.99 nm. RA-CSA nanoassemblies exhibited radical scavenging and antioxidant capacity. RA-CSA remarkably inhibited lipopolysaccharide-induced nitric oxide and TNF-α production in RAW 264.7 cells without cytotoxicity, whose inhibition rate was <5 % at 200 μg mL-1. Oral administration of RA-CSA nanoassemblies significantly attenuated colonic inflammation compared to the parent RA, as evidenced by significantly reduced the shortening of colon length (4.20 ± 0.15 cm), body weight loss, and colonic inflammatory damage in DSS-induced colitis mice. In addition, RA-CSA nanoassemblies suppressed the expression and production of typical pro-inflammatory cytokines of ulcerative colitis. These results suggest that RA-CSA nanoassemblies deserve further consideration as a potential therapeutic drug for the treatment of UC.

Effect of resistance training on body composition and physical function in older females with sarcopenic obesity-a systematic review and meta-analysis of randomized controlled trials

Objectives

A systematic review and meta-analysis was conducted to validate the effects of resistance training (RT) on body composition and physical function in older females with sarcopenic obesity (SO).

Design

Systematic review and meta-analysis.

Setting and participants

Older females (≥60 years).

Methods

Four electronic databases-PubMed, Web of Science, Embase, and the Cochrane Library-were comprehensively searched through June 2024. Randomized controlled trials (RCTs) comparing RT with non-exercise interventions or health education were included. Outcomes measured included key indicators such as body composition and physical function. The quality of the included studies was evaluated using the Physiotherapy Evidence Database (PEDRO) score, and the risk of bias was assessed utilizing the Cochrane Risk of Bias 2.0 Tool (RoB 2). Ultimately, a meta-analysis was conducted using RevMan 5.4.

Results

Results of our meta-analysis revealed that RT partially ameliorated body composition in patients, significantly reducing body fat percentage (BF%; WMD = -2.83, 95% CI: -4.55 to -1.12, p = 0.001). However, through comparative analysis of the control groups, we revealed that it did not significantly influence other indices such as body mass index (BMI; WMD = -0.42, 95% CI: -1.92 to 1.08, p = 0.58), total skeletal muscle mass (TSM; WMD = -0.62, 95% CI: -2.38 to 1.15, p = 0.49), or bone mineral density (BMD; WMD = 0.01, 95% CI: -0.03 to 0.05, p = 0.68). Notably, RT demonstrated substantial efficacy in enhancing physical function, as evidenced by improvements in the 10-meter walk test (10WMT; WMD = 0.22 s, 95% CI: 0.04 to 0.39, p = 0.01), Timed Up and Go test (TUG; WMD = -2.23 s, 95% CI: -2.96 to -1.49, p = 0.00001), and Timed Chair Rise test (TCR; WMD = 5.20 repetitions, 95% CI: 3.98 to 6.43, p = 0.00001).

Conclusion

This meta-analysis indicates that RT exerts a significant positive influence on the physical function of older females with SO. Despite these benefits, the impact on body composition parameters, such as BF%, appears to be limited. These findings underscore the need for further investigation into the mechanisms by which RT affects body composition in this patient population.

Systematic review registration

INPLASY202430061 https://inplasy.com/inplasy-2024-3-0061/.

The safety of COVID-19 vaccines in a large French series of patients with neuromuscular conditions and the impacts of vaccination on their daily lives

This prospective observational study assessed how well patients with neuromuscular disorders (NMDs) tolerated coronavirus disease 2019 (COVID-19) vaccination, and the safety thereof. Patients treated in 55 expert centres of the French NMD (FILNEMUS) network were asked to complete online questionnaires that explored COVID-19 vaccine injection status, adverse effects (AEs), and the impacts thereof on the activities of daily living (ADLs). All patients were followed-up for 12 months. We enrolled 1,020 patients with various NMDs; 38% with myopathy, 33% peripheral neuropathy, 20% myasthenia and 5% spinal muscular atrophy (SMA). Of all patients, 18% were on immune system-modifying therapies. A total of 1,865 vaccine injections were given. Of all patients, 70.4% lacked AEs impacting ADLs (they experienced no AEs or minor AEs), 20.4% reported AEs compromising ADLs, 9% AEs preventing ADLs and 0.2% AEs that required hospitalisation. We found no association between AEs impacting ADLs and the NMD type, physiopathology, or treatment. However, correlations were found between the development of AEs that impacted ADLs and both the modified Rankin score at baseline and vaccination with mRNA-1273 (Moderna). The AE types and frequencies were similar to those of the general population. Our study is reassuring; COVID-19 vaccination is safe for patients with NMDs including those with immune system-mediated diseases and those who are receiving immune system-modifying therapies. Patients with severe disabilities were at an increased risk of AEs that impacted ADLs but this must be weighed against the fact that they are also at increased risk of severe COVID-19 infection. Our mRNA-1273 (Moderna) vaccine findings require confirmation; few patients received this vaccine compared to those injected with BNT162b2 (Pfizer-BioNTech).

Neoantigen-based immunotherapy: advancing precision medicine in cancer and glioblastoma treatment through discovery and innovation

Neoantigen-based immunotherapy has emerged as a transformative approach in cancer treatment, offering precision medicine strategies that target tumor-specific antigens derived from genetic, transcriptomic, and proteomic alterations unique to cancer cells. These neoantigens serve as highly specific targets for personalized therapies, promising more effective and tailored treatments. The aim of this article is to explore the advances in neoantigen-based therapies, highlighting successful treatments such as vaccines, tumor-infiltrating lymphocyte (TIL) therapy, T-cell receptor-engineered T cells therapy (TCR-T), and chimeric antigen receptor T cells therapy (CAR-T), particularly in cancer types like glioblastoma (GBM). Advances in technologies such as next-generation sequencing, RNA-based platforms, and CRISPR gene editing have accelerated the identification and validation of neoantigens, moving them closer to clinical application. Despite promising results, challenges such as tumor heterogeneity, immune evasion, and resistance mechanisms persist. The integration of AI-driven tools and multi-omic data has refined neoantigen discovery, while combination therapies are being developed to address issues like immune suppression and scalability. Additionally, the article discusses the ongoing development of personalized immunotherapies targeting tumor mutations, emphasizing the need for continued collaboration between computational and experimental approaches. Ultimately, the integration of cutting-edge technologies in neoantigen research holds the potential to revolutionize cancer care, offering hope for more effective and targeted treatments.

Special Issue "Functional Role of Cytokines in Cancer and Chronic Inflammation"

Cytokines are a diverse group of signaling proteins that are secreted by a wide range of cell types, including, but not limited to, immune cells [...].

A Literature Review on the Impact of the Gut Microbiome on Cancer Treatment Efficacy, Disease Evolution and Toxicity: The Implications for Hematological Malignancies

The gut microbiome plays a crucial role in modulating the efficacy and toxicity of cancer therapies, particularly in hematological malignancies. This review examines the dynamic interplay between gut microbiota and cancer treatments, such as chemotherapy, immunotherapy, and hematopoietic stem cell transplantation (HSCT). Disruptions in the gut microbiome, known as dysbiosis, are associated with adverse effects like gastrointestinal toxicity, neutropenia and cardiotoxicity during chemotherapy. Conversely, the supplementation of probiotics has shown potential in mitigating these side effects by enhancing gut barrier function and regulating immune responses. In HSCT, a higher diversity of gut microbiota is linked to better patient outcomes, including reduced graft-versus-host disease (GVHD) and improved survival rates. The microbiome also influences the efficacy of immunotherapies, such as immune checkpoint inhibitors and CAR-T cell therapy, by modulating immune pathways. Research suggests that certain bacteria, including Bifidobacterium and Akkermansia muciniphila, enhance therapeutic responses by promoting immune activation. Given these findings, modulating the gut microbiome could represent a novel strategy for improving cancer treatment outcomes. The growing understanding of the microbiome's impact on cancer therapy underscores its potential as a target for personalized medicine and offers new opportunities to optimize treatment efficacy while minimizing toxic side effects.

Glycemic Control, Inflammatory Mediators, and Periodontal Health: A Cross-Sectional Study in Patients with Diabetes

Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients' awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes-periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations.

The Mystery of Certain Lactobacillus acidophilus Strains in the Treatment of Gastrointestinal Symptoms of COVID-19: A Review

COVID-19 presents a wide range of symptoms, including gastrointestinal manifestations such as diarrhea, nausea, and abdominal pain. Lactobacillus acidophilus has been proposed as a potential adjunct therapy to alleviate these symptoms due to its probiotic properties, which help restore gut microbiota balance and modulate immune responses. This review systematically analyzed studies assessing the effects of L. acidophilus in COVID-19 patients with gastrointestinal symptoms. The literature search was conducted through PubMed and the WHO COVID-19 database using keywords such as "Lactobacillus acidophilus", "COVID-19", "gastrointestinal symptoms", and "inflammation markers". The search covered studies published until February 2025. Inclusion criteria: observational and clinical trials with L. acidophilus for symptom relief. Exclusion: animal studies and non-ethical approvals. The findings suggest that L. acidophilus supplementation may contribute to faster resolution of diarrhea, improved gut microbiota balance, and reduced inflammatory markers. However, some studies have found no significant impact on hospitalization rates or disease progression. The probiotic's mechanisms of action appear to involve microbiota modulation, intestinal barrier reinforcement, and anti-inflammatory effects rather than direct viral inhibition in COVID-19 after progression. Some L. acidophilus strains show promise, and clinical validation should follow careful preclinical studies (in vitro, cell lines, and animal models), especially in vulnerable populations such as immunocompromised individuals. Understanding the gut-lung axis and its role in immune response regulation, together with the need for a thorough characterization of the specific strains, including biochemical, genomic, and functional properties, before testing in humans, may provide deeper insights into the therapeutic potential of probiotics in viral infections.

Disease burden in inflammatory arthritis: an unsupervised machine learning approach of the COVAD-2 e-survey dataset

Objectives

To comprehensively compare the disease burden among patients with RA, PsA and AS using Patient-Reported Outcome Measurement Information System (PROMIS) scores and to identify distinct patient clusters based on comorbidity profiles and PROMIS outcomes.

Methods

Data from the global COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 e-survey were analysed. Patients with RA, PsA or AS undergoing treatment with DMARDs were included. PROMIS scores (global physical health, global mental health, fatigue 4a and physical function short form 10a), comorbidities and other variables were compared among the three groups, stratified by disease activity status. Unsupervised hierarchical clustering with eXtreme Gradient Boosting feature importance analysis was performed to identify patient subgroups based on comorbidity profiles and PROMIS outcomes.

Results

The study included 2561 patients (1907 RA, 311 PsA, 343 AS). After adjusting for demographic factors, no significant differences in PROMIS scores were observed among the three groups, regardless of disease activity status. Clustering analysis identified four distinct patient groups: low burden, comorbid PsA/AS, low burden with depression and high-burden RA. Feature importance analysis revealed PROMIS global physical health as the strongest determinant of cluster assignment, followed by depression and diagnosis. The comorbid PsA/AS and high-burden RA clusters showed a higher prevalence of comorbidities (56.47% and 69.7%, respectively) and depression (41.18% and 41.67%, respectively), along with poorer PROMIS outcomes.

Conclusion

Disease burden in inflammatory arthritis is determined by a complex interplay of factors, with physical health status and depression playing crucial roles. The identification of distinct patient clusters suggests the need for a paradigm shift towards more integrated care approaches that equally emphasize physical and mental health, regardless of the underlying diagnosis.

Fatigue is common in myositis and is associated with disease activity

BACKGROUND

Fatigue is a prevalent and debilitating symptom frequently reported by patients with idiopathic inflammatory myopathies (IIM). This study investigated the reliability, validity and responsiveness of fatigue in myositis, along with its correlation with disease activity.

METHODS

Adults with IIM were enrolled in a prospective observational study. Myositis core set measures and functional measures were collected at baseline, 3 months and 6 months, while patient-oriented outcomes were assessed monthly. Fatigue was evaluated using the energy-fatigue average component of the Short Form (SF)-36, and a 10 cm Visual Analog Scale (VAS).

RESULTS

Fifty patients (60 % females, 94 % Caucasian) with a mean age of 51.6 ± 14.9 years were enrolled. The majority of patients reported moderate to severe fatigue (67 % based on fatigue VAS and 52 % through the energy-fatigue average). Both fatigue measures showed strong test-retest reliability. Moderate to strong baseline association, along with a longitudinal correlation, was demonstrated between fatigue and various myositis outcome measures, encompassing both muscle and extra muscular disease, physician global assessment, pain, physical function, and quality of life measures. Fatigue significantly improved with improvement in myositis disease activity as assessed by 2016 ACR/EULAR response criteria as well as physician and patient-reported assessments of change in disease activity.

CONCLUSION

Fatigue is common in myositis, and demonstrates favorable psychometric properties including reliability, validity and responsiveness. Fatigue improves in conjunction with improvement in disease activity and should be regarded as an integral component of disease activity in both clinical trials and practice.

Development and validation of a prognostic nomogram for predicting mortality risk in adult rheumatoid arthritis: an analysis of NHANES 1999-2018 data

Objective

This study aims to identify potential independent risk factors for rheumatoid arthritis (RA)- related mortality and develop a nomogram model to predict individualized mortality risk.

Methods

This study included 310 RA patients from the National Health and Nutrition Examination Survey (NHANES) during 1999 - 2018. We applied LASSO, univariate, and multivariate logistic regression analyses to determine risk factors in the training cohort and construct a nomogram model. Calibration plots evaluated the nomogram's accuracy. Finally, we established the nomogram's clinical utility through DCA and performed internal validation within the training cohort.

Results

Of the 310 patients, 140 experienced RA - related deaths, corresponding to a mortality rate of 45.16%. Within the training cohort, age, heart failure, and systemic inflammatory response index (SIRI) emerged as independent predictors of RA - related mortality. A nomogram model, constructed through multivariable logistic analysis, demonstrated an AUC of 0. 852 (95% CI: 0. 799 - 0. 904) in the training cohort and an AUC of 0. 904 (95% CI: 0. 846 - 0. 963) in the validation cohort. The calibration curve revealed a strong agreement between predicted and actual probabilities. In both training and validation cohorts, DCA highlighted the nomogram's significant net benefits for predicting RA - related mortality risk.

Conclusions

This study demonstrates age, heart failure, and SIRI's ability to predict RA mortality with good discrimination and clinical utility. The model gives clinicians a simple tool to quickly identify high - risk RA patients, promoting early intervention, personalized treatment, and better prognosis.

Beyond the Pandemic Era: Recent Advances and Efficacy of SARS-CoV-2 Vaccines Against Emerging Variants of Concern

Vaccination has been instrumental in curbing the transmission of SARS-CoV-2 and mitigating the severity of clinical manifestations associated with COVID-19. Numerous COVID-19 vaccines have been developed to this effect, including BioNTech-Pfizer and Moderna's mRNA vaccines, as well as adenovirus vector-based vaccines such as Oxford-AstraZeneca. However, the emergence of new variants and subvariants of SARS-CoV-2, characterized by enhanced transmissibility and immune evasion, poses significant challenges to the efficacy of current vaccination strategies. In this review, we aim to comprehensively outline the landscape of emerging SARS-CoV-2 variants of concern (VOCs) and sub-lineages that have recently surfaced in the post-pandemic years. We assess the effectiveness of existing vaccines, including their booster doses, against these emerging variants and subvariants, such as BA.2-derived sub-lineages, XBB sub-lineages, and BA.2.86 (Pirola). Furthermore, we discuss the latest advancements in vaccine technology, including multivalent and pan-coronavirus approaches, along with the development of several next-generation coronavirus vaccines, such as exosome-based, virus-like particle (VLP), mucosal, and nanomaterial-based vaccines. Finally, we highlight the key challenges and critical areas for future research to address the evolving threat of SARS-CoV-2 subvariants and to develop strategies for combating the emergence of new viral threats, thereby improving preparedness for future pandemics.

High-intensity resistance training in patients with myositis - 1-year follow-up on a randomised controlled trial

Reduced quality of life in patients with myositis is partly due to impairments in muscle strength, muscle endurance and functional capacity. In a recent randomised controlled trial (RCT) (NCT04486261) we showed that high-intensity resistance training improved quality of life, muscle strength, and endurance. This follow-up study aimed to investigate if these improvements remained persistent one year after completing 16 weeks of high-intensity resistance training. A total of 32 participants (intervention group (IG): 15; control group (CG): 17) were enrolled in the RCT, with 27 (IG: 13; CG: 14) completing the 1-year follow-up. Outcomes were assessed at three time points: baseline (weeks - 4 - 0), post-intervention (weeks 17-18), and 1-year follow-up (weeks 52-54). Outcomes included quality of life (QoL, SF36), functional capacity, muscle endurance (functional index 3 (FI3)), body composition (DEXA), and disease activity/damage, including manual muscle test 8 (MMT8). Training-induced improvements in muscle endurance (FI3) remained at 1-year follow-up, with a mean change of 10.7 (CI95: 2.2;19.1) in favour of IG (p = 0.01). Within-group improvements in IG were sustained for QoL (SF36, physical component summary) (4.8 (CI95: 0.9;8.7), p = 0.02), muscle strength (MMT8) (1.8 (CI95: 0.8; 2.9), p < 0.01), and functional capacity measures (p ≤ 0.04), although not significantly different from CG at 1-year follow-up. Disease activity and disease damage were similar between IG and CG at 1-year follow-up. Patients with myositis completing 16 weeks of high-intensity resistance training showed sustained improvements in muscle endurance at 1-year follow-up compared to controls. Indications of lasting enhancements in quality of life and strength were also present, with no increase in disease activity or damage. NCT04486261.

T helper 17 cells and interleukin-17 immunity in type 1 diabetes: From pathophysiology to targeted immunotherapies

Type 1 diabetes (T1D) is a chronic organ-specific autoimmune disorder characterized by a progressive loss of the insulin-secreting pancreatic beta cells, which ultimately results in insulinopenia, hyperglycemia and lifelong need for exogenous insulin therapy. In the pathophysiological landscape of T1D, T helper 17 cells (Th17 cells) and their hallmark cytokine, interleukin (IL)-17, play pivotal roles from disease onset to disease progression. In this narrative mini-review, we discuss the dynamic interplay between Th17 cells and IL-17 in the context of T1D, providing insights into the underlying immunologic mechanisms contributing to the IL-17-immunity-mediated pancreatic beta-cell destruction. Furthermore, we summarized the main animal and clinical studies that investigated Th17- and IL-17-targeted interventions as promising immunotherapies able to alter the natural history of T1D.