Lactiplantibacillus plantarum (CECT7484 and CECT7485) and Pedioccoccus acidilactici (CECT7483) enhance actin cytoskeleton and CYP1A1 expression restoring epithelial permeability alterations induced by irritable bowel syndrome mediators

Irritable bowel syndrome (IBS) is a multifactorial condition with heterogeneous pathophysiology, including intestinal permeability alterations. The aim of the present study was to assess the ability of a probiotic blend (PB) consisting of two Lactiplantibacillus plantarum strains (CECT7484 and CECT7485) and one strain of Pediococcus acidilactici (CECT7483) to recover the permeability increase induced by mediators from IBS mucosal biopsies and to highlight the underlying molecular mechanisms. Twenty-one IBS patients diagnosed according to ROME IV criteria (11 IBS-D and 10 IBS-M) and 7 healthy controls were enrolled. Mucosal mediators spontaneously released by IBS and HC biopsies were collected and incubated with/without the PB (104 and 106 CFU/ml). Paracellular permeability was assessed by evaluating the amount of sulfonic-acid-conjugated to fluorescein passing through the Caco-2 monolayer. RNA was extracted from Caco-2 cells and used to perform qPCR analyses, to evaluate the expression of ZO-1 and β-actin, and RNAseq to evaluate the transcriptomic profile. Untargeted metabolomics was used to characterize metabolites produced by the PB. The PB significantly reduced paracellular permeability after 3 h of incubation. Both doses of the PB significantly recovered the increase in paracellular permeability induced by IBS mediators. qPCR analyses showed that both doses of the PB co-incubated with IBS mediators induced a significant increase in beta-actin expression compared to IBS mediators alone. Concerning IBS subtypes, the high dose of the PB recovered the increase of permeability induced by IBS-D mediators. Transcriptomic analyses, confirmed by qPCR, showed that the high dose of the PB significantly increased CYP1A1 compared to IBS mediators alone. The PB produced a high amount of indole-3-lactic acid. The PB recovers the permeability increase induced by IBS mediators inducing the up-regulation of β-actin. In addition, the PB up-regulates the expression of CYP1A1, known to be involved in the metabolism of xenobiotics, possibly through the production of the indole-3-lactic acid.

Gut microbial dysbiosis associated to diarrheic irritable bowel syndrome can be efficiently simulated in the Mucosal ARtificial COLon (M-ARCOL)

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder, with diarrhea-predominant IBS (IBS-D) as the most frequent subtype. The implication of gut microbiota in the disease's etiology is not fully understood. In vitro gut systems can offer a great alternative to in vivo assays in preclinical studies, but no model reproducing IBS-related dysbiotic microbiota has been developed. Thanks to a large literature review, a new Mucosal ARtifical COLon (M-ARCOL) adapted to IBS-D physicochemical and nutritional conditions was set-up. To validate the model and further exploit its potential in a mechanistic study, in vitro fermentations were performed using bioreactors inoculated with stools from healthy individuals (n = 4) or IBS-D patients (n = 4), when the M-ARCOL was set-up under healthy or IBS-D conditions. Setting IBS-D parameters in M-ARCOL inoculated with IBS-D stools maintained the key microbial features associated to the disease in vivo, validating the new system. In particular, compared to the healthy control, the IBS-D model was characterized by a decreased bacterial diversity, together with a lower abundance of Rikenellaceae and Prevotellaceae, but a higher level of Proteobacteria and Akkermansiaceae. Of interest, applying IBS-D parameters to healthy stools was not sufficient to trigger IBS-D dysbiosis and applying healthy parameters to IBS-D stools was not enough to restore microbial balance. This validated IBS-D colonic model can be used as a robust in vitro platform for studies focusing on gut microbes in the absence of the host, as well as for testing food and microbiota-related interventions aimed at personalized restoration of gut microbiota eubiosis.

Effects of body mass index on gastric motility: Comparing children with functional abdominal pain disorders and healthy controls

BACKGROUND

Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers, yet the underlying reasons remain unclear. Gastrointestinal motility, a key pathophysiological factor in functional gastrointestinal disorders, may be influenced by body mass index (BMI).

AIM

To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders (FAPDs).

METHODS

We assessed gastric motility in 176 children with FAPDs (61.4% females, mean age 7.94 years, SD 1.96 years) and 63 healthy controls (57.1% females, mean age 9.17 years, SD 1.90 years) at the Gastroenterology Research Laboratory, University of Kelaniya, Sri Lanka. FAPDs were diagnosed and subtyped using the Rome IV criteria: Functional abdominal pain 97 patients; irritable bowel syndrome 39 patients, functional dyspepsia (FD) 25 patients; and abdominal migraine 15 patients. Gastric motility was measured using a validated ultrasound method. Weight and height were measured using sensitive standard scales.

RESULTS

The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m², respectively (P = 0.33). Fasting antral area (FAA) and antral area at 1 min (AA1) and 15 min (AA15) were significantly greater in patients with FAPD with a higher BMI (2.71 cm², 12.57 cm², and 7.19 cm², respectively) compared with those with a lower BMI (2.12 cm², 10.68 cm², and 6.13 cm², respectively) (P < 0.01). BMI positively correlated with FAA and AA15 (r = 0.18 and r = 0.19, respectively) (P < 0.01) in those with FAPDs. In controls, only AA1 was greater in the higher BMI group (12.51 cm² vs 9.93 cm²) and had a positive correlation (r = 0.33) (P ≤ 0.01). Subgroup analysis revealed that in patients with FD, BMI negatively correlated with gastric emptying rate (GER) (r = -0.59) and antral motility index (MI) (r = -0.49), while in functional abdominal pain, MI positively correlated (r = 0.25) with BMI (P ≤ 0.01).

CONCLUSION

In children with FAPDs, higher BMI was associated with increased gastric antral distention during fasting and postprandial periods (as indicated by FAA, AA1, and AA15) but not with contractility and transit (MI, GER). However, in the FD subgroup, high BMI correlated with reduced GER and MI. This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD. These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs, particularly FD.

An insight into in silico strategies used for exploration of medicinal utility and toxicology of nanomaterials

Nanomaterials (NMs) and the exploration of their comprehensive uses is an emerging research area of interest. They have improved physicochemical and biological properties and diverse functionality owing to their unique shape and size and therefore they are being explored for their enormous uses, particularly as medicinal and therapeutic agents. Nanoparticles (NPs) including metal and metal oxide-based NPs have received substantial consideration because of their biological applications. Computer-aided drug design (CADD) involving different strategies like homology modelling, molecular docking, virtual screening (VS), quantitative structure-activity relationship (QSAR) etc. and virtual screening hold significant importance in CADD used for lead identification and target identification. Despite holding importance, there are very few computational studies undertaken so far to explore their binding to the target proteins and macromolecules. Although the structural properties of nanomaterials are well documented, it is worthwhile to know how they interact with the target proteins making it a pragmatic issue for comprehension. This review discusses some important computational strategies like molecular docking and simulation, Nano-QSAR, quantum chemical calculations based on Density functional Theory (DFT) and computational nanotoxicology. Nano-QSAR modelling, based on semiempirical calculations and computational simulation can be useful for biomedical applications, whereas the DFT calculations make it possible to know about the behaviour of the material by calculations based on quantum mechanics, without the requirement of higher-order material properties. Other than the beneficial interactions, it is also important to know the hazardous consequences of engineered nanostructures and NPs can penetrate more deeply into the human body, and computational nanotoxicology has emerged as a potential strategy to predict the delirious effects of NMs. Although computational tools are helpful, yet more studies like in vitro assays are still required to get the complete picture, which is essential in the development of potent and safe drug entities.

Adherence to statins and development of atherosclerosis-related events. A systematic review and meta-analysis

BACKGROUND

Adherence to lipid-lowering treatment (LLT) is of paramount importance for the prevention of atherosclerosis-related events (ASCVD). The threshold for someone to be adherent is ≥80 % of the total prescribed medication. We conducted a meta-analysis to assess how adherence to LLT affects the development of ASCVD.

METHODS

We searched PubMed (up to February 2025) for randomized controlled trials, cohorts and nested case control studies that assessed adherence to LLT. We performed random effects meta-analysis with primary outcome the development of ASCVD based on the level of adherence to LLT.

RESULTS

We included 66 articles corresponding to 3,345,718 individuals. All studies evaluated statins as LLT. Good vs. poor statin adherence reduced by 35 % the risk for all-cause mortality (RR:0.65; 95%CI: 0.56-0.76; I2 = 98 %), 24 % for any cardiovascular (CV) event (RR:0.76; 95%CI: 0.72-0.80; I2 = 90 %), 30 % for myocardial infarction (MI) (RR:0.70; 95%CI: 0.62-0.80; I2 = 90 %) and 32 % for stroke (RR:0.68; 95%CI: 0.58-0.79; I2 = 81 %). For participants without established ASCVD, statin adherence reduced by 32 % the risk for any CV event (RR:0.68; 95%CI: 0.46-1.00; I2 = 97 %). For those with established ASCVD, statin adherence reduced by 25 % the risk for any CV event (RR:0.75; 95%CI: 0.64-0.88; I2 = 64 %), 51 % for MI (RR:0.49; 95%CI: 0.32-0.73; I2 = 80 %) and 50 % for stroke (RR:0.50; 95%CI: 0.26-0.97; I2 = 87 %). Statin discontinuation increased by 90 % the mortality risk (RR:1.90; 95%CI: 1.33-2.71; I2 = 87 %). Even good vs. intermediate adherence (40 %-79 %) decreased by 32 % the risk for any CV event (RR:0.68; 95%CI: 0.60-0.76; I2 = 94 %). Sensitivity analyses including studies with different than the standard (≥80 %) threshold did not differ from the main results.

CONCLUSION

Statin adherence is of paramount importance to reduce ASCVD risk and mortality. Understanding adherence patterns or barriers and ensuring consistent adherence to LLT by tailored interventions should be a key priority in clinical practice and healthcare policies.

Understanding potentially inappropriate medication: A focus group study with general practitioners

INTRODUCTION

Polypharmacy and Potentially Inappropriate Medication (PIM) pose significant challenges for older adults, frequently leading to adverse health outcomes. While digital health tools offer promise solutions to improve medication management for this population, their integration into primary care settings remains slow. This study aims to explore the perspectives of Portuguese general practitioners (GPs) regarding polypharmacy, PIM, and the adoption of digital health-related tools for medication appropriateness in older adults.

METHODS

Five qualitative focus group sessions were conducted with 37 GPs working in Portuguese primary healthcare facilities of the north. The sessions were recorded, and a thematic analysis was performed.

RESULTS

The following five themes emerged: factors associated with polypharmacy, challenges in deprescribing, problems related to PIM, strategies to handle polypharmacy, and barriers and facilitators adopting digital health-related tools for medication appropriateness. Eight barriers and nine facilitators were identified.

CONCLUSION

This study underscores the complexity of medication management in older adults and highlights the potential of digital health tools to optimize medication use. Tailored interventions and collaborative efforts among all healthcare stakeholders are essential to enhance medication management and improve health outcomes in older adults.

Phytoestrogens as potential anti-osteoporosis nutraceuticals: Major sources and mechanism(s) of action

By 2050, the global aging population is predicted to reach 1.5 billion, highlighting the need to enhance the quality of life of the elderly population. Osteoporotic fractures are projected to affect one in three women and one in five men over age 50. Initial treatments for osteoporosis in postmenopausal women include antiresorptive agents such as bisphosphonates, strontium ranelate, estrogen replacement therapy (ERT) and selective estrogen receptor modulators (SERMs). However, these do not rebuild bone, limiting their effectiveness. Denosumab, an FDA-approved antiresorptive monoclonal antibody, also has drawbacks including high costs, biannual subcutaneous injections, slow healing, impaired bone growth and side effects like eczema, flatulence, cellulitis, osteonecrosis of the jaw (ONJ) and an increased risk of spinal fractures after discontinuation of treatment. Nutraceuticals, particularly phytoestrogens, are gaining attention for their health benefits and safety in osteoporosis prevention, management and treatment. Phytoestrogens are plant metabolites similar to mammalian estrogens and include isoflavones, coumestans, lignans, stilbenes, and flavonoids. They interact with estrogen receptor isoforms ERα and ERβ, acting as agonists or antagonists based on concentration and bioavailability. Their tissue-selective activities are particularly significant: anti-estrogenic effects in reproductive tissues may lower the risk of hormone-related cancers (such as ovarian, uterine, breast and prostate), while estrogenic effects on bone could contribute to the preservation of bone mineral density.Phytoestrogens are, thus, used in managing breast and prostate cancers, cardiovascular diseases, menopause and osteoporosis. The present review focuses on the botanical origin, classification, sources and mechanism(s) of action of major phytoestrogens, their potential in prevention and management of osteoporosis and the requirement for additional clinical trials to achieve more definitive outcomes in order to confirm their efficacy and dosage safety.

Decoding Gastric Reflexes: The Role of Mechanosensitive Enteric Neurons in Stomach Motility

This review focuses on mechanosensitive enteric neurons (MEN) in the guinea pig stomach and their roles in gastric motor reflex pathways. The guinea pig model is advantageous for studying gastric physiology, as its stomach structure and function closely resemble those of humans. Gastric motility involves distinct functional regions: the fundus and proximal corpus act as reservoirs, while the distal corpus and antrum handle food mixing and propulsion. Mechanosensitivity in both gastric cholinergic and nitrergic enteric neurons plays a critical role in adapting muscle activity in response to gastric content volume. These neurons enable reflex circuits involved in the accommodation reflex, with cholinergic excitatory and nitrergic inhibitory pathways promoting relaxation. This review summarizes the anatomical, functional, and neurochemical characteristics of MEN across gastric regions, their direct and indirect interactions with smooth muscle, and the role of distinct neurotransmitters in modulating gastric motility. The need for future studies on mechanosensitive pathways and involved neuronal receptors is highlighted to enhance our understanding, finally aiding therapeutic development.

CUPID: A free drug discovery platform for the explainable multi-ion channel assessment of cardiotoxicity

The withdrawal of numerous approved drugs in late development stages, or even from the market, due to safety concerns remains a major challenge, contributing to the high attrition rate in drug discovery and development. Among these concerns, cardiotoxicity is a critical toxicological issue, particularly in oncology, as drugs can induce heart damage by triggering pathological conditions such as arrhythmia, myocardial infarction, and myocardial hypertrophy. Here, we introduce CUPID (Cardiotox Understanding Platform for Intelligent Drug Discovery), an explainable artificial intelligence (XAI) framework designed to predict cardiotoxicity associated with ERG (ether-à-go-go-related gene) potassium, Nav1.5 sodium, and Cav1.2 calcium ion channels. The framework was trained using three carefully curated interspecies experimental datasets from the latest ChEMBL database (release 34) and the CSFP (Core-Substituent Fingerprint), which encodes molecular fragments derived from the decomposition of drug-like small molecules. By leveraging these experimental datasets, highly accurate explainable machine learning models were developed, achieving approximately 80 % accuracy in 5-fold stratified cross-validation analyses. CUPID provides a comprehensive risk assessment of early cardiotoxicity and a key feature is its interpretability: predictions are annotated with clear applicability domain information, while chemical substructures linked to cardiotoxicity risks are highlighted using SHAP (SHapley Additive exPlanations) values. This enhances molecular understanding and facilitates the rational design of safer bioactive compounds. Last but not least, CUPID is freely accessible at https://prometheus.farmacia.uniba.it/cupid.

Donepezil-induced degradation of hERG potassium channel via lysosomal pathway is exacerbated by hypoxia

Donepezil (DPZ), an acetylcholinesterase inhibitor for Alzheimer's disease, has drawn attention for causing prolonged QT interval and torsade de pointes (TdP). Acquired long QT syndrome (acLQTS) is usually caused by blockage of the cardiac potassium current IKr/hERG, which is essential for cardiac repolarization. This study aimed to investigate DPZ's effect on hERG channel and its cardiotoxic mechanism, particularly focusing on whether hypoxia increases the risk of DPZ-induced acLQTS. To explore these, we employed western blotting to analyze protein levels, the patch clamp technique to measure hERG current and the action potentials of human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). Additionally, immunoprecipitation was utilized to detect protein-protein interactions. Finally, optical mapping monitored guinea pig ECGs and APD, providing in vivo insights. Our results indicate that 24-h incubation with DPZ inhibits hERG protein levels and current in the plasma membrane. Mechanistically, DPZ induces an imbalance in hERG protein acetylation/ubiquitination and decreases the stability of hERG by promoting HDAC6 expression, and the ubiquitinated hERG protein was degraded at lysosomes via K63-polyubiquitin chains. DPZ affects hERG membrane protein via two pathways: it accelerates endocytosis and directs degradation via CHMP3 (a sorting protein of ESCRT-III), while inhibiting recycling through Rab11. Hypoxia exacerbates DPZ-induced hERG degradation and APD prolongation in guinea pigs and hiPSC-CMs. Collectively, DPZ reduces hERG protein stability in the membrane, promoting its degradation in lysosomes. Hypoxia further exacerbates the risk of arrhythmia caused by DPZ. These findings remind us to pay attention to acLQTS induced by DPZ inhibition of hERG in clinical applications.

Using patient videos in pharmacology education within medicine and pharmacy curricula

Safe and effective pharmacotherapy not only requires biomedical and pharmacological knowledge, but also insight into the patient's perspective. Although factors such as personal beliefs, acceptance of side effects or medicine costs influence pharmacotherapy, these non-clinical factors are not extensively discussed within the health professions education (HPE) curricula. Incorporating patient-perspective into pharmacology could therefore help minimize drug-related problems in patients. As videos provide a holistic depiction of the patient's life, using patient videos, instead of commonly used, paper-based case studies, could be suitable to reach this objective. Here we aim to study effectiveness of patient videos as a tool for teaching HPE students on the value of patient's perspective in pharmacology and pharmacotherapy. An interactive lecture on pharmacokinetics was developed for first-year bachelor medical and pharmacy undergraduate students. The educational intervention included watching a patient video, followed by focused exercises and plenary discussions on various pharmacological and patient-perspective related topics. The lecture concluded with students filling up a questionnaire with both open-ended questions and Likert-scale based statements. Besides learning about pharmacological principles (e.g. clinical relevance of pharmacokinetics), students additionally learnt about other prescribing-related topics (e.g. therapy failure, shared decision making) and were able to identify skills required of healthcare professionals, beyond those connected directly to pharmacotherapy (e.g. empathy, listening). The study identifies patient videos as a highly suitable educational tool. Not only do videos teach about the various pharmacological principles, but they also add an extra dimension to pharmacology teaching and learning and can easily be integrated into existing teaching modalities.

Cardiovascular therapeutic targets of sodium-glucose co-transporter 2 (SGLT2) inhibitors beyond heart failure

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are oral antidiabetic agents that have shown significant improvements in cardiovascular and renal outcomes among patients with heart failure (HF), regardless of diabetic status, establishing them as a cornerstone therapy. In addition to glycemic control and the osmotic diuretic effect, the inhibition of SGLT2 improves endothelial function and vasodilation, optimizing myocardial energy metabolism and preserving cardiac contractility. Moreover, SGLT2 inhibitors may exhibit anti-inflammatory properties and attenuate acute myocardial ischemia/reperfusion injury, thereby reducing cardiac infarct size, enhancing left ventricular function, and mitigating arrhythmias. These pleiotropic effects have demonstrated efficacy across various cardiovascular conditions, ranging from acute to chronic coronary syndromes and extending to arrhythmias, valvular heart disease, cardiomyopathies, cardio-oncology, and cerebrovascular disease. This review provides an overview of the current literature on the potential mechanisms underlying the effectiveness of SGLT2 inhibitors across a wide range of cardiovascular diseases beyond HF.

Alexithymia in Parkinson's Disease: A Meta-analysis

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor manifestations, including alexithymia. This condition is defined by difficulty in recognizing, articulating, and expressing one's emotional states. In this study, we conducted a systematic review and meta-analysis to compare the prevalence of alexithymia in PD patients and a healthy population, and to identify associated demographic and clinical factors. We identified 16 observational studies through Pubmed, EMBASE, PsycINFO, and SCOPUS, selecting articles published since 2002. Data were analyzed using a random-effects model. We conducted additional prevalence meta-analyses and correlation meta-analyses. We found that PD patients exhibit higher levels of alexithymia compared to the general population (combined effect size 0.65 [95% CI = 0.49-0.81; P <0.05]), and moderate but significant heterogeneity (I² = 52.42%, Q = 29.42, P <0.05), partially explained by regional differences, levodopa equivalent dosage (positive regression coefficient of 0.0006 [95% CI = 0.0001; 0.0011, P <0.05]); and cognitive scores (negative regression coefficient of -0.14 [95% CI = -0.24; -0.04, P<0.05]), after adjusting for covariates. The additional meta-analysis reported higher prevalence of alexithymia in PD and a pooled correlation coefficient of 0.496 (95% CI = 0.40-0.59, P <0.05) when we analyzed alexithymia and depression scores. To our knowledge, there are no previous meta-analysis applied to alexithymia in PD patients. Even though we could not determine whether alexithymia is a primary characteristic of PD, we found an association of higher levels of alexithymia with depression and higher levodopa equivalent daily dose. Furthermore, there are not enough studies to draw clear conclusions about the influence of cognitive status.

Antibiotic-induced decrease of bacterial load in guinea pig intestine reduces α2-adrenoceptor expression and activity in peristaltic motor inhibition

BACKGROUND AND PURPOSE

The use of analgosedatives in critically ill patients carries the risk of impairing gastrointestinal (GI) propulsion and could thereby lead to sepsis. The gut microbiota can influence GI motility, but whether GI microbial dysbiosis modifies GI peristalsis impairment by analgosedative drugs has not yet been analysed. This question was addressed in the guinea pig small intestine following a decrease of bacterial load by antibiotic pretreatment.

EXPERIMENTAL APPROACH

Guinea pigs were enorally (within the mouth) pretreated with meropenem, neomycin and vancomycin, and antibiotic-induced decrease of bacterial load was confirmed by 16S rDNA sequencing. Peristalsis in the isolated guinea pig small intestine was evaluated by determining the pressure threshold at which a peristaltic wave is triggered. The expression of factors that may be relevant to communication between GI microbiota and the motor system was examined at the mRNA (quantitative (q)PCR]) and/or protein (enzyme-linked immunosorbent assay [ELISA]) level.

KEY RESULTS

Antibiotic treatment disturbed the small intestinal microbiome as shown by decrease of bacterial load and reduced alpha diversity. Microbial dysbiosis did not affect peristalsis at baseline but blunted the ability of α2 agonists to inhibit peristalsis, while the anti-peristaltic effects of sufentanil, midazolam, neostigmine and propofol were inconsistently affected. These functional alterations were complemented by a decreased expression of α2-adrenoceptors, toll-like receptors (TRL) 3, 4 & 7, IFN-γ and iNOS.

CONCLUSION AND IMPLICATIONS

Antibiotic-induced decrease of bacterial load in the small intestine selectively blunts the ability of α2 agonists to impair peristalsis. This effect is explained by decreased α2-adrenoceptor expression, which may arise from TLR down-regulation in the dysbiotic gut.

Three-dimensional imaging and computational quantitation as a novel approach to assess nerve fibers, enteric glial cells, mast cells, and the proximity of mast cells to the nerve fibers in human sigmoid mucosal biopsies from healthy subjects

BACKGROUND

The visualization and quantitation of nerve fibers (NFs), enteric glial cells (EGCs), mast cells (MCs), and their spatial configurations in the human colonic mucosa represent considerable challenges due to the meshed network of these components and the arborizing of NFs in a three-dimensional (3D) structure.

NEW METHOD

We developed a novel approach combining tissue clearing, 3D imaging and computerized quantitation of NFs, EGCs and MCs in sigmoid mucosal biopsies of healthy subjects using a modified CLARITY tissue clearing protocol and adapting Imaris Surfaces Rendering Technology.

RESULTS

The cleared colonic biopsies are compatible with immunostaining using 10 marker antibodies and capable of generating 3D images rendering clear spatial views and computational quantitation of NFs, MCs, EGCs, in particular the proximity of MCs to NFs with Imaris 9.7-9.9.

COMPARISON WITH EXISTING METHODS

Our modified tissue clearing protocol shortened the membrane lipid removal time to 1 day from the original 1-2 weeks and total tissue clearing time to 3-4 days from the original 2-4 weeks. The 3D images displayed a clear spatial landscape of NFs, MCs and EGCs in the biopsies which cannot be portrayed with 2D images acquired from sections. Computerized quantitation is faster than measuring manually, allowing us to quantify a larger number of samples with less bias.

CONCLUSION

The novel approach enables faster tissue clearing/immunolabeling, high-quality 3D imaging and precise computational quantitation of NFs, cells and proximity of MCs to NFs in human sigmoid biopsies which may allow new insight to detect alterations in colonic-related diseases.

DILI prediction in drug development: present and future

INTRODUCTION

Idiosyncratic drug-induced liver injury (iDILI) results in significant patient morbidity and significantly increases the risk of drug development. The current methods to screen for iDILI risk are inadequate.

AREAS COVERED

The general mechanism of iDILI and the current methods to screen for iDILI are reviewed. Then the potential for new biomarkers is explored.

EXPERT OPINION

Better biomarkers of iDILI risk should be based on the mechanism of iDILI. In general, it is an adaptive immune response, specifically CD8+ cytotoxic T cells, that is responsible for hepatocyte cell death, not direct toxicity of the drug. Therefore, in vitro cytotoxicity assays represent an artifact not the mechanism of iDILI. Activation of the adaptive immune response leading to iDILI requires an innate immune response, in particular activation of antigen presenting cells. The innate immune response is immediate and unlikely to be idiosyncratic. For example, studies have found that incubation of hepatocytes with drugs causes the release of molecules that activate THP-1-derived macrophages. The response of hepatocytes, the release of damage-associated molecular pattern molecules (DAMPs), especially in extracellular vesicles, and the response of antigen presenting cells (APCs) are likely to provide better biomarkers of iDILI risk.

A Study of Sudden Cardiac Death in Schizophrenia

BACKGROUND

The incidence of sudden cardiac death (SCD) in patients with schizophrenia is three to four times higher than in the general population. While the majority of SCD in patients with schizophrenia are due to ischaemic or structural heart disease, about 10% of deaths remain unexplained. In recent reviews of premature deaths in patients with schizophrenia, these deaths were postulated to be secondary to malignant cardiac arrhythmias.

METHODS

A retrospective study conducted jointly by the Victorian Institute of Forensic Medicine and the Department of Genomic Medicine, The Royal Melbourne Hospital, Australia, was designed to identify novel genomic loci that link schizophrenia and sudden unexplained death. Cases included deceased patients over a 5-year period (2016-2021) with an in-life diagnosis of schizophrenia and an unascertained cause of death after comprehensive post-mortem histopathological and toxicological assessment. Individuals also required a source of DNA to be available.

RESULTS

Thirty-six individuals, 26 males and 10 females, age range 18-65 years, met the study inclusion criteria. Autopsy revealed 10 individuals had cardiomegaly, six had cardiac hypertrophy, six had a body mass index (BMI) >40, and four had mild myocardial fibrosis. Thirteen next of kin (NOK) (36%) consented to involvement in the study and 12 individuals (92%) underwent whole exome sequencing (WES) via a research platform. Two clinically actionable results were detected-a pathogenic Desmoplakin (DES) variant and a dihydropyrimidine dehydrogenase (DPYD) pharmacogenomic variant.

CONCLUSION

Our study, with comprehensive autopsy examination adds to the literature on SCD in schizophrenia. Genes that are currently associated with inherited arrhythmias or schizophrenia such as Neuregulin 1 were not found in this study group. The pathogenic DES variant would likely have been found had the family accepted referral to a Cardiac Genetics service, at the time of death.

Shedding new light on BACE1-mediated modulation of IL-6 signaling: Implications for neural activity and synaptic plasticity in mice

The pleiotropic cytokine IL-6 regulates numerous processes in the body, including neuronal functions. IL-6 either binds to membrane-bound receptor (mIL-6R) and triggers signaling via heteromerization with the signal transducer gp130 (classical signaling), or binds to its soluble form (sIL-6R) to act on cells that do not express mIL-6R (trans-signaling). The ß-secretase BACE1 can cleave gp130 as well as IL-6R and we hypothesized that BACE1 may alter neuron activity and synaptic transmission via modulation of IL-6 signaling. We used multielectrode array (MEA) recordings to monitor electrical activity of neuronal networks in acute cerebellar slices as well as long-term potentiation (LTP) induced by high-frequency stimulation in the hippocampus and to assess how exposure to IL-6 affects these processes. A pharmacological approach was applied to elucidate the contribution of trans-signaling involving BACE1. Spontaneous neuronal activity in cerebellar slices significantly decreased upon perfusion with IL-6 but not LIF and recovered during wash out. BACE1 inhibitors verubecestat or AZD3839 abolished the inhibitory effects of IL-6. Furthermore, IL-6 and LIF reversibly inhibited LTP in hippocampal slices, and in contrast to cerebellar neurons, BACE1 inhibitors verubecestat or AZD3839 did not abolish the inhibitory effect of IL-6 on LTP. Interestingly, a dramatic rebound effect on excitatory postsynaptic potentials was observed with BACE1 inhibitor AZD3839 but not verubecestat during wash out. Our results support relevant and differential roles of IL-6, LIF and BACE1 in pathways modulating neuronal discharge activity in the cerebellum and the synaptic plasticity in the hippocampus, and a possible involvement of this interaction in deficits of memory and learning.

A comprehensive review of scientifically reported phytochemicals to manage allodynia in chronic diabetes complications

BACKGROUND

The global prevalence of diabetes mellitus and its associated complications is increasing, impacting both developed and developing nations. One common complication is neuropathy and neuropathic pain, which often manifests as symptoms such as allodynia-a condition where patients experience pain from non-painful stimuli.

OBJECTIVE

This review seeks to explore scientifically validated medicinal plants and phytochemicals, presenting the findings in an organized format based on published literature.

METHODOLOGY

Data were searched in pubmed literature and only the scientifically reported phytochemicals were considered to include in this review.

KEY FINDINGS

The U.S. Food and Drug Administration (FDA) has not approved many medications targeting the root causes of neuropathy. Instead, various strategies are employed to manage the symptoms of allodynia. Research on plant-based ethno-pharmaceuticals aims to address the symptoms without affecting the disease's progression, which involves the gradual loss of nerve fibres from the extremities. This article delves into allodynia's different forms, implications, and underlying signalling mechanisms.

CONCLUSION

The hope is that further research on phytochemicals could lead to the development of therapies for managing various forms of allodynia in diabetic patients.

The therapeutic mechanisms of quercetin on inflammatory diseases: an update

Bioactive compounds derived from medicinal plants have become a significant source of drugs for inflammatory diseases treatment, particularly those caused by immune system abnormalities. Quercetin, a flavonol found in a wide variety of herbs, fruits, and vegetables, has garnered attention for its diverse biological properties, including anti-inflammatory, anticancer, and antiviral activities. Numerous in vivo and ex vivo studies have validated quercetin's role in treating inflammatory diseases through multiple pathways, mainly involving anti-oxidative stress, modulation of metabolism, intestinal flora, apoptosis, endoplasmic reticulum stress, and macrophage polarization, indicating it a promising pharmaceutical candidate for managing inflammatory and autoimmune conditions. We aimed to systematically review quercetin's anti-inflammatory activity and the mechanisms of action across various inflammatory diseases in the digestive, respiratory, endocrine, neurological, and osteoarticular systems. By summarizing the therapeutic potential of quercetin in these multifaceted conditions, this review seeks to provide a solid foundation for future clinical research and application strategies involving quercetin.

Attitudes, barriers, and facilitators toward tools supporting appropriate prescribing among healthcare professionals: a cross-sectional study

PURPOSE

Potentially inappropriate prescriptions are associated with an increased risk of drug-drug interactions, adverse events, and unfavorable clinical outcomes, especially in older adults. Although different tools to improve appropriate prescribing have been developed to support healthcare professionals, their application and the barriers to their use remain insufficiently explored. This study aimed to assess Italian healthcare professionals' knowledge of these tools and identify obstacles to their adoption.

METHODS

The study used a purposefully designed questionnaire to assess knowledge, adoption, and barriers related to appropriateness tools. The tools included were identified through a literature review and subsequently refined via expert consensus. Open-ended responses were analyzed using a conventional content analysis approach, and the analyses focused on differences across professional groups.

RESULTS

The survey collected 657 responses from pharmacists (35%), nurses (26%), general practitioners (22%), geriatricians/internists (9%), and other physicians (8%). The Beers and STOPP/START criteria were used by 38% and 34% of participants, respectively, with geriatricians and other physicians being the primary users. Additionally, 34% of participants reported using specific software integrated into their institutional computer systems. Among 294 respondents identifying barriers to appropriate prescribing, the most common were lack of time (14%), lack of knowledge (10%), and accessibility/costs of digital tools (8%). Key facilitators included specific training (38%), integrated software/apps (29%), and more time with patients (11%).

CONCLUSIONS

The adoption of tools supporting appropriate prescribing remains limited among healthcare professionals in Italy, with significant differences among professionals. Policymakers and healthcare institutions should focus on education, interprofessional collaboration, and user-friendly digital solutions to improve prescribing process and patient safety.

Expert Guidelines on the Use of Cariprazine in Bipolar I Disorder: Consensus from Southeast Asia

Background/Objectives: Cariprazine, a D3/D2 partial agonist, is one of the few recommended treatment options for bipolar 1 disorder (BP1D) in Southeast Asia. This study aims to generate insights from leading experts on the safe and effective use of cariprazine for BP1D, specifically by formulating practical recommendations not thoroughly covered in the existing literature. Methods: A formal consensus methodology using the modified RAND/UCLA Appropriateness Method was employed to develop consensus recommendations. The methodology included a targeted literature search, creation of clinical scenarios, two rounds of rating of the appropriateness of each scenario on a nine-point Likert scale by an expert panel of psychiatrists from Southeast Asia (n = 13), and a face-to-face discussion among the expert panel between the two rounds of rating. In the absence of disagreement, scenarios were classified as appropriate (7-9), equivocal (4-6), or inappropriate (1-3) based on median scores. Clinical scenarios were subsequently converted to consensus recommendations upon approval by the expert panel. Results: Most experts recommended a 4-8-week trial of cariprazine for bipolar depression (85%) and 3-4 weeks for acute mania/mixed (71%). For longer treatment, 61.5% and 69% recommended >1 year for acute mania/mixed and bipolar depression, respectively. Cariprazine was also considered suitable as first-line therapy, including for first-episode bipolar depression (Mdn: 8, IQR: 7-9) and first-episode mania (Mdn: 8; IQR: 8-9). Conclusions: The consensus recommendations may serve as practical guidance for clinicians to make informed decisions regarding the management of adult patients with BP1D, while considering the preferences and circumstances of individual patients.

Emerging cardiovascular toxicity associated with CDK4/6 inhibitors: real-world insights from the FDA adverse event reporting system

Background

Despite the unprecedented advancement of cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) in the treatment paradigm for hormone-dependent breast cancer, reports of cardiovascular adverse events (CVAEs) in both pivotal trials and real-world settings have garnered concerns.

Objectives

we aim to profile the incidence, clinical characteristics and risk factors of CVAEs associated CDK4/6i to provide a vigilant reference for cancer management.

Methods

The global disproportionality study was conducted by utilizing safety reports submitted to the FDA adverse event reporting system (FAERS) during the period from January 2015 to September 2024. Reporting odds ratio (ROR) was employed to identify and evaluate emerging CVAEs related to CDK4/6i. Multivariable logistic regression analysis was utilized to explore factors associated with CVAEs following CDK4/6i treatment. Parametric and cumulative distribution was used for the reported time-to-onset analysis.

Results

A total of 4,709 reports of CVAEs were identified with CDK4/6i, of which 4264 (90.5%) were classified as serious and 12.0% were fatal situation. The median onset time of CVAEs with CDK4/6i was 102 days (interquartile range [IQR], 25-374 days). Disproportionality analysis revealed that Abemaciclib was significantly increased signal of venous thromboembolism (ROR = 2.57 [2.24-2.96]), whereas cardiac arrhythmia (ROR = 2.51 [2.13-2.96]) and torsade de pointes/QT prolongation (ROR = 5.7 [5-6.5]) were showed significantly disproportionate for ribociclib. Meanwhile, cerebrovascular accident and thrombosis were showed significant associated with Abemaciclib ribociclib or palbociclib treatment. Some emerging potential CVAEs, such as myocardial infarction and pulmonary edema, were found to be significantly associated with ribociclib and palbociclib. Additionally, age exceeding 65 years and types of CDK4/6i were significant risk factors for the incidence of CDK4/6i-related CVAEs.

Conclusion

CVAEs might occur with a greater frequency in the context of CDK4/6i than had been previously acknowledged. Our study provide an overview of the incidence, characteristics and risk factors of CDK4/6i-related CVAEs, and also uncovered potential CVAEs that were not identified in the clinical trials.

Adverse events associated with four atypical antipsychotics used as augmentation treatment for major depressive disorder: A pharmacovigilance study based on the FAERS database

BACKGROUND

There is insufficient understanding of the long-term studies on adverse events (ADEs) in major depressive disorder (MDD) treated with atypical antipsychotics (AAPs), risks in patients with different psychiatric disorders, and differences between male and female patients.

METHODS

This study retrieved ADE reports for aripiprazole, quetiapine XR, brexpiprazole, and cariprazine from the FDA Adverse Event Reporting System (FAERS) for the time periods of FDA approval for MDD in the first quarter (Q1) of 2007, the Q1 of 2009, the Q1 of 2015, and the Q1 of 2022 respectively to the Q1 of 2024. Four algorithms (ROR, PRR, BCPNN, and MGPS) assessed ADE signals. We compared positive signal rates between MDD and non-MDD, and assessed sex differences in drug-related risks by ROR.

RESULTS

Patients with MDD had significantly higher rates of impulse control disorders (ICDs), obsessive-compulsive disorder (OCD), weight gain, extrapyramidal symptoms, and metabolic disorders compared to non-MDD (P < 0.05). Restless legs syndrome was associated with aripiprazole (P < 0.01), brexpiprazole (P < 0.01), and quetiapine XR. Serotonin syndrome, eosinophilic myocarditis, and angle closure glaucoma were new signals of aripiprazole in patients with MDD (P < 0.05). Female patients were more likely to gain weight (P < 0.05) with using aripiprazole, quetiapine XR, and brexpiprazole, whereas male patients with aripiprazole (P < 0.01) or brexpiprazole (P < 0.05) reported higher rates of ICDs and OCD.

CONCLUSION

It is suggesting a potential increased risk of various ADEs in patients with MDD when taking AAPs. The causal relationship and the exact mechanism between drugs and ADEs remains unclear, requiring further research.

Unraveling the mechanisms of irAEs in endometrial cancer immunotherapy: insights from FAERS and scRNA-seq data

Endometrial cancer (EC) is one of the most common malignancies in women. In recent years, immunotherapy has gradually become a significant treatment option. However, the mechanisms underlying immune checkpoint inhibitor (ICI)-related Adverse Events (AEs) remain poorly understood, posing significant challenges for optimizing clinical treatment strategies. This study aims to integrate the FAERS database and single-cell transcriptomic data to investigate potential mechanisms underlying PD-1 inhibitor-related AEs in EC immunotherapy, with a focus on exploring the PD-1-associated cell communication network and its potential compensatory activation pathways. Data related to AEs were extracted from the FAERS database. Disproportionality analyses, including Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS), were used to quantify signals of immune-related AEs (irAEs) associated with ICIs. We compared the occurrence timing and characteristics of AEs across different drugs. Subsequently, scRNA-seq was performed to analyze the tumor microenvironment of EC, focusing on PD-1-high expressing cell populations. Cell Communication was analyzed and key receptor-ligand pairs were identified. From Q1 2004 to Q3 2024, 21,838,627 drug-related reports were retrieved from FAERS, including 2,202 related to ICIs. ICI-associated irAEs involved 26 organ systems, with general disorders, gastrointestinal disorders, and injury/poisoning as the top System Organ Class (SOC). Fatigue, product use issues, and diarrhea were the most reported Preferred Terms (PTs). PD-1 inhibitors were associated with faster onset of AEs compared to PD-L1 inhibitors and Weibull modeling indicated an early failure-type AE pattern for both treatments. Single-cell analysis further demonstrated that PD-1 was highly expressed in CD8 + cytotoxic T cells and Tfh cells, which communicated with other cells within the tumor microenvironment through key receptor-ligand pairs such as CXCL12-CXCR4 and CXCL16-CXCR6. These findings suggested that PD-1 inhibitors may induce AEs through compensatory activation of the CXCR4 and CXCR6 pathways. This study suggested that PD-1 inhibitors may contribute to irAEs in EC, potentially through compensatory activation of the CXCR4 and CXCR6 pathways. By integrating FAERS and scRNA-seq data, key receptor-ligand interactions were identified, providing preliminary insights that could inform future efforts to optimize immunotherapy efficacy and mitigate AEs. However, further validation through clinical studies and mechanistic research is needed to confirm these findings.

Safety and quality of life of CDK4/6 inhibitors therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: a multicenter cross-sectional survey in China

BACKGROUND

To investigate the treatment pattern, adverse events, and quality of life of Chinese patients treated with CDK4/6 inhibitors (CDK4/6i) for hormone receptor (HR)+/HER2- advanced breast cancer.

METHODS

This multicenter cross-sectional survey enrolled patients with HR+/HER2- advanced breast cancer currently treated with CDK4/6i. The patients reported adverse events and quality of life during CDK4/6i treatment with a questionnaire and EORTC QLQ-BR23. Meanwhile, the oncologists collected the treatment information, adverse events and patient characteristics from medical record.

RESULTS

The analysis included 1254 patients. Most patients received only one CDK4/6i, of which 38.92% received dalpiciclib, 35.81% received abemaciclib, 15.07% received palbociclib, and 0.47% received ribociclib, while 9.73% patients were treated with two CDK4/6i sequentially. The oncologists reported adverse events occurred in > 81.17% of patients, and most common AEs were leukopenia (63.30%) and neutropenia (58.73%). The most common symptomatic adverse events reported by the patients were fatigue (34.13%), alopecia (14.02%) and weakness (11.30%). The incidence of alopecia in patients receiving dalpiciclib was lower than in those receiving palbociclib (8.81% vs. 16.40%, P < 0.001) and abemaciclib (8.81% vs. 19.82%, P = 0.027). Regard to quality of life, breast symptom scores were lower in the palbociclib group than in the abemaciclib group (3.84 ± 8.57 vs. 5.70 ± 9.81, P = 0.047). Patient reported alopecia was associated with body image, systemic therapy side effects, breast symptoms, arm symptoms, and upset by hair loss (all P < 0.001).

CONCLUSIONS

The safety profile of different CDK4/6i varies and has different impacts on patients' quality of life, which needs more attention in clinical practice.

Clinical and radiological features of pseudoprogression in brain tumors treated with immune checkpoint inhibitors

PURPOSE

Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment, resulting in the emergence of various immune-related adverse effects, including pseudoprogression (PsP). We sought to evaluate the characteristics of pseudoprogression in adults treated with ICIs for brain tumors (either primary or secondary), and to compare it with a non- PsP group.

METHODS

We retrospectively identified adults with brain tumors treated with ICIs at our institution between 2015 and 2023. Eligibility required one brain magnetic resonance imaging scan prior to treatment and another obtained within 6 months after treatment initiation. PsP was defined as radiological worsening within 6 months of ICI initiation, followed by stabilization or improvement without therapy modification. Demographic, clinical, and radiological characteristics were analyzed and compared between the PsP and the non-PsP groups.

RESULTS

Among 102 eligible patients, 10 (9.8%) developed PsP. Clinical symptoms occurred in 4 (40%) cases, all of which showed favorable outcomes with corticosteroid therapy. The PsP group had higher baseline tumor burden (p = 1.29 × 10⁻¹³) and higher PD-L1 expression (p < 0.001) than the non-PsP group. Median progression-free survival and overall survival were numerically longer in the PsP group with no significant difference.

CONCLUSIONS

PsP is a frequent complication of ICIs. We describe 4 symptomatic patients with pseudoprogression, challenging the iRANO criteria that recommend excluding this diagnosis in symptomatic cases. Clinical impairment should not automatically rule out pseudoprogression, and each case requires thorough evaluation. High PD-L1 expression and greater tumor burden may be associated with PsP, but further studies are needed to confirm these findings.

Psychiatric disorders with antiseizure medications in children: an analysis of the FDA adverse event reporting system database

BACKGROUND

Epilepsy is a chronic neurological disorder marked by a persistent tendency to generate seizures, leading to substantial cognitive, behavioral, and psychosocial consequences. This study investigated psychiatric disorder-related adverse events (AEs) associated with antiseizure medications (ASMs) in children using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS

This study conducted a comprehensive analysis of FAERS data from 2004 to 2024, focusing on psychiatric AEs in children with epilepsy or seizures treated with ASMs. Signal values were computed using reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS).

RESULTS

A total of 2539 preferred terms (PTs) were included, involving 25 system organ classifications (SOCs). Nervous system, skin and subcutaneous tissue, and psychiatric disorders are the three most common SOCs for ASMs in children. There were 24 ASMs, whose AEs involved psychiatric disorders, totaling 110 PTs and 214 drug-PT relationships. Psychotic symptoms (notably lorazepam and topiramate, n = 116 and 109), substance dependence and abuse (notably pregabalin and clonazepam, n = 291 and 110), and the other neuropsychiatric symptoms (notably levetiracetam and valproic acid, n = 70 and 62) were the common types of psychiatric disorder-related AEs of ASMs in children. A total of nine ASMs (brivaracetam, clonazepam, diazepam, eslicarbazepine, gabapentin, lamotrigine, lorazepam, perampanel, and tiagabine) were associated with suicidal and self-injurious behavior in children.

CONCLUSIONS

This study highlights psychiatric AEs of ASMs in children, offering critical insights to improve clinical medication practices and enhance treatment safety. Further research with broader clinical data is needed to promote safe and rational medication use.

Evaluation of post-market adverse events of lubiprostone: a real-world adverse event analysis from the FAERS database

OBJECTIVE

Lubiprostone is a selective intestinal chloride channel activator approved for treating chronic idiopathic constipation and constipation-predominant irritable bowel syndrome in adults. However, real-world data on its long-term safety, particularly regarding adverse events necessitating ongoing supplementation, remain limited.

METHODS

Data from the FDA Adverse Event Reporting System (FAERS) database were collected from the second quarter of 2006 to the fourth quarter of 2023. The data was normalized, and various signal quantification techniques such as Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-Item Gamma Poisson Shrinker (MGPS) were used for analysis.

RESULTS

A total of 1436 adverse event reports associated with lubiprostone were extracted from the FAERS database. These reports indicated a higher proportion of female patients compared to male patients (65.39% vs. 21.10%). Among those with explicit age data, the largest proportion of patients were 45-65 years old (20.6% of reports), followed by those ≥ 75 (19.9%), 18-45 (14.8%), and 65-75 years (10.1%). Adverse events induced by lubiprostone were observed in 24 System Organ Classes (SOCs), including common gastrointestinal disorders, general disorders, administration site conditions, as well as respiratory, thoracic, and mediastinal disorders, consistent with findings from clinical trials. Applying four algorithms simultaneously, 22 SOCS were detected, revealing a total of 57 positive response items, including 22 related to the digestive system. The most stringent algorithm, empirical Bayesian geometric mean (EBGM), highlighted severe gastrointestinal adverse reactions like gastric fistula (n = 5, ROR = 150.03, PRR = 149.87, IC = 7.21, EBGM = 147.71) and ischemic colitis (n = 19, ROR = 36.78, PRR = 36.63, IC = 5.19, EBGM = 36.51), which were not listed in the drug insert. This suggests the need for heightened vigilance towards these potential adverse reactions during clinical use.

CONCLUSIONS

Our study comprehensively evaluated the safety of lubiprostone in the post-marketing setting. Despite its therapeutic advantages, there is a potential for various systemic adverse effects. In addition to adverse events consistent with information from existing clinical trials and the insert, we discovered several serious localized adverse reactions and previously unreported systemic adverse reactions. These may be potentially associated with lubiprostone, but are not confirmed adverse effects. This will provide valuable evidence for future studies and further prospective clinical trials to confirm these results and elucidate the relationship between them, thus better guiding the clinical practice of lubiprostone.

Mapping the complexity of multiple sclerosis: a novel perspective on genetic, environmental, and neurobiological insights

Multiple sclerosis (MS) is the most common chronic demyelinating disease of the central nervous system (CNS) that mainly affects young adults. MS is a neuroinflammatory disease traditionally classified as an autoimmune disorder; however, its exact cause remains unknown. A wide variety of etiology and risk factors have been proposed to contribute, among which genetics and environment are the leading ones. The heterogeneity of MS can be attributed to a variety of factors, including diverse pathobiological mechanisms. In this narrative review, before discussing the most prevalent etiologies of MS and risk factors, we look at the main neurobiological pathways, blood-brain barrier (BBB) breakdown, and glymphatic system dysfunction. Several intrinsic factors, including genetics and epigenetic implications, hormones, immune system dysregulation, age, and microbiome, have definite roles in developing and worsening MS severity. However, external factors like viruses, bacteria, bioclimate impacts, environmental toxins, lifestyle factors, stress, and psychological factors revealed different or controversial impacts on MS disease. On the other hand, some nascent ones, such as intestinal dysbiosis and COVID-19, need to be further experimentally and clinically investigated. Both may contribute to MS by promoting inflammation and triggering autoimmune responses. Although it assumes that more than one factor contributes to MS development, finding the leading underlying cause and, consequently, the probable involvement mechanisms certainly could help take appropriate, efficient, and personalized therapeutic strategies.

Peripheral neuropathy associated with immunomodulatory drugs: a pharmacovigilance analysis based on the FDA adverse event reporting system database

BACKGROUND

Peripheral neuropathy requires early detection and intervention.

AIM

This study aimed to examine the association between immunomodulatory medications (IMiDs; thalidomide, lenalidomide, and pomalidomide) and peripheral neuropathy.

METHOD

OpenVigil 2.1 was used to retrieve data associated with IMiDs and peripheral neuropathy from the FDA Adverse Event Reporting System (FAERS). Disproportionality analysis was performed using the reporting odds ratio (ROR) and information components (IC) with a 95% credibility interval. Peripheral neuropathy signals were further prioritized using a rating scale.

RESULTS

We found 645 cases of peripheral neuropathy in 19,622 adverse event reports for thalidomide, 4849 cases in 197,866 adverse event reports for lenalidomide, and 933 cases in 40,582 adverse event reports for pomalidomide. Based on the clinical priority assessment, peripheral neuropathy was identified as having moderate clinical priority for the three immunomodulatory drugs (priority score = 6). In plasma cell myelomas, more peripheral neuropathy was reported for thalidomide [4.24% vs. 2.51%; ROR = 1.72 (1.42, 2.08); IC = 0.23 (0.05, 0.41)] and lenalidomide [2.71% vs. 1.06%, ROR = 2.59 (2.29, 2.91); IC = 0.14 (0.08, 0.20)] than in non-plasma cell myelomas. Peripheral neuropathy signals were detected in age groups 51-74, 63-74, and 51-62 for lenalidomide, thalidomide, and pomalidomide, respectively. No disproportionate gender differences were detected.

CONCLUSION

Our study indicated that the risk of peripheral neuropathy varied among patients with different indications and age subgroups for the same IMiD. Further investigation is required to verify these risk signals.

Analysis of therapeutic adherence to antidepressants and associated factors in patients with depressive disorder: A population-based cohort study

BACKGROUND

Non-adherence to antidepressants is a common problem that can significantly impact health outcomes in patients with depressive disorders. The aim of this study was to assess antidepressant adherence rates and identify factors associated with non-adherence in a population-based cohort of patients with depressive disorders, using real-world data.

METHODS

This retrospective, population-based cohort study used real-world data from patients diagnosed with depression in the Canary Islands, Spain, between 2013 and 2021. Adherence to antidepressants was assessed using the Medication Possession Ratio (MPR) over a 12-month follow-up period. Patients were classified as adherent if they had an MPR ≥ 0.8. To assess the association with sociodemographic, clinical, and lifestyle variables, multivariate logistic regression models were performed.

RESULTS

Among the 39,800 patients included, the overall adherence rate to antidepressants was 31.02 %. Older age, female sex, and the presence of multiple comorbidities were significantly associated with higher adherence rates. In contrast, alcohol, and tobacco use, as well as inadequate nutrition, were significantly linked with lower adherence.

CONCLUSION

Non-adherence to antidepressants is a highly prevalent problem in patients with depressive disorders. The findings of this study highlight the importance of identifying factors that influence adherence and developing specific interventions to improve treatment outcomes in this population.

FDA Adverse Event Reporting System (FAERS) Essentials: A Guide to Understanding, Applying, and Interpreting Adverse Event Data Reported to FAERS

The US Food and Drug Administration (FDA) performs safety assessments throughout the life cycle of a drug. Postmarketing safety surveillance promotes the identification of adverse events not known at the time of approval. Adverse event reports, also called individual case safety reports (ICSRs), submitted to FDA, are collected and stored in the FDA Adverse Event Reporting System (FAERS). ICSRs stored in FAERS may be reviewed-along with multiple other data sources-to detect potential safety signals and to perform a thorough evaluation to determine if a causal association exists between a drug and an adverse event. Although FAERS is a powerful tool for drug safety surveillance and assessment, understanding the content, application, and proper interpretation of the data contained in FAERS is necessary to reach scientifically and medically accurate conclusions and contextualize findings. This article aims to highlight considerations and explain fundamental concepts of FAERS to promote accurate analyses and appropriate interpretation of the data available.

Ribociclib-Induced hepatotoxicity exacerbated by fenugreek supplement use: A case report

BackgroundCyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, such as ribociclib, are the cornerstone of treatment for estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer. However, ribociclib is known to cause hepatotoxicity, and the role of other dietary supplements in this process is not well understood.Case PresentationA 47-year-old woman with metastatic breast cancer experienced grade III hepatotoxicity shortly after starting ribociclib. Despite discontinuing the drug, transaminase levels remained elevated. Using the the Roussel Uclaf Causality Assessment Method (RUCAM), a probable drug-induced liver injury was identified (score: 6). Upon disclosure of concurrent use of a fenugreek-based supplement, the revised RUCAM score dropped to 4. Further anamnesis revealed concurrent intake of a fenugreek-based supplement, prompting a revised RUCAM score of 4. The Naranjo Adverse Drug Reaction Probability Scale also indicated a possible association (score: 4). In contrast, the Drug Interaction Probability Scale (DIPS) scored 5, suggesting a probable herb-drug interaction between ribociclib and fenugreek.Management and OutcomeTransaminase levels gradually returned to normal within eight weeks of stopping ribociclib and four weeks after discontinuing the fenugreek supplement. The patient was counseled to avoid herbal supplements and initiated on palbociclib as an alternative CDK4/6 inhibitor. Liver function remained stable with no recurrent hepatotoxicity.DiscussionFenugreek modulates CYP3A4, which metabolizes ribociclib. This case highlights underrecognized herb-drug interactions in oncology.

What the diabetologist needs to know about the risk of non-arteritic anterior ischaemic optic neuropathy and GLP-1 receptor agonist use in patients with type 2 diabetes

AIM

Recent findings have raised concern about a potential association between semaglutide use and non-arteritic anterior ischaemic optic neuropathy (NAION), a rare form of permanent vision loss. This report provides a critical analysis of the current knowledge of GLP-1 receptor agonist (RA) use and risk of NAION in patients with type 2 diabetes (T2D).

METHODS

A literature search strategy was conducted for all English-language literature with a systematic review of key references up to April 2025.

RESULTS

Across studies including patients with T2D, the relative increase in NAION risk associated with the use of a GLP-1 RA, mainly semaglutide, ranged from nonsignificant to fourfold, while the absolute number of affected patients remained low. Given the retrospective design of the main studies, no causal link could be established between the use of GLP-1RAs and NAION. Some mechanistic hypotheses have been put forward without any being formally demonstrated to date. The profound metabolic and haemodynamic changes induced by GLP-1RAs might be the trigger of NAION in predisposed patients with an optic "disc-at-risk", a potent anatomical risk factor easily detected by ocular examination.

CONCLUSION

Pending studies clarifying this risk, these findings call for cautious use of GLP-1 RAs, particularly in patients with ocular risk factors. Given the widespread use of GLP-1RAs, clinicians should be aware of this potential risk, without overshadowing the remarkable benefit of GLP-1RAs in patients with type 2 diabetes.

Radiation recall dermatitis induced by abemaciclib with successful rechallenge: a case series and literature review

PURPOSE

To raise awareness of radiation recall dermatitis (RRD) in the context of radiotherapy combined with abemaciclib, and to explore its potential mechanisms, characteristics, and treatment options.

METHODS

We conducted a case series study reporting the first instances of RRD induced by abemaciclib in two women with locally advanced luminal breast cancer. Both patients experienced skin reactions in previously irradiated areas following abemaciclib administration. Additionally, a comprehensive literature review was performed to analyze the potential mechanisms of RRD, characteristics of radiotherapy, triggering drugs, and available treatments.

RESULTS

The case series demonstrated that abemaciclib can induce RRD in patients who have undergone radiotherapy. Both patients experienced significant skin reactions, which were successfully managed and resolved upon rechallenge with abemaciclib. The literature review highlighted the importance of recognizing RRD as a potential adverse effect of cyclin-dependent kinase 4/6 inhibitors (CDK4/6is), emphasizing the need for careful monitoring and appropriate management strategies.

CONCLUSION

Radiation recall dermatitis is a potential adverse effect of abemaciclib in patients receiving radiotherapy for breast cancer. Our findings underscore the importance of awareness and vigilance in managing patients on CDK4/6is.

Clinical practice recommendations on the use of neuromodulators in gastroenterology: AMG (Asociación Mexicana de Gastroenterología) - AMNM (Asociación Mexicana de Neurogastroenterología y Motilidad) expert joint review

Disorders of gut-brain interaction (DGBI) are characterized by alterations in both central and peripheral gut-brain axis (GBA)-related stimuli, and include esophageal, gastroduodenal, intestinal and anorectal disorders. Despite the fact that several pathophysiologic mechanisms are involved, the mainstay of treatment is neuromodulators, a heterogeneous group of drugs that act on pathways related to central and peripheral pain processing. This expert review by both the AMG (Asociación Mexicana de Gastroenterología) and AMNM (Asociación Mexicana de Neurogastroenterología y Motilidad) summarizes a series of updated clinical recommendations based on an exhaustive review of the literature, regarding the use of neuromodulators for DGBI, and is grouped into six sections: pharmacologic principles, definition, classification, mechanism of action, indications and use in each DGBI subtype, up/downscaling strategies, combination therapy, adverse events, joint use along with psychiatry in the case of comorbidities, and non-pharmacologic neuromodulation. Furthermore, drug selection process tips and dose personalization according to individual groups and sensitivities are provided, and special cases with DGBI-psychiatric comorbidity, as well as overlap with another DGBI, are considered.

Chlorogenic acid and intestinal health: mechanistic insights and therapeutic applications

Chlorogenic acid (CGA), a polyphenolic compound found in various plant species, has shown considerable potential in the treatment and management of several diseases due to its potent bioactive properties. Increasing evidence indicates that CGA exerts significant antioxidant, anti-inflammatory, and immunomodulatory effects by modulating key signaling pathways, including MAPK, PTEN/Akt, STAT3, and NF-κB/NLRP3. Furthermore, CGA enhances intestinal barrier function and positively influences the gut microbiota composition, making it a promising natural therapeutic agent for conditions such as inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer. This review provides a comprehensive summary of the most recent research on CGA's role in managing intestinal disorders. It first discusses CGA's chemical structure and pharmacokinetics (including absorption and metabolism), followed by an in-depth analysis of the mechanisms through which CGA mediates its therapeutic effects. These insights aim to advance our understanding of CGA's therapeutic potential in treating intestinal diseases.

EASL Clinical Practice Guidelines on the management of hepatitis B virus infection

The updated EASL Clinical Practice Guidelines on the management of hepatitis B virus (HBV) infection provide comprehensive, evidence-based recommendations for its management. Spanning ten thematic sections, the guidelines address diagnostics, treatment goals, treatment indications, therapeutic options, hepatocellular carcinoma surveillance, management of special populations, HBV reactivation prophylaxis, post-transplant care, HBV prevention strategies, and finally address open questions and future research directions. Chronic HBV remains a global health challenge, with over 250 million individuals affected and significant mortality due to cirrhosis and hepatocellular carcinoma. These guidelines emphasise the importance of early diagnosis, risk stratification based on viral and host factors, and tailored antiviral therapy. Attention is given to simplified algorithms, vaccination, and screening to support global HBV elimination targets. The guidelines also discuss emerging biomarkers and evolving definitions of functional and partial cure. Developed through literature review, expert consensus, and a Delphi process, the guidelines aim to equip healthcare providers across disciplines with practical tools to optimise HBV care and outcomes worldwide.

IRAK1/4/pan-FLT3 Kinase Inhibitors with Reduced hERG Block as Treatments for Acute Myeloid Leukemia

We report the optimization of a series of IRAK1/4/pan-FLT3 kinase inhibitors. These efforts have produced a key compound 27 that displays potent and selective inhibition of IRAK1, IRAK4, and FLT3, reduced block of hERG, and good pharmacokinetic properties. In a mouse xenograft model of acute myeloid leukemia (AML), 27 produces survival prolongation superior to that of gilteritinib, the leading FDA-approved FLT3 inhibitor currently used to treat AML.

Advancing herbal medicine safety: the need for a global pharmacovigilance approach

Herbal and traditional medicines (H&TMs) form a significant part of healthcare practices worldwide, often perceived as safe alternatives to conventional treatments. However, this perception has led to challenges in ensuring the safety and efficacy of these products, highlighting the critical importance of pharmacovigilance for herbal medicines. Over the past two decades, concerted efforts have been made globally to establish robust regulatory frameworks, leading to the emergence of phytovigilance systems. This review provides a comprehensive overview of the pharmacovigilance mechanisms in various countries, emphasizing recent developments, persistent challenges, and international perspectives in the field. The study underscores the need for systematic monitoring of adverse events (AEs) associated with herbal medicines to safeguard patient health. A key focus is placed on comparing the processes and mechanisms employed by different nations in building up safety monitoring systems, identifying gaps in knowledge and practices, and evaluating stakeholder awareness and involvement. The findings highlight the necessity of harmonizing global regulations under the guidance of the World Health Organization (WHO) to ensure uniformity and efficacy in reporting systems. This article advocates for a collaborative international approach, inclusive of all regulatory agencies, to enhance the safety of herbal therapies. By proposing comprehensive, standardized guidelines, it aims to bridge existing gaps and strengthen the pharmacovigilance infrastructure for herbal medicines globally, paving the way for improved patient safety and trust in traditional medical practices.

New drugs and their performance 10 years after approval: a systematic analysis

More than 10,000 drugs are available on today's market in Germany, with an increasing number receiving institutional approval every year. However, their general efficacy and utility for patients are often not thoroughly analyzed and, in some cases, remain questionable. The lack of systematic analysis for these parameters hinders learning from failures and successes. As a result, there is a risk of wasting resources by the pharmaceutical industry and approving new drugs that offer no additional benefit to patients in need of innovative treatments. Therefore, we set out to analyze the evolution of new drugs with innovative principles over 10 years after approval by the European Medicines Agency (EMA). We focused on drugs approved from 2004 to 2011, excluding protein kinase inhibitors and monoclonal antibodies, and identified 190 new drugs using the Arzneiverordnungsreport (AVR, Drug prescription report). With data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Fund, AOK), we analyzed their number of prescriptions, sales, defined daily doses (DDD), and daily costs. We then extended our analysis with a focus on Rote-Hand-Briefe (RHB, Direct Healthcare Professional Communication). We identified factors of success, which was defined as a drug appearing in the top 3000. We then conducted a detailed analysis of outliers in terms of sales, focusing on parameters such as indications, innovation regarding their mechanism of action, relative costs, competition, pharmacological properties, and clinical studies. The analysis of both the most and least successful, allowed us to identify clear correlations and determine potential red flags as well as green flags regarding pharmaceutical sales. Nearly half (49%) of the drugs analyzed met our success criterion, most very early (66% within the first 2 years). Most of these drugs also showed a notable progression in the drug rankings over the years. Thirty percent of all analyzed drugs received RHBs, with most of them (84% of the said 30%) receiving at least one deemed potentially influential regarding sales. The successful drugs were more often subject to these potentially influential RHBs than their non-successful counterparts, and most of the potentially influential RHBs were related to adverse drug reactions (53%) or indications or contraindications (14.8%). Based on the analysis of the tops and flops, we conclude that market success, measured by sales, is influenced by multiple factors. These include indication(s), innovation, the competitive landscape, costs, and pharmacological aspects as well as studies regarding the efficacy and the adverse drug reactions of the drug. These results underline the necessity of a multifactorial approach based on value-adding to assess potential new drugs by pharmaceutical companies.

Effects of Cholinesterase Inhibitor Medication on QTc Interval in Memory Clinic Patients

BACKGROUND

Cholinesterase inhibitors (ChEIs)-donepezil, rivastigmine, and galantamine-are beneficial in treating Alzheimer disease (AD). However, due to their impact on extra-cerebral acetylcholine signaling, concerns about cardiac adverse effects, including QT interval prolongation, persist. Despite this, evidence-based guidelines for electrocardiogram (ECG) monitoring during ChEI treatment are lacking, and prior studies on ChEIs and corrected QT intervals (QTc) yield inconsistent findings.

OBJECTIVE

This study aimed to investigate the association between ChEI use and changes in QTc intervals among older adults.

METHODS

We collected retrospective data from first-time visitors to the geriatric memory clinic of Turku City Hospital in 2017 and 2019. We included patients who were newly prescribed ChEIs and had ECG data available (n = 126, mean age 81.1 years, 56.3% female). QTc prolongation was defined as ≥460 ms in females and ≥450 ms in men. Paired t tests compared QTc means before and during ChEI use, and McNemar tests analyzed changes in the proportion of prolonged QTc.

RESULTS

Mean ± SD QTc (ms) before versus during ChEI use was: 420.8 ± 24.0 versus 423.9 ± 28.0 (P = .13) for donepezil; 416.0 ± 20.4 versus 416.5 ± 26.1 (P = .92) for galantamine; 416.1 ± 22.3 versus 409.6 ± 20.1 (P = .30) for rivastigmine; and 419.7 ± 23.4 versus 421.5 ± 27.3 (P = .34) for all ChEIs. Prolonged QTc occurred in 7.9% of patients before versus 12.7% during ChEI use (P = .21).

CONCLUSION AND RELEVANCE

We found no statistically significant association between ChEI use and QTc interval prolongation or an increased proportion of pathological QTc values during ChEI treatment. Larger studies are warranted to establish evidence-based recommendations on ECG monitoring during ChEI medication.

Discovery of novel tranylcypromine-indazole-based derivatives as LSD1 inhibitors for acute myeloid leukemia treatment

As an epigenetic enzyme, Lysine-specific demethylase (LSD1) has emerged as a promising target for cancer therapy. Based on the structure of tranylcypromine indazole, a series of LSD1 inhibitors have been designed and synthesized in this work. Most compounds have excellent inhibitory activity against LSD1. The representative compound, 9e, proved to be a highly effective LSD1 inhibitor, with an IC50 value of 9.85 nM, and demonstrated exceptional selectivity for LSD1 over both MAOs and hERG. Meanwhile, compound 9e exhibited significant inhibitory activity against leukemia cells, especially MV-4-11, HL-60, and THP-1 cells, with IC50 values of 1.40, 1.54, and 1.96 μM respectively. Additional biological mechanisms suggested that compound 9e could directly target LSD1 and inhibit LSD1 in MV-4-11 cells, resulting in a significant increase in the expression levels of H3K4me1/2. In addition, compound 9e was found to induce apoptosis and upregulate of CD86-expression in MV-4-11 cells. All these findings indicated that compound 9e, a tranylcypromine-indazole derivative, provided a structural basis for LSD1 inhibitors in the treatment of acute myeloid leukemia.

Colon-Targeted β3-Adrenoceptor Agonist Mirabegron Enhances Anticolitic Potency of the Drug via Potentiating the Nrf2-HO-1 Pathway

The selective agonist of β3-adrenergic receptor mirabegron (MBG), clinically used to treat overactive bladders, exerts beneficial effects in animal models of colitis. Here, we aimed to enhance the therapeutic activity and safety of MBG as an anticolitic drug by implementing colon-targeted drug delivery using a prodrug approach. MBG was azo-linked with salicylic acid (SA) to yield SA-conjugated MBG (MAS), which was conjugated with aspartic acid (Asp) and glutamic acid (Glu) to yield more hydrophilic derivatives: Asp-conjugated MAS (MAS-Asp) and Glu-conjugated MAS (MAS-Glu). MBG derivatives reduced the distribution coefficient and cell permeability of MBG, which were greater with the amino acid-conjugated MAS than with MAS. MBG derivatives were cleaved to release MBG in the cecal contents. Upon oral gavage, compared with MBG, MBG derivatives delivered greater amounts of MBG to the cecum while limiting the systemic absorption of MBG, and the amino acid-conjugated MAS exhibited a greater performance than MAS. In a rat colitis model, MBG derivatives were more effective than MBG in ameliorating colonic damage and inflammation, and the amino acid-conjugated MAS was more potent than MAS. MAS-Glu was therapeutically superior to sulfasalazine, a current drug to treat inflammatory bowel disease, against rat colitis. Moreover, MBG activated the anti-inflammatory nuclear factor erythroid 2-related factor 2 (Nrf2)-hemeoxygenase (HO)-1 pathway in inflamed colonic tissue, and the MAS-Glu-mediated amelioration of colitis was significantly compromised by an HO-1 inhibitor. Taken together, colon-targeted delivery of MBG may enhance the anticolitic activity, reduce the risk of systemic side effects of MBG, and elicit the therapeutic effects, at least partly by activating the Nrf2-HO-1 pathway.

Exploring the landscape of pharmacology education in Health Professions Programs: From historical perspectives to current approaches to teaching

Although health care professionals have been providing care as part of organized medical systems for millennia, therapeutics in its current sense only emerged in the nineteenth century. Teaching was conducted primarily using a lecture-based format. The Therapeutic Revolution of the 1930s heralded an explosion in the number and types of therapies available. As therapy has evolved so has teaching. Didactic teaching has, in many cases, been replaced by active learning and the health professions curriculum has shifted from an instructor-centered and discipline-based to a learner-centered, competence-based model. Pharmacology as a stand-alone discipline has largely been integrated into systems based or other modes of teaching. Assessments have also evolved from traditional examination formats that emphasized rote knowledge memorization to other assessment formats such as objective structured clinical examinations that emphasize evaluation of skills and attitudes. It has been challenging to define the best modalities given the wide variances in health professions education and the structure of health care systems internationally. Nonetheless, International collaboration efforts have been crucial to define core competencies which can then be used to guide curricular development. Challenges facing educators also include teaching ethical conduct of prescribing and how Artificial Intelligence (AI) can be used in both teaching and evaluation, suggesting the need for on-going dialogue, continuing professional development and research in these important areas.

Design and Synthesis of Tetrahydropyrrolo[3,4-c]Pyrazole Sigma-1 Receptor Ligands

This study presents a series of tetrahydropyrrolo[3,4-c]pyrazole-based compounds designed as sigma-1 receptor (S1R) ligands, focusing on optimizing affinity and reducing off-target effects. We synthesized various derivatives from commercially available precursors and, through radioligand binding assays, assessed their binding affinity for S1R and sigma-2 receptor (S2R). Compound 19 (AD417), containing a benzyl group and an amide substituent, demonstrated notable S1R affinity (Ki=75 nM) with 6-fold selectivity over S2R. Modifications on the pyrrolidine nitrogen were crucial in enhancing receptor interaction, as the protonated nitrogen likely interacts with Glu172 within the S1R binding site. Furthermore, to address hERG potassium ion channel inhibition, a known limitation in S1R drug development, we evaluated compound 19's cardiotoxicity potential. With an experimental hERG IC50 of 5.8 μM, significantly higher than verapamil's IC50 of 0.41 μM, and haloperidol's IC50 of 0.16 μM, compound 19 showed a safer profile, suggesting a reduced risk of cardiotoxicity. These findings underscore the role of nitrogen accessibility, structural flexibility, and functional group modifications in optimizing S1R ligand interactions and provide a promising foundation for developing safer S1R-targeted therapeutics with minimized hERG-related risks.

The role of antibacterial prophylaxis in high-risk neutropenia: benefits, risks, and current perspectives

PURPOSE OF REVIEW

To review the benefits, risks and specific considerations surrounding antibacterial prophylaxis (ABP) in adults with neutropenia, focusing primarily on high-risk patients with hematologic malignancies (HM) and/or hematopoietic cell transplantation (HCT).

RECENT FINDINGS

There has been an overall reduction in benefit of fluoroquinolone prophylaxis (FQP) observed in recent studies, with a lack of overall mortality benefit and less efficacy in reducing Gram-negative bloodstream infections (BSI) rates, which may be explained by increasing rates of fluoroquinolone resistance (both on center-level and patient-level) and improved early sepsis management. In the context of FQP, epidemiology of BSIs has changed with greater Gram-positive BSIs and resistant Gram-negative BSIs.

SUMMARY

ABP, most frequently FQP, has been introduced since the 1980s with the aim of reducing rates of infection and mortality. While older meta-analyses support its efficacy in reducing episodes of febrile neutropenia (FN), BSI and most importantly mortality, more recent data report lack of benefit on mortality, and negative impacts such as rising antimicrobial resistance, and in the broader literature, safety concerns for FQP. The role of ABP in neutropenia has been increasingly questioned and should be considered at a center-by-center and an individual-patient level.