International Society of Sports Nutrition Position Stand: Long-Chain Omega-3 Polyunsaturated Fatty Acids

Position Statement: The International Society of Sports Nutrition (ISSN) presents this position based on a critical examination of the literature surrounding the effects of long-chain omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation on exercise performance, recovery, and brain health. This position stand is intended to provide a scientific foundation for athletes, dietitians, trainers, and other practitioners regarding the effects of supplemental ω-3 PUFA in healthy and athletic populations. The following conclusions represent the official position of the ISSN: Athletes may be at a higher risk for ω-3 PUFA insufficiency.Diets rich in ω-3 PUFA, including supplements, are effective strategies for increasing ω-3 PUFA levels.ω-3 PUFA supplementation, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has been shown to enhance endurance capacity and cardiovascular function during aerobic-type exercise.ω-3 PUFA supplementation may not confer a muscle hypertrophic benefit in young adults.ω-3 PUFA supplementation in combination with resistance training may improve strength in a dose- and duration-dependent manner.ω-3 PUFA supplementation may decrease subjective measures of muscle soreness following intense exercise.ω-3 PUFA supplementation can positively affect various immune cell responses in athletic populations.Prophylactic ω-3 PUFA supplementation may offer neuroprotective benefits in athletes exposed to repeated head impacts.ω-3 PUFA supplementation is associated with improved sleep quality.ω-3 PUFA are classified as prebiotics; however, studies on the gut microbiome and gut health in athletes are currently lacking.

The role of the early-life gut microbiome in childhood asthma

Asthma is a chronic disease affecting millions of children worldwide, and in severe cases requires hospitalization. The etiology of asthma is multifactorial, caused by both genetic and environmental factors. In recent years, the role of the early-life gut microbiome in relation to asthma has become apparent, supported by an increasing number of population studies, in vivo research, and intervention trials. Numerous early-life factors, which for decades have been associated with the risk of developing childhood asthma, are now being linked to the disease through alterations of the gut microbiome. These factors include cesarean birth, antibiotic use, breastfeeding, and having siblings or pets, among others. Association studies have highlighted several specific microbes that are altered in children developing asthma, but these can vary between studies and disease phenotype. This demonstrates the importance of the gut microbial ecosystem in asthma, and the necessity of well-designed studies to validate the underlying mechanisms and guide future clinical applications. In this review, we examine the current literature on the role of the gut microbiome in childhood asthma and identify research gaps to allow for future microbial-focused therapeutic applications in asthma.

Fecal gut microbiota and amino acids as noninvasive diagnostic biomarkers of Pediatric inflammatory bowel disease

BACKGROUND AND AIMS

Fecal calprotectin (FCP) has limited specificity as diagnostic biomarker of pediatric inflammatory bowel disease (IBD), leading to unnecessary invasive endoscopies. This study aimed to develop and validate a fecal microbiota and amino acid (AA)-based diagnostic model.

METHODS

Fecal samples from a discovery cohort (de novo IBD and healthy controls [HC]) were used to develop the diagnostic model. This model was applied in a validation cohort (de novo IBD and controls with gastrointestinal symptoms [CGI]). Microbiota and AAs were analyzed using interspace profiling and liquid chromatography-mass spectrometry techniques, respectively. Machine learning techniques were used to build the diagnostic model.

RESULTS

In the discovery cohort (58 IBD, 59 hC), two microbial species (Escherichia coli and Alistipes finegoldii) and four AAs (leucine, ornithine, taurine, and alpha-aminoadipic acid [AAD]) combined allowed for discrimination between both subgroups (AUC 0.94, 95% CI [0.89, 0.98]). In the validation cohort (43 IBD, 38 CGI), this panel of six markers could differentiate patients with IBD from CGI with an AUC of 0.84, 95% CI [0.67, 0.95]). Leucine showed the best diagnostic performance (AUC 0.89, 95% CI [0.81, 0.95]).

CONCLUSIONS

Leucine might serve as adjuvant noninvasive biomarker in the diagnostic work-up of pediatric IBD. Future research should investigate whether the combination of leucine with FCP could improve specificity and may help tailor the course of diagnostics.

Melatonin-mediated intestinal microbiota homeostasis improves skin barrier damage involvement of gut-skin axis dysfunction in aging mice

Researches suggested a close connection between the gut microbiome homeostasis and skin health. Melatonin, as a multifunctional molecule, has the potential to regulate intestinal homeostasis and skin function. The study further explored the potential mechanism of melatonin in ameliorating skin barrier damage from the perspective of the association between intestinal microbiota and gut-skin axis in aging mice. We established a natural aging-induced skin barrier damage mouse model with or without melatonin supplementation and fecal microbiota transplantation (FMT) to clarify the crucial role of intestinal microbiota-mediated gut-skin axis in melatonin improving skin barrier damage. Furthermore, lipopolysaccharide (LPS)-treated mice and human keratinocytes cells (HaCaT) explored the modulation mechanism of melatonin. Our results suggested that aging induced skin barrier damage, including skin microbiota disorder and epidermal barrier structure disruption, and intestinal dysbiosis. Similarly, FMT from aging mice and LPS treatment rebuild the aging-like skin barrier damage. Whereas, melatonin or resatorvid (TAK242, the antagonist of LPS) supplementation restored all consequence in aging and LPS-treated mice. In vitro, melatonin restored LPS-induced skin barrier proteins deficiency in HaCaT via decreasing the expression level of TLR4 and MyD88 and increasing the content of p-ERK, p-GSK-3β and β-catenin proteins, while the improving effects was mimicked by pretreatment with a TLR4 antagonist but were blocked by GSK-3β agonists. Our study revealed that melatonin-mediated intestinal microbiota homeostasis suppresses LPS escape to restore the skin barrier function, including skin dysbiosis and epidermal structural disruption via LPS/TLR4/MyD88/ERK/GSK-3β/β-catenin loop, further improving skin aging in mice.

Establishment and validation of a clinical prediction model for colorectal adenoma risk factors

Colorectal adenomas are benign tumors of the colorectal mucosal epithelium that have malignant potential and are regarded as precancerous lesions of colorectal cancer, for which the specific risk factors are unclear. The present study aimed to identify independent risk factors for colorectal adenoma to develop a prediction model and test its predictive value. A retrospective analysis was performed using data from patients who underwent electronic colonoscopy at the Department of Proctology (Affiliated Hospital of Shandong University of Traditional Chinese Medicine; Jinan, China) from January 2013 to December 2023 and had polyps removed during colonoscopy. Patients with colorectal adenoma were included in the case group, whilst those with no visible abnormalities on endoscopy or with non-adenomatous polyps were included as a control group. The patients were randomly divided into a training and validation group in a 7:3 ratio. Variables were screened using single-component analysis and the filtered variables were employed in multivariate logistic regression to create a clinical prediction model. Finally, the model was internally and externally validated. A total of 730 patients were included in the present study, with 286 assigned to the case group and 444 to the control group. After the initial screening of 39 variables, 12 continued to the next round, resulting in four potential predictors including age, daily number of bowel movements, thrombin time and the number of polyps. A prediction model was created based on these variables. Regarding internal validation, the C-index was 0.7054 [95% confidence interval (CI), 0.6596-0.7512] and the prediction probability in the calibration curve was close to the diagonal line of the calibration graph, indicating that the prediction probability of the model was reasonable. Regarding external validation, the C-index in the validation cohort was 0.6306 (95% CI, 0.5560-0.7053) and the calibration curve also demonstrated good identification capabilities. The Hosmer-Lemeshow test revealed that the model had a reasonable calibration degree, with χ2=9.7893, degree of freedom=8 and P=0.28. The receiver operating characteristic curve and decision curve analysis for the training and validation cohorts demonstrated good efficacy and an ideal application value. In conclusion, the model constructed in the present study demonstrated moderate predictive accuracy for colorectal adenoma risk, laying the groundwork for early detection of colorectal adenoma and secondary prevention of colorectal cancer.

The dichotomous impacts of Semaphorin3E deficiency on exacerbating airway hyperresponsiveness, remodelling, and inflammation in type-2 low and type-2 high asthma models

Semaphorin3E has shown promise in alleviating the severity of asthma in preclinical studies; however, its role in the chronic features of type 2-low asthma remains unclear. Therefore, we aimed to investigate the role of Sema3E in a mouse model of severe asthma that exhibits a mix of granulocytic inflammation with neutrophils dominance and compared the results with those from the type-2 high eosinophilic asthma model. Sema3E knockout (KO) and wild-type (WT) mice were subjected to type-2 low and type-2 high regimens using house dust mite (HDM) combined with cyclic-di-GMP or HDM alone, respectively. Airway hyperresponsiveness parameters were measured using the FlexiVent ventilator. Bronchoalveolar lavage fluid cell phenotyping was performed by flowcytometry. Additionally, cytokines and antibodies were quantified using Mesoscale and ELISA. Mucus overproduction and goblet cell hyperplasia were visualized by Periodic-acid-Schiff staining. In comparison to WT mice, Sema3E KO mice exhibited an enhanced tissue resistance and tissue elastance in the type 2-low asthma model. Concurrently, Sema3E KO mice that were subjected to the type-2 low asthma model demonstrated an elevated presence of pulmonary neutrophils, dendritic cells, CD4 T cells, as well as increased levels of IL-17, TNF, IL-1β, CXCL-8, and MCP-1/CCL2 in comparison to their WT counterparts. However, in the type-2 high model, Sema3E KO mice exhibited a significant increase in goblet cell numbers and mucus overproduction, as well as enhancements in the number of eosinophils, IgE-producing B cells, and IL-4 levels compared to WT mice, highlighting the homeostatic role of Sema3E in the distinct immune niche of type-2 low and type-2 high asthma. Overall, our data showed that Sema3E is critical in modulating AHR, airway inflammation, and tissue remodelling in type 2 low and type 2 high phenotypes of asthma. The Sema3E regulatory network varies depending on the immunization regimen, affecting distinct parameters in type-2 low and type-2 high asthma models.

Probiotics in infants for prevention of allergic disease

RATIONALE

This is an update of a Cochrane review first published in 2007. Allergic disease and food allergy are prevalent, and contribute to a significant burden of disease on the individual, their family and the healthcare system. Probiotics are live bacteria that colonise the gastrointestinal tract, and have been studied in many clinical trials for preventing allergic conditions.

OBJECTIVES

To evaluate the benefits and harms of a probiotic, or a probiotic with added prebiotic ('synbiotic'), compared with control (placebo or no treatment) for preventing allergic diseases (asthma, eczema, allergic rhinitis) and dietary allergies in infants by two years of age.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and trial registries in December 2023. We reviewed the reference lists of studies selected for inclusion in this review, and systematic reviews on similar topics. We manually searched conference abstracts.

ELIGIBILITY CRITERIA

We included randomised controlled trials that compared a probiotic to a control, or a probiotic added to a prebiotic ('synbiotic'). We included enterally fed infants in the first six months of life without clinical evidence of allergic disease. We included probiotics added to human milk or infant formula, added in the manufacturing process or given separately.

OUTCOMES

Infant incidence by two years of age and childhood incidence (up to 10 years of age or up to the age of latest report between 2 and 10 years) of specific allergic diseases, including: asthma, eczema, allergic rhinitis, immunoglobulin E (IgE)-mediated food allergy, IgE-mediated cow's milk protein allergy. Events of anaphylaxis and potential harms including adverse effects, harms or infection with probiotic bacteria.

RISK OF BIAS

We used the Cochrane RoB 2 tool to assess bias in the studies.

SYNTHESIS METHODS

We used the random-effects (Mantel-Haenszel) model for meta-analysis where possible. Where this was not possible due to the nature of the data, we synthesised and interpreted individual studies separately. We used GRADE to assess the certainty of evidence for each outcome.

INCLUDED STUDIES

We included 24 studies (7077 mother-infant pairs). The studies were conducted in many parts of the world, including the USA, Europe, South Korea, Japan, Singapore and Australia, with most being conducted in Europe. Studies were published between 2001 and 2020. As some studies measured outcomes such as eczema using different criteria, we made assumptions to allow us to combine data.

SYNTHESIS OF RESULTS

Probiotics may result in little to no difference in asthma (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.65 to 1.44; 4 studies, 954 participants; low-certainty evidence), allergic rhinitis (RR 0.89, 95% CI 0.45 to 1.77; 5 studies, 1045 participants; low-certainty evidence) and IgE-mediated cow's milk protein allergy (RR 0.99, 95% CI 0.82 to 1.20; 4 studies, 259 participants; low-certainty evidence) by two years of age. Probiotics may result in a slight reduction in eczema by two years of age (RR 0.87, 95% CI 0.78 to 0.97; 18 studies, 3494 participants; low-certainty evidence); however, sensitivity analysis of the studies at low risk of bias showed little or no difference in eczema by two years of age (RR 0.86, 95% CI 0.69 to 1.07; 4 studies, 892 participants). Probiotic supplementation may have little to no effect on the incidence of food allergy by two years, but the evidence is very uncertain (RR 1.12, 95% CI 0.57 to 2.20; 3 studies, 857 participants; very low-certainty evidence). The evidence is very uncertain about the effect of synbiotics on eczema by two years of age (RR 0.88, 95% CI 0.52 to 1.47; 3 studies, 1235 participants; very low-certainty evidence). Synbiotics may result in little to no difference in food allergy by two years of age (RR 1.06, 95% CI 0.55 to 2.07; 1 study, 223 participants; low-certainty evidence). There were no data for the effect of synbiotics on asthma, allergic rhinitis and IgE-mediated cow's milk protein allergy by two years of age. Probiotic or synbiotic supplementation may result in little to no difference in potential harms including adverse effects, harms or infection with probiotic bacteria at any point during the study intervention by two years of age. There were no serious adverse events related to probiotics or synbiotics reported. We had some concerns about risk of bias for most studies, with only a few judged at low risk of bias. Some studies had a high risk of bias due to unclear randomisation, missing data and lack of prespecified intentions. Estimates were often imprecise, with wide CIs due to limited events. The limited data prevented subgroup analyses on infant risk factors and feeding methods for outcomes other than the effect of probiotics on eczema. Only three studies assessed synbiotic supplementation, leaving their role in allergic disease prevention uncertain. The included studies were mainly in high-income countries in many different areas of the world, but may have limited applicability to other regions.

AUTHORS' CONCLUSIONS

There is insufficient evidence to make conclusions about the effect of probiotics and synbiotics on preventing the development of allergic diseases by two years of age and during childhood up to 10 years of age. Although there were no serious adverse events reported for the use of probiotics in infants, incorporating probiotics and synbiotics into routine practice requires further information to support their use.

FUNDING

This Cochrane review had no dedicated funding.

REGISTRATION

Protocol (2007) available via https://doi.org/10.1002/14651858.CD006475. Original review (2007) available via https://doi.org/10.1002/14651858.CD006475.pub2.

Melatonin and the Skin: Current Progress and Perspectives for Human Health

Skin has the capacity to produce and metabolize melatonin into biologically active metabolites. These metabolites exert phenotypic activities through receptor-dependent and receptor-independent action, including direct antioxidant activity, interaction with regulatory proteins, and regulation of mitochondrial function. They can act on G-protein-coupled melatonin receptors (MT1 and MT2) as well as nuclear aryl hydrocarbon receptor and peroxisome proliferator-activated receptor γ receptors. These metabolic pathways, together with receptor- and nonreceptor-mediated phenotypic activities of its intermediates, has been identified as a cutaneous melatoninergic system. Its pharmacological modulation and topical application of melatonin or its metabolites can be used to prevent and treat skin disorders and cutaneous aging.

Sodium butyrate alleviates colitis by inhibiting mitochondrial ROS mediated macrophage pyroptosis

Inflammatory bowel disease (IBD) is a chronic inflammatory bowel disease with unclear causes and limited treatment options. Sodium butyrate (NaB), a byproduct of dietary fiber in the intestine, has demonstrated efficacy in treating inflammation. However, the precise anti-inflammatory mechanisms of NaB in colon inflammation remain largely unexplored. This study aims to investigate the effects of NaB on dextran sulfate sodium (DSS)-induced colitis in rats. The findings indicate that oral administration of NaB effectively prevent colitis and reduce levels of serum or colon inflammatory factors. Additionally, NaB demonstrated in vitro inhibition of RAW264.7 inflammation cytokines induced by LPS, along with suppression of the ERK and NF-κB signaling pathway activation. Moreover, NaB mitigated LPS and Nigericin-induced RAW264.7 pyroptosis by reducing indicators of mitochondrial damage, including increased mitochondrial membrane potential (JC-1) levels and decreased Mito-ROS production. NaB increases ZO-1 and Occludin expression in CaCo2 cells by inhibiting RAW264.7 pyroptosis. These results suggest that NaB could be utilized as a therapeutic agent or dietary supplement to alleviate colitis.

Sex-Based Differences in Asthma: Pathophysiology, Hormonal Influence, and Genetic Mechanisms

Asthma is a chronic inflammatory disease characterized by airway hyperresponsiveness, variable airflow obstruction, and persistent inflammation. While its pathophysiology is well established, growing evidence highlights significant sex-based differences in its prevalence, severity, and treatment response. Epidemiological studies indicate that asthma is more common in prepubertal boys but shifts toward a female predominance after puberty, with adult women experiencing higher morbidity and greater healthcare utilization. These disparities suggest a crucial role for sex hormones, genetic predisposition, and epigenetic regulation in asthma pathogenesis. Sex hormones modulate immune responses, contributing to disease progression. Estrogen enhances type 2 inflammation, increases eosinophilic infiltration, and upregulates IL-4 and IL-13 expression, leading to greater airway hyperreactivity in women. Additionally, progesterone fluctuations correlate with perimenstrual asthma exacerbations, while testosterone appears to exert a protective effect by dampening Th2-driven inflammation and airway remodeling. These hormonal influences contribute to sex-specific asthma phenotypes and treatment responses. Genetic and epigenetic factors further shape sex-related differences in asthma. The X chromosome harbors immune-regulatory genes, including TLR7 and TLR8, which amplify inflammatory responses in females. The sex-dependent expression of IL13 and ORMDL3 influences eosinophilic inflammation and airway remodeling. Epigenetic modifications, such as DNA methylation and microRNA regulation, further impact immune activation and corticosteroid responsiveness. For instance, Let-7 miRNAs modulate IL-13 expression, contributing to sex-specific inflammatory profiles. Environmental factors, including air pollution, obesity, and diet, interact with hormonal and genetic influences, exacerbating sex disparities in asthma severity. Obesity-related metabolic dysfunction promotes systemic inflammation, airway remodeling, and steroid resistance, disproportionately affecting women. Given these complex interactions, sex-specific approaches to asthma management are essential. Personalized treatment strategies targeting hormonal pathways, immune regulation, and metabolic health may improve outcomes for both men and women with asthma. Future research should focus on sex-based therapeutic interventions to optimize disease control and mitigate healthcare disparities.

Meta-analysis for alterations of IFN-γ, TNF-α and granzyme B levels in vitiligo patients

BACKGROUND

Vitiligo is a chronic autoimmune skin depigmenting condition. IFN-γ, TNF-α and granzyme B play key roles in vitiligo pathogenesis, some findings suggest their roles may be contradictory.

OBJECTIVE

We aimed to assess IFN-γ, TNF-α and granzyme B levels in blood and skin of vitiligo patients using a meta-analysis approach. Additionally, we evaluated their association with disease activity.

METHODS

A Meta-analysis was conducted using Review Manager 5.4 software. A total of 55 studies including 3,023 vitiligo patients and 2,534 controls were included in the study.

RESULTS

Pooled results from our meta-analysis indicated significantly elevated IFN-γ protein and transcript levels in blood and skin of vitiligo patients (p < 0.05). TNF-α protein levels were also significantly increased in blood and skin of vitiligo patients (p < 0.05). IFN-γ and TNF-α levels were significantly higher in the lesional skin as compared to non-lesional skin (p < 0.05). Furthermore, elevated levels of IFN-γ and TNF-α were observed in patients with active vitiligo (p < 0.05). Additionally, our study suggested a significant increase in granzyme B levels in vitiligo patients (p < 0.05).

CONCLUSION

Overall, the meta-analysis suggests that IFN-γ, TNF-α and granzyme B play a crucial role in vitiligo pathogenesis and progression and may serve as potential therapeutic targets for managing the disease. The PROSPERO registration no. for meta-analysis is CRD42024620274.

Cow's Milk Allergy in Breastfed Infants: What We Need to Know About Mechanisms, Management, and Maternal Role

Cow's milk allergy is one of the most prevalent food allergies in infancy. Exclusive breastfeeding is the recommended source of nutrition for the first six months of life, but some infants may develop cow's milk allergy due to the transfer of milk proteins such as β-lactoglobulin through breast milk. There are still many uncertainties about cow's milk allergy in breastfed babies. The purpose of this review is to summarize the latest findings mainly focused on immunological mechanisms and challenges in diagnosis. We pointed out which clinical signs in breastfed infants are associated with immediate IgE responses and which are linked to delayed non-IgE mechanisms or mixed IgE/non-IgE-mediated reactions. Since standard IgE tests are often useless in non-IgE cases, diagnosis typically involves dietary elimination and cow's milk challenge. This study addresses the controversial topic of maternal elimination diets, assessing the nutritional risks to both mothers and infants in relation to their possible benefits. It has also been discussed whether the microbiota signature could be a potential factor in both tolerance development and the risk of cow's milk allergy in early life. Overall, accurate diagnosis and personalized treatment plans are vital to prevent overdiagnosis and ensure proper growth while maintaining the practice of breastfeeding.

Microbiome and pediatric leukemia, diabetes, and allergies: Systematic review and meta-analysis

BACKGROUND

Despite the different pathologies and genetic susceptibilities of childhood ALL, T1DM and allergies, these conditions share epidemiological risk factors related to timing of infectious exposures and acquisition of the gut microbiome in infancy. We have assessed whether lower microbiome diversity (Shannon Index) and shared genus/species profiles are associated with pediatric ALL, allergies, and T1DM.

METHODS AND FINDINGS

Literature search was performed using PubMed, Embase, Cochrane, and Web of Science databases. Case-control, meta-analyses, and cohort studies were considered for inclusion. Inclusion criteria: (i) subjects age 1-18 years at diagnosis, (ii) reports effect of microbiome measured prior to/at time of diagnosis/first intervention (iii) outcome of ALL, allergies, asthma, or T1DM, (iv) English text. Exclusion criteria: (i) age < 1 or >18 years at diagnosis, (ii) Down Syndrome-associated ALL, (iii) non-English text, (iv) reviews, pre-print, or abstracts, (v) heavily biased studies. Abstract and full text screening were performed by two independent reviewers. Data extraction was performed by one reviewer following PRISMA guidelines. Data were pooled using a random-effects model. Eighty-eight studies were included in the analysis, with seventy-seven in the qualitative analysis and 54 in the meta-analysis. Cases were found to have lower alpha-diversity than controls in ALL (SMD:-0.78, 95%CI:-1.21, -0.34), T1DM (SMD:-1.26, 95%CI:-3.49, 0.96), eczema (SMD:-0.34, 95%CI:-0.56, -0.12), atopy (SMD:-0.06, 95%CI:-0.34, 0.22), asthma (SMD:-0.37, 95%CI:-1.16, 0.42), and food allergy (SMD:-0.11, 95%CI:-0.63, 0.41).

CONCLUSIONS

These results highlight similarities in the microbiome diversity and composition of children with ALL, T1DM, and allergies. This is compatible with a common risk factor related to immune priming in infancy and highlights the gut microbiome as a potentially modifiable risk factor and preventative strategy for these childhood diseases.

Molecular Insight into the Role of Vitamin D in Immune-Mediated Inflammatory Diseases

In the last decades, it has become increasingly evident that the role of vitamin D extends beyond the regulation of calcium homeostasis and the maintenance of bone health. A significant extraskeletal function of vitamin D is its role in modulating the immune system, particularly highlighted in the context of immune-mediated inflammatory diseases, where correlations between vitamin D status and genetic variations in the vitamin D receptor have been observed about the incidence and severity of these conditions. Additionally, different studies have reported the existence of immunomodulatory effects of vitamin D, particularly the effects of vitamin D on dendritic cell function, maturation, cytokine production, and antigen presentation, and that its deficiency may be associated with a sub-inflammatory state. In this sense, different clinical trials have been conducted to assess the therapeutic efficacy of vitamin D in different immune-mediated inflammatory disorders, including asthma, atopic dermatitis (AD), rheumatoid arthritis (RA), psoriasis, thyroid diseases, infectious diseases, and systemic lupus erythematosus (SLE). This review will provide a comprehensive overview of the current understanding of the molecular mechanisms underlying vitamin D's immunomodulatory properties, its role, and innovative therapeutic applications in patients with immune-mediated inflammatory diseases.

Bioinformatics meets machine learning: identifying circulating biomarkers for vitiligo across blood and tissues

Background

Vitiligo is a skin disorder characterized by the progressive loss of pigmentation in the skin and mucous membranes. The exact aetiology and pathogenesis of vitiligo remain incompletely understood.

Methods

First, a microarray dataset of blood samples from multiple patients with vitiligo was collected from GEO database.The limma package was used to analyze the microarray data and identify significant differentially expressed genes (DEGs). The merged microarray data were then used for WGCNA to identify modules of features genes. DEGs selected with the limma package and module genes derived from the WGCNA were intersected using the Venn package in R. Enrichment analyses were performed on the overlapping genes, including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes methodology. Advanced screening was performed using the least absolute shrinkage and selection operator and support vector machine techniques from the machine learning toolkit. CIBERSORT was used to analyse the immune cell composition in the microarray data to assess the relationships among these genes and immune cells. Biological samples were obtained from the patients, and gene expression analysis was performed to evaluate the levels of core genes throughout the progression of vitiligo. Finally, we obtained the microarray datasets GSE53146 and GSE75819 from the affected skin of vitiligo patients and GSE205155 from healthy skin to perform expression analysis and gene set enrichment analysis of the hub genes.

Results

Two hub genes, HMGA1 and PSMD13, were identified via machine learning and WGCNA. The analysis of immune cell infiltration suggested that different immune cell types could play a role in the progression of vitiligo. Moreover, these hub genes exhibited varying degrees of association with immune cell profiles. qRT-PCR analysis of blood samples from vitiligo patients revealed notable downregulation of the hub genes. Analysis of the microarray datasets derived from skin lesions revealed that HMGA1 expression levels remained relatively stable, whereas PSMD13 expression levels markedly decreased.

Conclusion

PSMD13 may influence vitiligo development via the Nod-like receptor signaling pathway and could serve as a potential diagnostic marker for evaluating skin lesions in vitiligo.

Boosting Immunity Through Nutrition and Gut Health: A Narrative Review on Managing Allergies and Multimorbidity

The increasing global burden of allergic diseases and multimorbidity underscores the urgent need for innovative strategies to strengthen immune health. This review explores the complex relationships among nutrition, gut microbiota, immune regulation, allergic diseases, and multimorbidity. It highlights how targeted nutritional and microbial interventions may influence disease outcomes. Dietary components and microbial metabolites dynamically modulated immune function, highlighting the critical role of the gut-immune-metabolism axis in disease pathogenesis and management. Personalized nutrition, guided by advances in diagnostics such as component-resolved diagnostics, basophil activation tests, and epigenetic biomarkers, allows for precise dietary interventions tailored to individual allergy phenotypes and multimorbidity profiles. The Mediterranean diet, breastfeeding, and microbiota-targeted therapies have emerged as effective strategies to enhance immune resilience, reduce inflammation, and manage allergic reactions. Technological advancements, including artificial intelligence-driven dietary assessments, wearable devices, and mobile applications, have further revolutionized personalized dietary management, enabling real-time, precise nutritional monitoring and intervention. Despite these advances, challenges in implementing personalized nutrition persist, including variability in dietary patterns, cultural and socioeconomic factors, and accessibility concerns. Future research should focus on long-term interventional and longitudinal studies to validate precision nutrition strategies and enhance clinical applicability. This integrative approach, combining nutrition, microbiome science, technology, and personalized healthcare, holds substantial promises for sustainable disease prevention and enhanced immune resilience across diverse populations.

Identification of potential diagnostic markers and molecular mechanisms of asthma and ulcerative colitis based on bioinformatics and machine learning

Backgrounds

Asthma and ulcerative colitis (UC) are chronic inflammatory diseases linked through the "gut-lung axis," but their shared mechanisms remain unclear. This study aims to identify common biomarkers and pathways between asthma and UC using bioinformatics.

Methods

Gene expression data for asthma and UC were retrieved from the GEO database, and differentially expressed genes (DEGs) were analyzed. Weighted Gene Coexpression Network Analysis (WGCNA) identified UC-associated gene modules. Shared genes between asthma and UC were derived by intersecting DEGs with UC-associated modules, followed by functional enrichment and protein-protein interaction (PPI) analysis. Machine learning identified hub genes, validated through external datasets using ROC curves, nomograms, and boxplots. Gene Set Enrichment Analysis (GSEA) explored pathway alterations, while immune infiltration patterns were analyzed using the CIBERSORT algorithm. Molecular docking (MD) was performed to predict therapeutic compounds, followed by molecular dynamics simulations on the top-ranked docked complex to assess its binding stability.

Results

A total of 41 shared genes were identified, linked to inflammatory and immune pathways, including TNF, IL-17, and chemokine signaling. Four key hub genes-NOS2, TCN1, CHI3L1, and TIMP1-were validated as diagnostic biomarkers. Immune infiltration analysis showed strong correlations with multiple immune cells. Molecular docking identified several potential therapeutic compounds, with PD 98059, beclomethasone, and isoproterenol validated as promising candidates. The stability of the TIMP1-Beclomethasone complex was determined through molecular dynamics simulations.

Conclusion

This study highlights NOS2, TCN1, CHI3L1, and TIMP1 as potential biomarkers and therapeutic targets for asthma and UC, providing insights into shared mechanisms and new strategies for diagnosis and treatment.

Comprehensive single-cell transcriptomic reveals different destinies of melanocytes and dynamic changes of immune microenvironment in a psychological stress-induced leukoderma and leukotrichia mouse model

BACKGROUND

Vitiligo is an acquired skin depigmentation disorder often accompanied by leukoderma and leukotrichia. Half of vitiligo patients experience episodes of stress.

METHODS

We established a chronic unpredictable mild stimulation (CUMS) model in C57BL/6 J mice to simulate chronic mental stress-induced leukoderma and leukotrichia. Single-cell RNA sequencing was performed to determine the immune landscape and to characterize the relationship between immune-stromal cells. Immunohistochemistry was employed for validation.

RESULTS

We discovered a similar pro-inflammatory micro-environment composed of keratinocytes and fibroblasts similar to that in human vitiligo. Macrophages in CUMS mice expressed high levels of inflammatory factors and were inclined to an M1 pro-inflammatory phenotype. Two distinct clusters of melanocytes were also identified: Mel2, defined as melanocyte stem cells, and Mel3, defined as mature melanocytes. Mel2 cells were prone to pyroptosis and necroptosis, while Mel3 cells were susceptible to oxidative stress, mitochondrial dysfunction, and ferroptosis. Compared with control mice, higher expression of CXCL16 on dendritic cells and of the CXCL16 ligand, CXCR6, on γδT cells were observed in leukoderma. Dendritic cells and natural killer T cells in the CUMS mouse spleen exhibited elevated levels of CXCL16 and CXCR6, respectively. Activation of the CXCL16-CXCR6 axis and a non-specific immune response in our CUMS model might imitate chronic mental stress-induced vitiligo in humans better than CD8 + cytotoxic T lymphocyte-mediated models.

CONCLUSIONS

We discovered two melanocyte clusters with distinct fates and a pro-inflammatory micro-environment with CXCL16-CXCR6 axis activation of antigen-presenting cells and other innate immunocytes that might provide new insights into the pathogenesis of stress-induced vitiligo.

Skin and systemic infections in children with atopic dermatitis: review of the current evidence

Atopic dermatitis is a chronic, pruritic inflammatory skin disorder that affects approximately 2%-42% of children worldwide. Its course is frequently complicated by secondary bacterial, viral, and fungal infections, which can exacerbate disease severity and hinder treatment outcomes. These infections are thought to arise due to a disrupted skin barrier, reduced antimicrobial peptide production, alterations in the skin microbiome, and Th2-dominant inflammatory response. Identifying the most prevalent and pathogenic microorganisms in patients with AD is critical for early diagnosis, effective management, and prevention of complications. This review provides an updated synthesis of current knowledge on the infectious agents implicated in AD pathogenesis, summarizing recent findings on the epidemiology, microbial interactions, and immune mechanisms involved. Furthermore, it provides an overview of the latest therapeutic strategies for managing AD and its associated infections. By integrating recent insights into pathogenesis and treatment, this study offers a comprehensive perspective on the evolving landscape of AD management in children.

IL-10 sensing by lung interstitial macrophages prevents bacterial dysbiosis-driven pulmonary inflammation and maintains immune homeostasis

Crosstalk between the immune system and the microbiome is critical for maintaining immune homeostasis. Here, we examined this communication and the impact of immune-suppressive IL-10 signaling on pulmonary homeostasis. We found that IL-10 sensing by interstitial macrophages (IMs) is required to prevent spontaneous lung inflammation. Loss of IL-10 signaling in IMs initiated an inflammatory cascade through the activation of classical monocytes and CD4+ T cell subsets, leading to chronic lung inflammation with age. Analyses of antibiotic-treated and germ-free mice established that lung inflammation in the animals lacking IL-10 signaling was triggered by commensal bacteria. 16S rRNA sequencing revealed Delftia acidovorans and Rhodococcus erythropolis as potential drivers of lung inflammation. Intranasal administration of these bacteria or transplantation of human fecal microbiota elicited lung inflammation in gnotobiotic Il10-deficient mice. These findings highlight that IL-10 sensing by IMs contributes to pulmonary homeostasis by preventing lung inflammation caused by commensal dysbiosis.

Melatonin Interplay in Physiology and Disease-The Fountain of Eternal Youth Revisited

Melatonin (N-acetyl-5-methoxytryptamine) is a hormone associated with the regulation of biological rhythms. The indoleamine is secreted by the pineal gland during the night, following a circadian rhythm. The highest plasmatic levels are reached during the night, whereas the lowest levels are achieved during the day. In addition to the pineal gland, other organs and tissues also produce melatonin, like, for example, the retina, Harderian glands, gut, ovaries, testes, skin, leukocytes, or bone marrow. The list of organs is extensive, including the cerebellum, airway epithelium, liver, kidney, adrenals, thymus, thyroid, pancreas, carotid body, placenta, and endometrium. At all these locations, the availability of melatonin is intended for local use. Interestingly, a decline of the circadian amplitude of the melatonin secretion occurs in old subjects in comparison to that found in younger subjects. Moreover, genetic and environmental factors are the primary causes of diseases, and oxidative stress is a key contributor to most pathologies. Numerous studies exist that show interesting effects of melatonin in different models of disease. Impairment in its secretion might have deleterious consequences for cellular physiology. In this regard, melatonin is a natural compound that is a carrier of a not yet completely known potential that deserves consideration. Thus, melatonin has emerged as a helpful ally that could be considered as a guard with powerful tools to orchestrate homeostasis in the body, majorly based on its antioxidant effects. In this review, we provide an overview of the widespread actions of melatonin against diseases preferentially affecting the elderly.

Effect of seasonal exposure in aeroallergen-sensitised patients with irritable bowel syndrome-diarrhoea

Background

Pollen allergy may influence irritable bowel syndrome (IBS) symptoms; however, available data are scant.

Aims

This study aims to assess symptom variability in atopic IBS patients.

Methods

We retrospectively analysed consecutive adult IBS patients evaluated between 2021 and 2024. Patients from the overall IBS cohort and the IBS-diarrhoea (IBS-D) subgroup were classified according to their sensitisation into grass-positive, house dust mite (HDM)-positive, or unsensitised. Symptom burden was assessed using the gastrointestinal symptom rating scale (GSRS) and a visual analogue scale for abdominal pain/distension, both outside the season period (T0) and during the pollination season (T1).

Results

A total of 61 IBS patients were recruited (median age 34 years, IQR 25-50, F:M ratio 3.6:1), including 38 patients (62.8%) with IBS-D (median age 30 years, IQR 28-47, F:M ratio 2.8:1). Atopy was common in the IBS-D subgroup, particularly with respiratory manifestations. The mean GSRS significantly (p < 0.01) increased at T1 (variance of 3.4 points) only in grass-sensitised patients as opposed to those sensitised to HDM or unsensitised ones; this effect was present only in the IBS-D subgroup, while no significant variation was observed in the overall cohort.

Conclusions

Pollination season influences symptoms in IBS-D patients sensitised to seasonal allergens.

Gut microbiota dysbiosis orchestrates vitiligo-related oxidative stress through the metabolite hippuric acid

BACKGROUND

Vitiligo, a depigmenting autoimmune skin disease characterized by melanocyte dysfunction or death, is known to be associated with an imbalance in gut microbiota. Oxidative stress plays a critical role in the pathogenesis of vitiligo. However, the complex promising interaction between abnormal accumulation of reactive oxygen species (ROS) in the skin and gut microbiota has remained unclear.

RESULTS

Here, we compared transcriptome data of vitiligo lesions and normal skin and identified a high expression of oxidative stress-related genes in vitiligo lesions. We also established a vitiligo mouse model and found that the presence of gut microbiota influenced the expression of ROS-related genes. Depletion of gut microbiota reduced abnormal ROS accumulation and mitochondrial abnormalities in melanocytes, significantly improving depigmentation. Our findings from manipulating gut microbiota through cohousing, fecal microbiota transplantation (FMT), and probiotic supplementation showed that transferring gut microbiota from mice with severe vitiligo-like phenotypes exacerbated skin depigmentation while probiotics inhibited its progression. Targeted metabolomics of fecal, serum, and skin tissues revealed gut microbiota-dependent accumulation of hippuric acid, mediating excessive ROS in the skin. Elevated serum hippuric acid levels were also confirmed in vitiligo patients. Additionally, a microbiota-dependent increase in intestinal permeability in vitiligo mice mediated elevated hippuric acid levels, and we found that hippuric acid could directly bind to ROS-related proteins (NOS2 and MAPK14).

CONCLUSIONS

Our results suggested the important role of gut microbiota in regulating vitiligo phenotypes and oxidative stress. We identified hippuric acid, a gut microbiota-host co-metabolite, as a critical mediator of oxidative stress in vitiligo skin and its binding targets (NOS2 and MAPK14), resulting in oxidative stress. Validation in a small human cohort suggested that hippuric acid could serve as a novel diagnostic biomarker and therapeutic target for vitiligo. These findings provided new insights into how gut microbiota regulates skin oxidative stress in vitiligo and suggested potential treatment strategies for the disease. Video Abstract.

Pathobiology and Regulation of Eosinophils, Mast Cells, and Basophils in Allergic Asthma

Eosinophilia is a hallmark of allergic disorders, including asthma, allergic rhinitis, and atopic dermatitis. The onset and maintenance of allergic inflammation in atopic adults involves the activation of selective hemopoietic processes and the migration of mature and immature eosinophils to allergic tissue, where these cells release mediators of inflammation that participate in the regulation of inflammation. Eosinophils function in close cooperation with basophils and mast cells in allergic tissue, where crosstalk between these central effector cells regulates the inflammatory process. This chapter will review the cellular events leading to the accumulation of eosinophils and their progenitors in the airways in allergic asthma, with a particular focus on models of allergen-induced allergic inflammation. Inhaled allergen challenges in allergic asthmatics have advanced understanding of the pathogenesis of allergen exposure leading to early and late asthmatic responses and the associated airway hyperresponsiveness and type 2 airway inflammation. This chapter will also discuss the mechanisms of commonly used asthma therapies on allergen-induced eosinophilia and compare the effects of novel therapies targeting specific immune pathways for a better understanding of how to regulate airway eosinophil levels in patients with asthma.

Photobiomodulation of Blue Light Enhance Melanoma Cellular Recovery Following Viral Infection via Mitochondrial Pathways

This study aimed to elucidate the response of B16F10 cells to blue light following infection with an empty adenoviral vector (Adv). Twenty-four hours post-infection, the B16F10 cells underwent phototherapy, and a range of cellular parameters were assessed, including cell viability, melanin content, cell cycle progression, reactive oxygen species (ROS) production, mitochondrial membrane potential (MMP), apoptosis, necrosis, lactate dehydrogenase (LDH) release, and autophagy. The findings indicated that Adv infection elevated melanin content and autophagy, resulting in G1 phase cell cycle arrest. In comparison to the control group, light-treated, Adv-infected cells exhibited reduced inhibition rates, LDH release, apoptosis, and necrosis, while MMP and ROS levels were elevated. The study concluded that although Adv, as a gene delivery vector in conjunction with light therapy, significantly modulated melanin content and autophagy. Moreover, while melanin's light absorption capacity mitigated MMP reduction, the resultant excitation molecules generated ROS, enhancing oxidative stress.

Melatonin rescues cell respiration impaired by hypoxia/reoxygenation in aortic endothelial cells and affects the mitochondrial bioenergetics targeting the F1FO-ATPase

Melatonin is evaluated as a potential molecular therapy to counteract mitochondrial dysfunction caused by hypoxia/reoxygenation (H/R) in aortic endothelial cells (pAECs). The mitochondrial permeability transition pore (mPTP) opening undergoes a desensitizing action coupled with a reduction of superoxide anion production in mitochondria treated with melatonin. The effect on mPTP has been attributed to the direct interaction of melatonin with the hydrophilic F1 domain of Ca2+-activated F1FO-ATPase. Mutual exclusion analysis highlights an overlapping binding site between melatonin and the specific F1 inhibitor NBD-Cl. The results are corroborated by melatonin inhibition of ATPase activity of the purified F1 domain in the presence of Ca2+, but not in the presence of natural cofactor Mg2+. Moreover, the impairment of bioenergetics parameters in pAECs metabolism and the increase of oxidative stress arising by H/R injury have been rescued in cells protected by melatonin treatment.

Impact of Vitamin D3 Supplementation on Symptom Severity & IgE in Persistent Allergic Rhinitis

The potential for vitamin D₃ supplementation as adjunctive therapy in allergic rhinitis (AR) management remains a topic of considerable interest. Studies have investigated the relationship between serum vitamin D levels and AR severity, with conflicting results. To evaluate the impact of vitamin D₃ supplementation on symptom severity and IgE levels in patients with persistent allergic rhinitis (AR), and to assess the role of sustained supplementation in achieving long-term benefits. A randomized, double-blind, prospective interventional study was conducted at a teaching institute in India with 600 AR patients randomized into three groups: Group A (intranasal corticosteroids and placebo), Group B (intranasal corticosteroids and vitamin D₃ supplementation with maintenance doses), and Group C (intranasal corticosteroids and vitamin D₃ without maintenance doses). A control group of 200 healthy individuals was also included. Vitamin D₃, IgE levels, and Total Nasal Symptom Score (TNSS) were measured at baseline, 2 months, and 6 months. At baseline, 81.66% of AR patients had suboptimal vitamin D₃ levels compared to 65% in the control group. Group B showed the most significant improvement in vitamin D₃ levels, with 80% achieving normal levels by 6 months. TNSS and IgE levels also improved significantly in Group B, with sustained reductions compared to Groups A and C (p < 0.001). Group C showed a rebound in symptoms and IgE levels after discontinuation of supplementation. Sustained vitamin D₃ supplementation significantly improves symptom severity and IgE levels in patients with persistent AR. These findings suggest vitamin D₃ as a promising adjunct to standard AR treatment.

Optimised arylbiamidine derivative as potent in vivo antimelanoma agent: Drug-to-target approach reveals nanomolar GSK3β inhibition

Melanoma, particularly in its metastatic form, remains highly lethal. Despite advancements in treatment, nearly half of melanoma patients experience therapeutic failure due to resistance. Consequently, the development of new antimelanoma drugs is critical for those unresponsive to current therapies. Here, we report the discovery of a potent antimelanoma scaffold and a promising inhibitor of glycogen synthase kinase 3 beta (GSK3β) through a drug-to-target approach. A phenotypic screening of arylbiamidine derivatives identified lead compound 35, N-(N-(benzo[d]thiazol-2-yl)carbamimidoyl)pyrazine-2-carboximidamide, which exhibited the highest in vitro potency against melanoma cell lines and nanomolar inhibition of oncogenic GSK3β (IC50 = 73.8 nM). Moreover, compound 35 demonstrated a favourable pharmacological profile, significantly reducing tumour growth in vivo in an A375 xenograft mouse model.

Photoaging: Current Concepts on Molecular Mechanisms, Prevention, and Treatment

Photoaging is the consequence of chronic exposure to solar irradiation, encompassing ultraviolet (UV), visible, and infrared wavelengths. Over time, this exposure causes cumulative damage, leading to both aesthetic changes and structural degradation of the skin. These effects manifest as rhytids, dyschromia, textural changes, elastosis, volume loss, telangiectasias, and hyperkeratosis, collectively contributing to a prematurely aged appearance that exceeds the skin's chronological age. The hallmarks of photoaging vary significantly by skin phototype. Skin of color tends to exhibit dyschromia and features associated with "intrinsic" aging, such as volume loss, while white skin is more prone to "extrinsic" aging characteristics, including rhytids and elastosis. Moreover, susceptibility to different wavelengths within the electromagnetic spectrum also differs by skin phototype, influencing the clinical presentation of photoaging, as well as prevention and treatment strategies. Fortunately, photoaging-and its associated adverse effects-is largely preventable and, to some extent, reversible. However, effective prevention and treatment strategies require careful tailoring to an individual's skin type. In this review, we summarize molecular mechanisms underlying photoaging, examine its clinical manifestations, outline risk factors and prevention strategies, and highlight recent advancements in its treatment.

Study of Serum Metabolic Biomarkers and Prediction Models of Cantharidin-Induced Nephrotoxicity in Rats Based on Dynamic Metabolomics

The clinical application of cantharidin (CTD) is seriously limited due to its nephrotoxicity. Therefore, this study aims to investigate sensitive biomarkers for the evaluation and prediction of nephrotoxicity induced by CTD in rat. A total of 80 rats were randomly divided into four groups: control group and three doses of CTD groups. After 0, 1, 5, 15, and 28 days of intragastric administration, rat serum and urine were collected for biochemical indexes, then serum was used for metabolomic analyses, and rat kidney was collected for pathological and ultrastructural observation. The levels of serum crea (Scr), blood urea nitrogen (BUN), urea, urine crea (Ucrea), and urinary microalbumin (UmALB) were significantly increased after administration of different doses of CTD (p < 0.05). Additionally, histopathology and cell ultrastructure observation of kidney showed significant cell inflammatory infiltration and glomerular edema. Seven metabolic biomarkers including 6-hydroxymelatonin were significantly disturbed by CTD. The CatBoost Classifier prediction model was used to establish the CTD nephrotoxicity prediction model, and the prediction accuracy and precision were 0.645 and 0.640, respectively. Moreover, 6-hydroxymelatonin was found to be most useful biomarkers for evaluating the CTD nephrotoxicity. Finally, the seven metabolic biomarkers were found mainly involved in pyruvate metabolism, pantothenate and CoA biosynthesis.

E2F transcription factor 1 as a potential prognostic biomarker and promotes tumor proliferation in skin cutaneous melanoma

Cutaneous melanoma (SKCM) is a highly aggressive malignancy with an overall poor prognosis. The expression of E2F transcription factor 1 in SKCM tissues was analyzed using the data acquired from the Cancer Genome Atlas (TCGA)and Gene Expression Omnibus (GEO)databases. The expression of E2F1 was also analyzed in human biopsies using immunohistology, and its expression was detected in SKCM cell lines using qPCR and WB technology. The prognostic value of E2F transcription factor 1 in SKCM was investigated using Kaplan-Meier survival and Cox analysis. The Tumor Immunization Estimation Resource (TIMER) was used to analyze the invasion of immune cells and associated markers of immune cells. The prognostic value of E2F transcription factor 1 DNA methylation levels for each CpG was analyzed by means of the MethSurv. The results were verified in the Human Protein Atlas (HPA) database. Individuals with elevated E2F transcription factor 1 expression had a worse prognosis (HR=1.43, p = 0.01). Using the expression level of E2F transcription factor 1, a reliable distinction between tumor and normal tissues can be made (Area Under the Curve =0.949). Moreover, immune infiltrations analysis showed that the mRNA expression levels and somatic copy number alterations (SCNA) in E2F transcription factor 1 were significantly correlated with recruitment of several immune cells. Our study showed that overexpression of E2F transcription factor 1 was significantly associated with poor prognosis and malignant phenotype of melanoma cells in SKCM patients.

Australian Sunscreens: The Price of Protection for Skin of Colour With Pigmentary Disorders

Australia experiences some of the highest ultraviolet radiation (UVR) levels globally, known for causing sunburn, skin cancers, photoageing and immunosuppression. While effects of UVA and UVB are well-studied, visible light (VL; 400-700 nm) is the driving force behind pigmentary disorders, especially in skin of colour (SOC) patients. Nearly 50% of Australians are affected, with significant impacts on appearance and psychological well-being. Tinted sunscreens containing iron oxides and pigmentary-grade titanium dioxide are the only effective options for blocking VL. However, Australia's stringent Therapeutic Goods Administration (TGA) regulations limit the availability of colour-matched tinted sunscreens, significantly impacting SOC patients. SOC patients may also underestimate their need for photoprotection, believing their skin provides sufficient natural protection. In dermatological practice, tailored sunscreen recommendations for darker skin tones may sometimes be overlooked. This review explores the barriers to effective treatment and the cost implications for SOC individuals suffering from pigmentary disorders in Australia. The goal is to guide both patients and dermatologists in making informed decisions on VL protection and skin tone matching.

2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Opsin3 regulates cell proliferation, migration, and apoptosis in lung adenocarcinoma via GPX3 pathway

Despite recent progress in understanding lung adenocarcinoma (LUAD) and the emergence of new therapeutic strategies, LUAD continues to be one of the deadliest lung cancer types, with a five-year survival rate of under 5%. Opsin3 (OPN3), a member of the G protein-coupled receptor superfamily, has been linked to various cancer-related processes, including tumor progression and therapy resistance. However, its specific role in LUAD remains insufficiently investigated. This study aimed to explore OPN3's regulatory functions in LUAD and evaluate its potential as a therapeutic target. OPN3 expression in LUAD cells was assessed using quantitative PCR, Western blotting, and immunohistochemistry. The effects of OPN3 on cell migration and invasion were evaluated through wound healing and transwell assays. Additionally, the influence of OPN3 on cell cycle progression and signaling pathways in vivo-critical for cellular responses to external stimuli-was examined. Pathway enrichment analysis revealed significant disruption of genes associated with glutathione metabolism. Notably, a strong correlation between OPN3 expression and the regulation of Glutathione Peroxidase 3 (GPX3), a key enzyme in this metabolic pathway, was identified. Our results demonstrate that OPN3 is markedly overexpressed in LUAD tissues relative to normal lung tissues. Silencing OPN3 via siRNA significantly diminished the malignant features of LUAD cells, including proliferation, migration, and invasion. In contrast, OPN3 overexpression enhanced these malignant characteristics, indicating its involvement in tumor progression. Moreover, an inverse relationship between OPN3 expression and GPX3 levels was observed, suggesting that OPN3 may drive LUAD progression through the GPX3 pathway. This study offers new insights into the function of OPN3 in LUAD and suggests that targeting the OPN3-GPX3 axis could provide a promising therapeutic strategy for LUAD patients.

Emerging role of regulatory T cells in the immunopathogenesis of vitiligo and implications for treatment

Vitiligo is an autoimmune skin disease that targets pigment-producing melanocytes and results in depigmentation. This disfiguring condition frequently affects visible areas of the body and therefore causes a heavy psychological burden and a decreased quality of life. Although it remains intractable, the ever-growing understanding of its immunopathogenesis has dramatically shaped the treatment paradigm for vitiligo. With the impact of autoreactive cytotoxic T cells explained extensively, accumulating evidence suggests the unique role of regulatory T cells (Tregs) in the immune microenvironment of vitiligo. We systematically reviewed Treg deficiency, instability, reduced vitality and dysfunction in people with vitiligo, combined with novel findings regarding Treg function modulation in autoimmune backgrounds, including metabolic alteration, post-translational modifications and interaction with other immune cells. We further summarized classic and advanced Treg-targeted therapeutics in vitiligo practice and research. Herein, we share up-to-date knowledge of Tregs in vitiligo, providing insights into novel Treg-based therapeutic strategies.

HBV activates hepatic stellate cells through RUNX2/ITGBL1 axis

BACKGROUND

Chronic hepatitis B (CHB) remains a global health challenge, with liver fibrosis serving as a critical determinant of disease progression. Despite antiviral treatments, liver fibrosis often persists in CHB patients, highlighting the need for additional biomarkers and therapeutic targets. This study investigates the molecular mechanism underlying HBV-induced liver fibrosis, focusing on the role of RUNX2 in regulating integrin beta-like 1 (ITGBL1), a key factor in fibrogenesis.

METHODS

We examined the relationship between RUNX2 and ITGBL1 in both in vitro hepatocyte models and an in vivo HBV mouse model. Using chromatin immunoprecipitation (ChIP), luciferase reporter assays, and Western blotting, we assessed RUNX2 binding to the ITGBL1 promoter and its impact on gene expression. We also evaluated the effects of RUNX2 inhibition using Vitamin D3 and CADD522 on ITGBL1 expression and hepatic stellate cell activation.

RESULTS

Our findings reveal that RUNX2 directly binds to the ITGBL1 promoter, enhancing its expression and promoting hepatic stellate cell activation. We show that HBV infection significantly upregulates both RUNX2 and ITGBL1 in liver cells. Inhibition of RUNX2 with Vitamin D3 or CADD522 significantly reduced ITGBL1 levels and blocked hepatic stellate cell activation. These results suggest that the RUNX2/ITGBL1 pathway is critical in the progression of liver fibrosis in HBV-infected patients.

CONCLUSIONS

RUNX2 promotes liver fibrosis in HBV-infected patients by upregulating ITGBL1 expression. Our findings suggest that targeting RUNX2 could be a potential therapeutic approach to mitigate liver fibrosis in chronic hepatitis B.

Landscapes of gut microbiome and metabolic signatures in vitiligo patients with co-morbid emotional distress

BACKGROUND

Vitiligo is a depigmentation disorder frequently associated with emotional distress; however, the precise mechanisms underlying this co-morbidity remain unclear.

OBJECTIVE

This study aims to investigate whether gut dysbiosis and gut metabolites contributes to emotional distress in patients with vitiligo.

METHODS

Depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Totally enrolled 28 vitiligo patients were diagnosed with depression or anxiety (VWD), 44 without such conditions (VTD), and 37 healthy controls (HC). Stool samples were analyzed using 16S rRNA gene sequencing and liquid chromatography triple quadrupole tandem mass spectrometry.

RESULTS

The intestinal flora of VWD group changed significantly with reduced α-diversity. The β-diversity varied among groups. Megasphaera and Anaerostipes increased in the VWD group, whereas Bilophila etc. decreased. Linear Discriminant Analysis Effect Size revealed Lachnoclostridium as a representative flora in the VWD and Faecalibacterium as a representative flora in the VTD. Metabolites such as L-glutamic acid and indole were lower in the VWD group than in the HC, while oleamide, cuminaldehyde, and taurine were higher in the VWD with VTD group. Lachnoclostridium negatively correlated with indole and L-glutamic acid. This study identified notable variations in pathways involved in the biosynthesis of phenylalanine, tyrosine, and tryptophan bile secretion, GABAergic synapses, and taurine and hypotaurine metabolism between the VWD and HC groups.

CONCLUSION

Specific fecal microbes and metabolites may contribute to the pathogenesis of VWD. These findings provide a novel perspective for addressing emotional distress in patients with vitiligo by targeting the gut-brain-skin axis.

Assessment of Patients With Beta-Lactams Positive Provocation Tests by Biomarkers of IgG-Related Neutrophil Activation

BACKGROUND

Beta-lactams (BLs) are the predominant cause of immediate allergic reactions to drugs. Immediate hypersensitivity reactions (IHR) with positive provocation tests and negative skin and in vitro tests have undetermined mechanisms. We evaluated whether biomarkers of IgG-dependent neutrophil activation could help to assess this subgroup of BL IHRs.

METHODS

We evaluated biomarkers of neutrophil activation and neutrophil extracellular traps (NETs) in the serum of 26 BL IHR patients presenting with a positive provocation test, negative skin and serum specific IgE, and positive specific sIgG, and 8 perioperative BL IHR cases with positive skin tests and negative sIgE compared to 19 non-allergic matched controls.

RESULTS

We observed increased levels of DNase activity, neutrophil elastase (NE), myeloperoxidase (MPO)-DNA, IL8 and decreased IL4 and IL13 in patients, compared to matched controls, in the first 15 min of IHRs. DNAse activity, NE and MPO-DNA were maintained at high levels 2 h later (T0 + 2), while cell-free DNA and CXCR2 decreased significantly. IgG-related activation of neutrophils was suggested by significant correlations between NE, IL8 and CXCR2 axis and a single cluster associating BL sIgG antibodies and NE at T0 + 2, in principal factor analysis of all biomarkers.

CONCLUSION

Biomarkers of neutrophil activation and NETs were increased in BL IHRs with negative skin tests, positive sIgG and negative serum sIgE, and positive provocation test. We propose DNAse activity and NE as biomarkers for the biological assessment of BL IHRs and provocation tests and to consider IgG-related neutrophil activation as one of the mechanisms involved in BL IHRs with undetermined cause.

LncRNA SLNCR phenocopies the E2F1 DNA binding site to promote melanoma progression

The long non-coding RNA SLNCR and the transcription factor E2F1 are known melanoma oncogenes. We show that SLNCR binds to E2F1 to promote the proliferation, invasion, and migration of melanoma cells from the bloodstream into the lungs. Blocking SLNCR-E2F1 complex formation without reducing the levels of either SLNCR or E2F1 prevents lung extravasation in mice. A 60-nt fragment of SLNCR contains two RNA analogs of the E2F1 DNA binding site (BS) in opposite orientations and can form a hairpin RNA that phenocopies the E2F1 DNA BS. Molecular dynamics (MD) simulations and biochemical experiments indicate that this fragment of SLNCR binds to the E2F1 DNA-binding domain more effectively than the E2F1 DNA BS. MD simulations predict higher affinity for DNA-E2F1 complex formation but faster kinetics and a greater number of RNA-amino acid contacts for the RNA-E2F1 complex, suggesting that RNA binding to E2F1 is more kinetically favorable.

Comprehensive Overview of Cytokine Interplay in Vitiligo: A Decade of Meta-Analyses Systematically Reviewed

(1) Background: Vitiligo is an autoimmune skin disorder characterized by melanocyte destruction. Despite metabolic disturbances and oxidative stress also playing a key role in its pathogenesis, accumulating evidence highlights a prominent role for cytokine dysregulation. (2) Methods: A systematic search was conducted to identify meta-analyses published in the last decade that investigated cytokine involvement in vitiligo. (3) Results: Based on predefined inclusion criteria, nine meta-analyses were retrieved and reviewed. The findings confirm a central role for interferon-gamma (IFN-γ) in vitiligo pathogenesis, although recent meta-analyses suggest that IFN-γ gene polymorphisms are more broadly associated with autoimmunity rather than being vitiligo-specific. Elevated interleukin-17 (IL-17) levels have been consistently reported in vitiligo patients, supporting its contribution to immune-mediated melanocyte destruction. Regulatory T cell dysfunction appears to play a crucial role in disease progression. Additionally, TNF-α-308 G/A polymorphism has been linked to a genetic susceptibility to vitiligo, particularly in specific populations, reinforcing the role of TNF-α in immune dysregulation. Lastly, chemokines involved in immune cell recruitment to melanocytes further illustrate the complex inflammatory network underlying the disease. (4) Conclusions: This systematic review consolidates evidence from a decade of meta-analyses, underscoring the significance of cytokine dysregulation in vitiligo and highlighting potential therapeutic targets.

Thymic eosinophils: What are you doing here?

The thymus is a primary lymphoid organ where major types of T lymphocytes undergo essential developmental processes. Eosinophils are among the cell types present in microenvironments within the thymus, and perhaps surprisingly, the role of thymic eosinophils, especially during homeostatic conditions, remains unclear. Major physiological events impact thymic organization and function throughout life, including age-related involution, pregnancy, and exposure to chemotherapy or radiation. In this review, we summarize literature that has explored factors that regulate the accumulation, phenotype, and location of thymic eosinophils during homeostatic development and during conditions in which homeostasis is perturbed. Further, we discuss the current theories as to the function of thymic eosinophils and consider how the heterogeneity of thymic eosinophil populations may reflect a temporal, spatial, and situational multifunctionality of thymic eosinophils.

Neuro-immuno-endocrinology of the skin: how environment regulates body homeostasis

The skin, including the hypodermis, is the largest organ of the body. The epidermis, the uppermost layer, is in direct contact with the environment and is exposed to environmental stressors, including solar radiation and biological, chemical and physical factors. These environmental factors trigger local responses within the skin that modulate homeostasis on both the cutaneous and systemic levels. Using mediators in common with brain pathways, immune and neuroendocrine systems within the skin regulate these responses to activate various signal transduction pathways and influence the systemic endocrine and immune systems in a context-dependent manner. This skin neuro-immuno-endocrine system is compartmentalized through the formation of epidermal, dermal, hypodermal and adnexal regulatory units. These units can act separately or in concert to preserve skin integrity, allow for adaptation to a changing environment and prevent the development of pathological processes. Through activation of peripheral nerve endings, the release of neurotransmitters, hormones, neuropeptides, and cytokines and/or chemokines into the circulation, or by priming circulating and resident immune cells, this system affects central coordinating centres and global homeostasis, thus adjusting the body's homeostasis and allostasis to optimally respond to the changing environment.

Unveiling the Unseen: Exploring Cellular Dynamics in Nonlesional Vitiligo Skin

Vitiligo is a multifactorial disease involving genetic predispositions, intrinsic melanocyte abnormalities, and deregulated immune response. Recent studies show nonlesional skin involvement. Nonlesional melanocytes display mitochondrial dysfunction and increased oxidative stress affecting their adhesion and function and contribute to immune activation. Keratinocytes and fibroblasts display structural and functional abnormalities impairing melanocyte support and differentiation. They also contribute to the altered immune response by secreting proinflammatory chemokines. Despite immune cell infiltration, nonlesional skin remains clinically unaffected, suggesting that regulatory mechanisms maintain immune activation at a subclinical level. This review provides an overview of the cellular alterations in vitiligo nonlesional skin.

Anti-Psoriatic Efficacies of Psorogrit and Divya-Taila, in Murine Models of Imiquimod and TPA-Induced Psoriasis-Like Inflammation are Driven by Modulation in IL-17RA/IL-23 and IL-8/TNF-α Signaling Axes

Aim

Psoriasis is a chronic inflammatory skin disease that occurs among all age groups, irrespective of gender, and consequently it negatively impacts patient's quality of life. Medicines of herbo-mineral origin are being increasingly used for the mitigation of psoriasis, due to the side effects associated with the available treatment options. Present study characterizes the pharmacological efficacy of Psorogrit (PSO) and Divya-Taila (DT) using in vitro and in vivo assays.

Methods

Human keratinocyte (HaCaT) cells stimulated with TNF-α or Imiquimod (IMQ) were used to generate the in vitro models of psoriasis. PSO was further evaluated for modulation of mRNA expression, cytokine levels and NF-κB reporter activity. The in vivo anti-psoriatic activity of the orally given PSO and topically applied DT was assessed in mouse models of IMQ-induced psoriasis-like skin lesions and 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced ear edema. The animals were randomly allocated to the Normal control, Disease control, Clobetasol, PSO and DT groups. Analysis of ear thickness, ear punch weight, spleen weight, histopathology by hematoxylin and eosin (H&E), and Keratin 17 (KRT 17) mRNA expression was measured for evaluation of these herbal formulations. Moreover, the phytochemical composition of PSO and DT was evaluated by UHPLC and GC/MS/MS.

Results

Cytosafe concentrations of PSO significantly attenuated IL-8 release as well as mRNA expressions of IL-8, TNF-α, and IL-1β in TNF-α-induced human skin keratinocytes. PSO was observed to decrease the TNF-α-induced NF-κB reporter activity. Additionally, in IMQ-induced HaCaT cells, PSO reduced the release of IL-17RA and mRNA expression of IL-23 and IL-17RA. In the in vivo IMQ-induced model, PSO and DT were able to ameliorate the IMQ-induced increase in ear punch weight, relative spleen weight, and histopathological changes in both ear and dorsal back skin. In TPA-induced ear edema model, PSO and DT reduced the increase in ear thickness, ear punch weight, and histopathological lesions. Besides, the phytochemical analysis of PSO and DT revealed the presence of phytometabolites known to have anti-inflammatory activities.

Conclusion

The combinatorial use of Psorogrit and Divya-Taila has the potential to ameliorate clinical and pathological manifestations of psoriasis.

Classification of collagen remodeling in asthma using second-harmonic generation imaging, supervised machine learning and texture-based analysis

Airway remodeling is present in all stages of asthma severity and has been linked to reduced lung function, airway hyperresponsiveness and increased deposition of fibrillar collagens. Traditional histological staining methods used to visualize the fibrotic response are poorly suited to capture the morphological traits of extracellular matrix (ECM) proteins in their native state, hindering our understanding of disease pathology. Conversely, second harmonic generation (SHG), provides label-free, high-resolution visualization of fibrillar collagen; a primary ECM protein contributing to the loss of asthmatic lung elasticity. From a cohort of 13 human lung donors, SHG-imaged collagen belonging to non-asthmatic (control) and asthmatic donors was evaluated through a custom textural classification pipeline. Integrated with supervised machine learning, the pipeline enables the precise quantification and characterization of collagen, delineating amongst control and remodeled airways. Collagen distribution is quantified and characterized using 80 textural features belonging to the Gray Level Cooccurrence Matrix (GLCM), Gray Level Size Zone Matrix (GLSZM), Gray Level Run Length Matrix (GLRLM), Gray Level Dependence Matrix (GLDM) and Neighboring Gray Tone Difference Matrix (NGTDM). To denote an accurate subset of features reflective of fibrillar collagen formation; filter, wrapper, embedded and novel statistical methods were applied as feature refinement. Textural feature subsets of high predictor importance trained a support vector machine model, achieving an AUC-ROC of 94% ± 0.0001 in the classification of remodeled airway collagen vs. control lung tissue. Combined with detailed texture analysis and supervised ML, we demonstrate that morphological variation amongst remodeled SHG-imaged collagen in lung tissue can be successfully characterized.

Metabolic anomalies in vitiligo: a new frontier for drug repurposing strategies

Vitiligo is a chronic autoimmune condition characterized by the destruction of melanocytes, leading to patchy loss of skin depigmentation. Although its precise cause remains unclear, recent evidence suggests that metabolic disturbances, particularly oxidative stress and mitochondrial dysfunction, may play a significant role in the pathogenesis of the disease. Oxidative stress is thought to damage melanocytes and trigger inflammatory responses, culminating in melanocyte immune-mediate destruction. Additionally, patients with vitiligo often exhibit extra-cutaneous metabolic abnormalities such as abnormal glucose metabolism, dyslipidemia, high fasting plasma glucose levels, high blood pressure, out of range C-peptide and low biological antioxidant capacity, suggesting a potential link between metabolic impairment and vitiligo development. This implies that the loss of functional melanocytes mirrors a more general systemic targetable dysfunction. Notably, therapies targeting metabolic pathways, particularly those involving mitochondrial metabolism, such as the peroxisome proliferator-activated nuclear receptor γ (PPARγ) agonists, are currently being investigated as potential treatments for vitiligo. PPARγ activation restores mitochondrial membrane potential, mitochondrial DNA copy number and, consequently, ATP production. Moreover, PPARγ agonists counteract oxidative stress, reduce inflammation, inhibit apoptosis, and maintain fatty acid metabolism, in addition to the well-known capability to enhance insulin sensitivity. Additionally, increasing evidence of a strong relationship between metabolic alterations and vitiligo pathogenesis suggests a role for other approved anti-diabetic treatments, like metformin and fibrates, in vitiligo treatment. Taken together, these data support the use of approaches alternative to traditional immune-suppressive treatments for the treatment of vitiligo.

Defective Intracellular Insulin/IGF-1 Signaling Elucidates the Link Between Metabolic Defect and Autoimmunity in Vitiligo

Background: Vitiligo is featured by the manifestation of white maculae and primarily results from inflammatory/immune-selective aggression to melanocytes. The trigger mechanism leading to the activation of resident immune cells in the skin still lacks a molecular description. There is growing evidence linking altered mitochondrial metabolism to vitiligo, suggesting that an underlying metabolic defect may enable a direct activation of the immune system. Recent evidence demonstrated the association of vitiligo with disorders related to systemic metabolism, including insulin resistance (IR) and lipid disarrangements. However, IR, defined as a cellular defect in the insulin-mediated control of glucose metabolism, and its possible role in vitiligo pathogenesis has not been proven yet. Methods: In this study, we compared the Ins/IGF-1 intracellular signaling of dermal and epidermal cells isolated from non-lesional vitiligo skin to that belonging to cells obtained from healthy donors. Results: We demonstrated that due to the intensified glucose uptake, S6, and insulin receptor substrate 1 (IRS1) chronic phosphorylation, their inducibilities were downsized, a condition that coincides with the definition of insulin resistance at the cellular level. Correspondingly, the mitogenic and metabolic activities normally provoked by Ins/IGF-1 exposure resulted in significantly compromised vitiligo cells (p ≤ 0.05). Besides all the vitiligo-derived skin cells manifesting an energetic disequilibrium consisting of a low ATP, catabolic processes activation, and chronic oxidative stress, the functional consequences of this state appear amplified in the keratinocyte lineage. Conclusion: The presented data argue for insulin and IGF-1 resistance collocating dysfunctional glucose metabolism in the mechanisms of vitiligo pathogenesis. In vitiligo keratinocytes, the intrinsic impairment of intracellular metabolic activities, particularly when associated with stimulation with Ins/IGF-1, converges into an aberrant pro-inflammatory phenotype that may initiate immune cell recruitment.

Epigenetic Modifications in Vitiligo

Vitiligo is an autoimmune depigmenting skin disorder and can affect the mental health of the patients. Current research suggests that the development of vitiligo involves a combination of genetic susceptibility, immune imbalance, and oxidative stress. However, its pathogenesis has not been fully elucidated. Epigenetic modification has gained increasing attention as an emerging way to regulate gene expression at the transcriptional or post-transcriptional level. Currently known modes of epigenetic modification include the regulation of non-coding RNAs, DNA methylation, and histone modification. Studies suggest they play important roles in tumors, immune disorders, and inflammatory diseases. In recent years, the value of epigenetics in the diagnosis, treatment, and prognosis of vitiligo has been explored. They showed the potential to serve as biomarkers and play a therapeutic role. In this review, we summarize the epigenetic modification mechanisms involved in the pathogenesis of vitiligo, including physiological processes such as immune homeostasis, melanocyte survival, cell adhesion and migration, and metabolism. This will help us fully understand the progress of epigenetic research in vitiligo and lay the foundation for targeted therapeutic-related research.

Beyond skin deep: exploring the complex molecular mechanisms and holistic management strategies of vitiligo

Vitiligo is a multifactorial skin disorder characterized by the progressive loss of pigmentation due to the destruction of melanocytes, affecting 0.5-2% of the global population. This condition not only impacts physical appearance but also has profound psychosocial effects on patients. In this review, various aspects of vitiligo are explored, including its clinical forms, epidemiology, and underlying mechanisms. Advances in research have identified key molecular pathways, such as Wnt/β-Catenin, JAK-STAT, and AhR signaling, which are essential for melanocyte survival and immune regulation. These pathways provide valuable insights into the disease's progression and potential treatment targets. Furthermore, the role of microbial imbalances in the gut and skin microbiomes, stress-related factors, and nutritional deficiencies in influencing the onset and progression of vitiligo is investigated. The potential of herbal treatments to stimulate repigmentation is also discussed. By presenting a comprehensive overview, this review aims to deepen the understanding of vitiligo's complex pathology and foster the development of effective therapeutic strategies to enhance patient care.