Bioactive compounds from food-grade Bacillus

Bacillus species have attracted significant attention in recent years due to their potential for producing various bioactive compounds with diverse functional properties. This review highlights bioactive substances from food-grade Bacillus strains and their applications in functional foods and nutraceuticals. The metabolic capacities of Bacillus species have allowed them to generate a wide range of bioactive substances, including vitamins, enzymes, anti-microbial peptides, and other non-ribosomal peptides. These substances have a variety of positive effects, including potential cholesterol-lowering and immune-modulatory qualities in addition to anti-oxidant and anti-bacterial actions. The uses and mechanisms of action of these bioactive chemicals can be used to improve the functional qualities and nutritional profile of food products. Examples include the use of anti-microbial peptides to increase safety and shelf life, as well as the use of Bacillus-derived enzymes in food processing to improve digestibility and sensory qualities. The exploitation of bioactive compounds from food-grade Bacillus strains presents a promising frontier in the development of functional foods and nutraceuticals with enhanced health benefits. Due to their wide range of activity and applications, they are considered as important resources for the development of novel medications, agricultural biocontrol agents, and industrial enzymes. Ongoing research into the biosynthetic pathways, functional properties, and applications of these compounds is essential to fully realize their potential in the food industry. This review underscores the significance of various bioactive compounds generated from Bacillus in tackling global issues like environmental sustainability, sustainable agriculture, and antibiotic resistance. Future developments in microbiology and biotechnology will enable us to fully utilize the potential of these amazing microbes, resulting in novel approaches to industry, agriculture, and health. © 2024 Society of Chemical Industry.

Pemphigus Vulgaris: Clinical Aspects and Treatments

GENERAL PURPOSE

To review the clinical presentation, diagnostic evaluation, and management approaches for pemphigus vulgaris (PV).

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the learner will: 1. Summarize the clinical manifestations associated with PV. 2. Evaluate risk factors associated with PV. 3. Explain evidence-based diagnostic and treatment options for PV.

Biological roles of enhancer RNA m6A modification and its implications in cancer

Enhancers, as distal cis-regulatory elements in the genome, have a pivotal influence on orchestrating precise gene expression. Enhancer RNAs (eRNAs), transcribed from active enhancer regions, are increasingly recognized as key regulators of transcription. N6-methyladenosine (m6A), the most plentiful internal modification in eukaryotic mRNAs, has garnered significant research interest in recent years. With advancements in high-throughput sequencing technologies, it has been established that m6A modifications are also present on eRNAs. An accumulative body of evidence demonstrates that aberrant enhancers, eRNAs, and m6A modifications are intimately connected with carcinoma onset, progression, invasion, metastasis, treatment response, drug resistance, and prognosis. However, the underlying molecular mechanisms governing m6A modification of eRNAs in cancer remain elusive. Here, we review and synthesize current understanding of the regulatory roles of enhancers, eRNAs, and m6A modifications in cancer. Furthermore, we investigate the possible roles of eRNAs m6A modification in tumorigenesis based on existing literature, offering novel perspectives and directions for future research on epigenetic regulatory mechanisms in cancer cells.

Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis

OBJECTIVE

To compare the effects of treatments for mild or moderate (that is, non-severe) coronavirus disease 2019 (covid-19).

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

Covid-19 Living Overview of Evidence Repository (covid-19 L-OVE) by the Epistemonikos Foundation, a public, living repository of covid-19 articles, from 1 January 2023 to 19 May 2024. The search also included the WHO covid-19 database (up to 17 February 2023) and six Chinese databases (up to 20 February 2021). The analysis included studies identified between 1 December 2019 and 28 June 2023.

STUDY SELECTION

Randomised clinical trials in which people with suspected, probable, or confirmed mild or moderate covid-19 were allocated to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.

METHODS

After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias was assessed by use of a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, following GRADE guidance, drug treatments were classified in groups from the most to the least beneficial or harmful.

RESULTS

Of 259 trials enrolling 166 230 patients, 187 (72%) were included in the analysis. Compared with standard care, two drugs probably reduce hospital admission: nirmatrelvir-ritonavir (25 fewer per 1000 (95% confidence interval 28 fewer to 20 fewer), moderate certainty) and remdesivir (21 fewer per 1000 (28 fewer to 7 fewer), moderate certainty). Molnupiravir and systemic corticosteroids may reduce hospital admission (low certainty). Compared with standard care, azithromycin probably reduces time to symptom resolution (mean difference 4 days fewer (5 fewer to 3 fewer), moderate certainty) and systemic corticosteroids, favipiravir, molnupiravir, and umifenovir probably also reduce duration of symptoms (moderate to high certainty). Compared with standard care, only lopinavir-ritonavir increased adverse effects leading to discontinuation.

CONCLUSION

Nirmatrelvir-ritonavir and remdesivir probably reduce admission to hospital, and systemic corticosteroids and molnupiravir may reduce admission to hospital. Several medications including systemic corticosteroids and molnupiravir probably reduce time to symptom resolution.

SYSTEMATIC REVIEW REGISTRATION

This review was not registered. The protocol is publicly available in the supplementary material.

Data-Driven Visualization of the Dynamics of Antimicrobial Peptides in Cell Death

This study explores the current status, research hotspots, and emerging trends in AMP-induced cell death through bibliometric and data-driven visual analysis. The findings aim to provide researchers and clinical professionals with new insights and potential research directions. A total of 1,897 articles and reviews published between 2006 and 2024 were retrieved from the Web of Science Core Collection. Bibliometric and visual analyses were conducted using CiteSpace, VOSviewer, Scimago Graphica, Origin 2022, and WordClouds. The analysis focused on publication trends, contributing institutions, journals, authors, cited references, and keywords. China contributed the largest share of publications (28.15%). The Chinese Academy of Sciences emerged as the most collaborative institution, demonstrating the highest centrality. The author with the highest composite index was Chen, Jyh-Yih (2,985.27). Recent research hotspots have centered on elucidating the mechanisms of AMP-induced cell death and exploring the potential applications of AMPs in cancer therapy. Keywords such as anticancer peptides, mechanism, design, and antibiotic resistance currently dominate the field, reflecting its evolving focus. Research on the application of AMPs in cancer treatment is gaining momentum. The forefront of this field involves modifying and designing AMPs to address antibiotic-resistant bacterial infections and advance cancer therapeutics. However, further investigation is needed to uncover the specific molecular mechanisms underlying AMP-induced cell death, including necrosis, pyroptosis, and ferroptosis.

A meta-analysis on application and prospect of cell therapy in the treatment of diabetes mellitus

OBJECTIVE

Diabetes mellitus (DM) is a grave autoimmune disorder because of no insulin self-generation. Currently, mainly clinical methods exist, serious adverse effects leading to stem cell therapy are considered. The mesenchymal stem cells (MSCs), require high differentiation capacity and are judged as crucial in DM treatment. The meta-analysis aimed to systemically analyze the particular types of MSCs which play a more important role in DM and which DM is treated more effectively.

METHOD

A systematic review was conducted on the published literature, clinical trials and observational studies, utilizing databases such as PubMed, Embase, Cochrane and clinicaltrial.gov. RevMan software was adopted to draw Forest Plot and Funnel Plot, and subgroup analysis were employed to evaluate heterogeneity between different groups.

RESULTS

We identified the meta-analyses of 34 unique random controlled trials and divided our own systematic reviews into 8 groups. The MSCs were associated with placebo (OR = 2.79, 95% CI [1.63, 4.75]), Standard Clinical Treatment (SCT) (OR = 4.12, 95% CI [2.76, 6.14]), and monocyte (OR = 6.52, 95% CI [3.56, 9.48]). The comparison between Autologous MSCs and Allogenic MSCs (OR = 4.64, 95% CI [3.42, 6.31]), Autologous BMMSCs and other MSCs (OR = 5.28, 95% CI [3.64, 7.66]), Allogenic ASCs and UCMSCs (OR = 3.54, 95% CI [1.83, 6.86]), Type I DM and Type II DM (OR = 3.10, 95% CI [1.79, 5.38]), intravenous injection and other injections (OR = 4.81, 95% CI [3.34, 6.94]), diabetic foot ulcers and diabetic neurological disease (OR = 3.88,,95% CI [2.53,5.95]).

CONCLUSION

Current evidence suggests that MSCs hold significant potential for treating DM, demonstrating considerably high safety and efficacy. MSCs exhibit higher therapeutic benefits compared to monocytes, with autologous MSCs offering better clinical outcomes than allogenic sources. MSCs (BMMSCs) proved more effective than other types of MSCs. However, no significant differences were observed between adipose-derived MSCs (ASCs) and umbilical cord-derived MSCs (UCMSCs) in the allogeneic setting. Moreover, MSCs show more pronounced therapeutic effects in Type II DM, and the difference among the injection methods is minimally observed. In conclusion, the research scope on DM is relatively limited in this study and further research is necessary to improve the reliability of the estimates.

Vitamin D Imbalance and Hydro-Electrolyte Disturbances in Hospitalized Children: A Comparation Between Post-COVID-19 Status and SARS-CoV-2/EBV Coinfection

Background/Objectives: SARS-CoV-2 infection has the potential to cause multi-organ involvement and, when associated with Epstein-Barr virus (EBV) coinfection, may worsen the course of disease in pediatric patients by influencing the immune response. Methods: Our retrospective-observational study included 406 hospitalized children with post-COVID-19 status or SARS-CoV-2/EBV coinfection. Results: Hypovitaminosis D was more common in the coinfected sublot (59.18%) than in the COVID-19 one (50.74%), with a higher frequency of severe vitamin D deficiency (16.33% vs. 7.35%). Hypovitaminosis D was significantly associated with female sex (p = 0.033) only in the COVID-19 subgroup. Hypervitaminosis D, although rare, was only associated with severe forms of the disease (7.69%). Between clinical severity and vitamin D level, a statistically significant association of moderate intensity was identified only in the COVID-19 subgroup (χ2 = 11.708, φ = 0.293, p = 0.020). In the same subgroup, a significant correlation was found between vitamin D levels and serum potassium values (χ2 = 10.527, p = 0.032). Moreover, in the COVID-19 subgroup, an association between abnormal sodium levels and increased D-dimer levels was found (χ2 = 7.074, p = 0.029). Conclusions: These results underline the importance of monitoring immunologic, vitamin, and electrolyte imbalance in the management of these cases and highlight the need for personalized therapeutic strategies to prevent long-term complications.

IL-10 and IL-6/IL-10 as predictive biomarkers for treatment response in non-infectious uveitis

Uveitis, a group of heterogeneous diseases causing ocular inflammation, is a major contributor to vision loss globally. While systemic corticosteroids (CS) are the mainstay treatment, identifying CS-refractory patients remains a significant challenge. This study aimed to explore cytokine expression and Glucocorticoid Receptor (GR) levels as biomarkers for the early detection of CS-refractory cases in non-infectious uveitis. We assayed blood samples from 19 patients with non-infectious uveitis, for the expression of IL-6, IL-17A, TNF-α, IL-10 and GRα. The cohort included 11 refractory and 8 sensitive patients, categorized based on their clinical response to corticosteroids (prednisone 1 mg/kg/day). Blood draws were conducted at three time points (at baseline, day 7- and day 14 after CS initiation), and peripheral blood mononuclear cells (PBMCs) were isolated to measure cytokine and GRα transcript levels via real-time PCR. The expression levels of GRα and cytokines IL-6, IL-17A and TNF-α did not show significant changes between CS-sensitive and CS-refractory patients on the different days of treatment. However, IL-10 expression levels as the day14-to-day7 ratio were significantly higher in patients sensitive to CS therapy. A higher day14-to-day7 ratio was also found for the IL-6/IL-10, IL-17A/IL-10 and GRα/IL-10 ratios. ROC curve analysis demonstrated a robust predictive performance of IL-10 mRNA expression and the IL-6/IL-10 ratio for identifying CS-refractory patients. In conclusion, the expression of IL-10 and the IL-6/IL-10 ratio hold promise as early predictive biomarkers for CS treatment refractoriness in patients with non-infectious uveitis. These findings offer valuable insights into personalized treatment strategies, potentially leading to improved clinical outcomes.

Type 1 Diabetes Mellitus and Vitamin D

Type 1 diabetes mellitus (T1DM) is a multifactorial disease in which environmental factors and genetic predisposition interact to induce an autoimmune response against pancreatic β-cells. Vitamin D promotes immune tolerance through immunomodulatory and anti-inflammatory functions. The aim of this study is to provide a narrative review about the association between vitamin D status in the pathogenesis of T1DM and the role of vitamin D supplementation in the prevention and treatment of T1DM. Although vitamin D deficiency is more prevalent in children/adolescents with new-onset T1DM than in healthy individuals, there does not appear to be an association between vitamin D status before diagnosis and the onset of T1DMD later in life. The results of vitamin D as adjuvant therapy have, at best, a positive short-term effect in newly diagnosed T1DM patients. Intervention studies have been conducted in the clinical phase of T1DM, but it would be desirable to do so in the early stages of the autoimmune process (pre-diabetes).

Association of Vitamin D Supplementation with Glutathione Peroxidase (GPx) Activity, Interleukine-6 (IL-6) Levels, and Anxiety and Depression Scores in Patients with Post-COVID-19 Condition

Coronavirus disease 2019 (COVID-19) presents with various symptoms, and some patients develop post-COVID-19 condition (PCC). Vitamin D has shown therapeutic potential in COVID-19 and may offer benefits for PCC. The aim of this study was to evaluate the differences associated with two supplementation strategies (bolus and daily) on interleukin-6 (IL-6) levels, glutathione peroxidase (GPx) activity, and clinical outcomes in PCC patients, regardless of whether target 25 (OH) D levels reached the ideal range. We conducted a self-controlled study in which 54 participants with PCC were supplemented with vitamin D3 (n = 28 bolus and n = 26 daily) for 2 months. Blood samples were collected to measure IL-6 levels and GPx activity using spectrophotometric methods. The Hospital Anxiety and Depression Scale (HADS) was used to assess mental function. Both bolus and daily vitamin D supplementation were significantly associated with increased GPx activity and decreased IL-6 levels. Daily supplementation was additionally associated with a significant reduction in anxiety and depression scores. However, neither regimen was associated with improvements in cough, dyspnea, or fatigue. These findings suggest a potential association between vitamin D supplementation and improvements in antioxidant and neuropsychiatric parameters in PCC, possibly mediated by its immunomodulatory and antioxidant properties. Further placebo-controlled trials are warranted to determine whether these observed associations reflect causal relationships.

Construction and validation of a nomogram for detecting chronic kidney disease in patients with nonalcoholic fatty liver disease: Insights from the NHANES database

BACKGROUND AND OBJECTIVES

Fatty liver disease is often associated with renal impairment in many patients. Early detection and prompt intervention are crucial for improving patient quality of life and reducing mortality rates. This study aimed to develop and validate a nomogram for detecting the risk of Chronic Kidney Disease (CKD) comorbidity in adults with Nonalcoholic Fatty Liver Disease (NAFLD) in the United States.

METHODS

From the NHANES (2017‒2020) database, the authors enrolled 2848 NAFLD participants, of whom 633 also had CKD. The authors employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to identify variables with predictive value. The overlapping features were selected to construct a predictive model, which was presented as a nomogram. The effectiveness of the nomogram was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and decision curve analysis.

RESULTS

Six indicators were included in the model: age, systolic blood pressure, serum albumin, high-sensitivity C-reactive protein, total cholesterol, and triglycerides. The area under the curve of the nomogram for predicting CKD in the training set was 0.772, with a 95 % Confidence Interval (95 % CI) of 0.746 to 0.797. In the validation set, the area under the curve was 0.722, with a 95 % CI of 0.680 to 0.763. The calibration curve analyses demonstrated that the prediction outcomes of the model aligned well with the actual outcomes, indicating good clinical applicability.

CONCLUSIONS

The nomogram demonstrated excellent performance and has the potential to serve as an auxiliary tool for detecting CKD in NAFLD patients.

Metabolic syndrome and dermatological diseases: association and treatment

Metabolic syndrome (MetS) is a clinical syndrome associated with cardiovascular disease, diabetes, obesity, and dyslipidemia. Its primary features include dyslipidemia, hypertension, abdominal obesity, and insulin resistance (IR). Recently, research has revealed that MetS is not only a manifestation of internal metabolic disturbances but is also closely associated with various dermatological conditions, including inflammatory skin diseases, autoimmune skin diseases, and skin tumors. These studies have clarified the complex mechanisms underlying the interaction between MetS and these skin diseases, including IR, chronic inflammatory responses, and oxidative stress. This review summarizes the association between MetS and related dermatological conditions and their shared physiological mechanisms. It aims to provide clinicians with new therapeutic strategies and preventive measures to improve the treatment outcomes and quality of life of patients with skin conditions.

Impact of Tumor Size on Prolactinoma Characteristics and Treatment Outcomes: A Study of a Tunisian Cohort

Issues: The clinical and paraclinical characteristics of prolactinomas differ mainly according to sex and tumor size. Drug treatment with dopamine agonists (ADs) has a crucial role in the management of prolactinomas. The use of surgery also has its indications. Purpose of the work: We aimed to establish the therapeutic strategy and the follow-up profiles of prolactinoma while analyzing the predictive factors of remission; we also looked for correlations between the size of the prolactinoma and the various clinical and paraclinical parameters. Materials and methods: This was a retrospective, descriptive, and analytical study of 77 cases of prolactinomas collected and monitored at the endocrinology and diabetology department of the Hedi Chaker CHU in Sfax between 2000 and 2017. Our patients were divided into three groups according to the size of their prolactinomas. Statistical correlations were sought between tumor size and clinical and biological parameters. Results: The mean age of our patients was 38.3 ± 14.2 years. The sample comprised 51 women (66.2%) and 26 men (33.7%). Anterior pituitary syndrome was observed in 75.3% of cases. The number of antehypophyseal deficits was significantly correlated with tumor size. Comparing the three groups, we noted that age, discovery circumstances, metabolic parameters, hypopituitarism, and pituitary extensions on imaging were significantly different. Therapeutically, our results showed that the favorable evolution of prolactinomas was correlated with tumor size and the duration of treatment. Conclusions: Tumor size appears to be a cornerstone in hormonal and radiological interpretation on the one hand and in the therapeutic decision on the other.

Elevated Tumor Mutation Burden in Cancer Patients with Underlying HIV Infection: Data from the Oncology Research Information Exchange Network (ORIEN)

BACKGROUND

People living with HIV (PWH) have improved life expectancy because of effective human immunodeficiency virus (HIV) therapy but still experience immune impairment (e.g., altered CD4/CD8 T cells). We hypothesized that tumors diagnosed in PWH would have distinct molecular features.

METHODS

We utilized whole-exome sequencing of paired tumor and germline DNA and RNA from 229 patients with cancer enrolled into the Oncology Research Information Exchange Network to classify total tumor mutation burden (TMB), MHC class I neoantigen count, and MHC class II neoantigen count.

RESULTS

Specimens from 229 patients with cancer (110 PWH and 119 without HIV) were evaluated. Average TMB for tumors diagnosed in PWH was 249, compared with 172 for those without HIV. After adjustment for age, sex, race, smoking, and cancer site, the association between HIV and TMB remained statistically significant (OR = 1.72; 95% confidence interval (CI), 1.26-2.43). We further observed an association between HIV and higher putative class I neoantigen count (OR = 1.62; 95% CI, 1.10-2.41) but no association with putative class II neoantigens. When considering cancer sites separately in unadjusted analyses, average TMB was elevated in PWH for thyroid (P < 0.01) and bladder cancers (P = 0.03) and sarcoma (P = 0.04). Similarly, putative class I neoantigen count was elevated in PWH for head and neck (P < 0.01) and thyroid (P = 0.01) cancers, as well as sarcoma (P = 0.04).

CONCLUSIONS

Our findings indicate that tumors diagnosed in PWH harbor a higher TMB and a higher number of putative class I neoantigens.

IMPACT

A higher TMB in PWH may portend a more favorable response to certain cancer treatment modalities such as immune checkpoint inhibitors.

Evaluating the Causal Relationship Between Human Blood Metabolites and the Susceptibility to Alopecia Areata

BACKGROUND

Alopecia areata, a common autoimmune disease, is not fully understood in terms of its cause. However, research suggests that an imbalance in specific blood metabolites may trigger immune system dysfunction, leading to an attack on hair follicles and ultimately resulting in alopecia areata.

METHODS

Two-sample MR analysis was conducted to investigate the causal relationship between plasma metabolites and alopecia areata using various methods. Heterogeneity and pleiotropy were assessed, robustness of findings evaluated, and reverse MR performed for effect analysis.

RESULTS

The MR analysis found a positive causal relationship between alpha-ketoglutarate, propionylcarnitine (c3) and other metabolites with alopecia areata risk. Conversely, xylose 3-(3-hydroxyphenyl)propionate, glycochenodeoxycholate glucuronide (1) along with other metabolites, showed a protective effect against alopecia areata development. Both BWMR and MR-PRESSO confirmed the accuracy of the above results. Reverse MR revealed no reverse causality between plasma metabolites and AA. The robustness of the results was confirmed using the leave-one-out method, which demonstrated no influential instrumental variables affecting the outcomes while accounting for heterogeneity and eliminating horizontal gene pleiotropy effects on estimating causal effects.

CONCLUSION

This study establishes a causal relationship between plasma metabolism and alopecia areata, enhancing our understanding of its underlying mechanisms. These findings also provide valuable references for future screening and prevention strategies.

A novel molecular imaging technique using [68Ga]Ga-mDesmo PET-CT for localizing tumors in Cushing's disease

INTRODUCTION

Localizing the source of adrenocorticotropic hormone (ACTH) in patients with ACTH-dependent Cushing's syndrome (CS) poses significant challenges. There is a pressing need for novel imaging modalities that provide both anatomical delineation and functional confirmation of corticotropinomas.

METHODS

This study utilized a modified form of desmopressin (mDesmo), an agonist of the V1b receptor, which is overexpressed in tumoral corticotrophs. After modification, radionuclide 68Ga was chelated to produce a new radiopharmaceutical for positron emission tomography (PET) imaging. A total of 234 patients with CS were screened and 30 underwent [68Ga]Ga-mDesmo imaging. Patient demographics and hormonal levels (plasma cortisol and ACTH) were recorded, and the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) and [68Ga]Ga-mDesmo was compared, with histopathological evidence of a corticotropinoma serving as the reference standard.

RESULTS

The cohort comprised 10 males (33%, CI: 16-50%) and 20 females (67%, CI: 50-84), with a mean age of 33.5 ± 13.5 years. Of 30 patients with CS, 24 patients had treatment naïve Cushing's disease (CD) of which 17 (71%, CI: 53-89%) had microadenomas and 7 (30%, CI: 12-48%) had macroadenoma; 4 (13%, CI: 0-25%) patients had ectopic Cushing syndrome (ECS). CE-MRI identified lesions in 16 patients (67%, CI: 48-86%), while [68Ga]Ga-mDesmo successfully identified corticotropinomas in all 24 patients (100%, CI: 86-100%). In patients with microadenomas, CE-MRI had a diagnostic accuracy of 53% (CI: 29-77%), whereas [68Ga]Ga-mDesmo achieved 100% (CI: 86-100%). There was no uptake of [68Ga]Ga-mDesmo in the pituitary of patients with ECS.

CONCLUSION

This study demonstrates that [68Ga]Ga-mDesmo imaging is an effective in vivo molecular imaging technique for delineating corticotropinomas, surpassing the accuracy of CE-MRI and BIPSS, regardless of adenoma size.

TRIAL REGISTRATION NUMBER

CTRI/2022/08/044615 dated 03/08/2022.

Vitamin D and COVID-19: Clinical Evidence and Immunological Insights

Vitamin D has emerged as a potential modulator of immune responses, sparking interest in its role in COVID-19 susceptibility and clinical outcomes. This review synthesizes current clinical evidence and explores immunological insights into the relationship between vitamin D levels and COVID-19 infection severity. Epidemiological studies indicate an inverse correlation between vitamin D deficiency and an increased risk of severe disease, hospitalization, and mortality in COVID-19 patients. Immunologically, vitamin D exerts regulatory effects on both innate and adaptive immunity, enhancing antimicrobial defense mechanisms, reducing excessive inflammatory responses, and potentially mitigating cytokine storm events observed in severe COVID-19 cases. Despite promising observational data, clinical trials evaluating vitamin D supplementation have shown mixed results, underscoring the need for standardized dosing regimens and patient stratification. Future research should focus on large-scale randomized controlled trials to conclusively determine the therapeutic potential and optimal supplementation strategies for vitamin D in managing COVID-19.

The role of gut flora-driven Th cell responses in preclinical rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with an immune pathogenesis that evolves over decades. Preclinical RA (PreRA) represents a dynamic immune phase preceding clinical RA, marked by the loss of autoimmune tolerance, the appearance of tissue-invasive effector T cells, and the production of autoantibodies (such as antibodies against citrullinated proteins and rheumatoid factors). Extensive research has demonstrated that gut microbiota influence mucosal T-cell responses, driving the progression of PreRA through multiple mechanisms, including altered intestinal permeability, gene-environment interactions, bacterial antigenic specificity, molecular mimicry, and metabolite production. Environmental risk factors such as smoking, hormonal changes, and high-sodium (Na) diets, may contribute to RA pathogenesis via the gut microbiome. The next challenge in RA research lies in developing therapeutic strategies to intervene during the asymptomatic autoimmune phase, where dietary adjustments, natural compounds, probiotics, and other approaches could effectively modulate gut flora to prevent or delay RA onset.

25(OH)D3 and F-25(OH)D as indicators of chronic kidney disease progression in patients with rheumatoid arthritis

Vitamin D (VitD) deficiency has been associated with the development of rheumatoid arthritis (RA) and chronic kidney disease (CKD), but its exact role in patients with RA and CKD remains unclear. This cross-sectional study explored the relationship of 25(OH)D2, 25(OH)D3, and Free 25(OH)D [F-25(OH)D] with CKD progression in patients with RA. Patients with RA (n = 1514) were enrolled and divided into the mild, moderate, and severe CKD groups. Total 25(OH)D, 25(OH)D3, and F-25(OH)D in the moderate and severe CKD groups were lower than in the mild CKD group (all P < 0.05), while there were no differences in 25(OH)D2 levels (P = 0.095). As the severity of CKD progressed, total 25(OH)D, 25(OH)D3, and F-25(OH)D decreased (all Padj.<0.05). When progressing from moderate to severe CKD, only 25(OH)D3 decreased significantly (Padj.=0.014). Partial correlation and multiple logistic regression analyses revealed a significant association between 25(OH)D3 and the progression of CKD deterioration, as did F-25(OH)D (all P < 0.05). Further seasonal stratified analysis showed that this correlation existed only in spring, summer, and autumn for 25(OH)D3 and only in spring and summer for F-25(OH)D (P < 0.05). In conclusion, the serum 25(OH)D3 and F-25(OH)D levels may be indicators of CKD progression in patients with RA to plan for timely intervention and management.

Research Progress on the Immunological Correlation Between Papillary Thyroid Carcinoma and Hashimoto's Thyroiditis

In recent years, a growing body of evidence has suggested a correlation between Hashimoto's thyroiditis (HT) and the onset and progression of papillary thyroid carcinoma (PTC). However, the mechanism underlying the relationship between HT and PTC remains incompletely understood. This review discusses the literature on the correlation between PTC and HT and summarizes the research concerning the immunological interplay between these two conditions. It also delves into tumor-associated cells (such as CD8+ T cells), tumor-associated macrophages (TAMs), regulatory T cells (Tregs), and cancer-associated fibroblasts (CAFs), alongside other tumor-associated factors, including interleukins (ILs), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and hypoxia-inducible factor-1 (HIF-1), highlighting their roles in the interaction between PTC and HT. We also explore the strategic direction of immunotherapy in thyroid malignancies, particularly PTC with HT, and propose novel targeted immunotherapies for advanced thyroid cancer.

Neonatal hyperinsulinism: a retrospective study of presentation and management in a tertiary neonatal intensive care unit in the UK

OBJECTIVE

Reports of hyperinsulinism typically focus on infants managed by highly specialised services. However, neonates with hyperinsulinism are initially managed by neonatologists and often not referred to specialists. This study aimed to characterise the diversity in presentation and management of these infants.

SETTING

Level 3 neonatal intensive care.

PATIENTS

Neonates with hyperinsulinism, defined as blood glucose <2.8 mmol/mL and insulin level >6 pmol/L.

DESIGN

7-year retrospective study (January 2015-December 2021).

RESULTS

99 cases were identified: severe-treated with diazoxide (20%), moderate-clinically concerning hyperinsulinism not treated with diazoxide (30%), mild-biochemical hyperinsulinism (50%). Birth weight z-score was -1.02±2.30 (mean±SD), 42% were preterm, but neither variable correlated with clinical severity. The severe group received a higher concentration of intravenous glucose (27±12%) compared with the moderate (15±7%) and mild (16±10%) groups (p<0.001). At diagnosis, the intravenous glucose intake was similar in the severe (7.43±5.95 mg/kg/min) and moderate (5.09±3.86 mg/kg/min) groups, but higher compared with the mild group (3.05+/2.21 mg/kg/min) (p<0.001). In the severe group, term infants started diazoxide earlier (9.9±4.3 days) compared with preterm (37±26 days) (p=0.002). The national congenital hyperinsulinism service was consulted for 23% of infants, and 3% were transferred.

CONCLUSIONS

This study highlights the diversity in clinical presentation, severity and prognosis of neonatal hyperinsulinism, irrespective of birth weight and gestational age. More infants were small rather than large for gestational age, and the majority had transient hyperinsulinism and were not referred to the national centre, or treated with diazoxide. Further research is required to understand the breadth of neonatal hyperinsulinism and optimal management.

Immune training enhances anti-viral responses and improves outcomes in Pax5-/+ mice susceptible to chronic infection

Viral infections pose a significant global burden. Host susceptibility to pathogens is determined by many factors including genetic variation that can lead to immunodeficient or dysregulated antiviral immune responses. Pax5 heterozygosity (Pax5-/+), resulting in reduced PAX5 levels in mice, mimics germline or somatic PAX5 dysregulation contributing to diseases such as childhood B-cell precursor acute lymphoblastic leukemia (B-ALL). In contrast to the well-characterized roles of PAX5 during early B-cell development, little is known about how Pax5 heterozygosity impacts antiviral responses. We infected Pax5-/+ mice with the noncytopathic Lymphocytic Choriomeningitis Virus (LCMV) and found that infection with the chronic Docile strain resulted in decreased survival of Pax5-/+ mice. While early adaptive CD8+ T-cell (CTL) immunity was robust in Pax5-/+ mice, LCMV-specific neutralizing antibody production was compromised leading to impaired long-term viral clearance and a pro-inflammatory milieu in the bone marrow (BM). Here we show that survival outcomes were improved upon prophylactic treatment with the β-glucan immune trainer through induction of heterologous protection against chronic infection. β-Glucan enhanced viral clearance, CTL immunity, neutralizing antibody production and reduced monocyte immunosuppression in multiple LCMV-resident host organs. New insight from this study will help design effective prophylactic treatment strategies against chronic viral infections, particularly in genetically predisposed susceptible hosts.

Antidesmoglein 1 and 3 serum IgG and positivity by direct immunofluorescence microscopy is associated with relapse in pemphigus in a prospective bicontinental study

Background

Prospective studies identifying immunological parameters that can predict clinical relapse in pemphigus are scarce.

Objective

To periodically assess immunological parameters in patients with pemphigus vulgaris and foliaceous in remission to understand immunological events preceding clinical relapse.

Methods

A total of 105 patients were included. Baseline assessment included direct immunofluorescence (DIF), serum IgG against desmoglein (Dsg) 1, IgG, IgG1, and IgG4 against Dsg 3, IgG against the extracellular domains 1 and 2 of Dsg 3, IgG against muscarinic (M3)-AchR, and peripheral CD19+CD27+ memory B cells/plasma cells, repeated every 3 months for up to 12 months or until clinical relapse. DIF was repeated at month 12 and on relapse.

Results

About 29 of 105 patients (28%) experienced a relapse. Longer duration of clinical remission, presence of pruritus and positive anti-Dsg1 at baseline correlated with higher relapse rates. Compared with the visit immediately preceding relapse, a significantly increased number of patients with positive anti-Dsg1 (38% vs 31.1%, P = .01), anti-Dsg3 (51.7% vs 41.4%, P = .01) and IgG positivity by DIF (85.7% vs 25%, P < .001) was observed at the time of relapse.

Conclusion

Regular monitoring of anti-Dsg 1 and anti-Dsg 3 serum levels and DIF positivity during the course of the disease in remission may predict relapse.

Comparing the therapeutic influence of bone marrow Mesenchymal stem cells versus its derived exosomes against diabetic hepatopathy in rats

Diabetes mellitus (DM) is a chronic widespread metabolic disorder, involving a high blood glucose level which causes multiple serious complications including liver, kidney, brain and peripheral nerves damage. Due to the undesirable side effects of the anti-diabetic drugs, the current studies directed to use stem cells and exosomes to overcome the limitations of traditional therapy. We aimed to compare the antidiabetic effect of Bone marrow mesenchymal stem cells (BMMSCs) and its derived exosomes against diabetic hepatopathy induced by streptozotocin (STZ) in albino rats. Our study was conducted on 28 male albino rats divided into 4 groups {control negative non diabetic group, control positive diabetic group, exosomes treated group received (5 × 109 particle/rat) through tail vein twice per week for one month} and Stem cell treated group received (107) BMMSCs through tail vein twice per week for one month. Hepatic structure together with blood glucose level, liver function enzymes were assayed in addition to a lipid profile tests, oxidative stress, and gene expression. Both treated groups by exosomes and stem cells expressed significantly low levels of fasting blood glucose, liver function parameters (ALT, AST, ALP), lipid profile tests (cholesterol and triglycerides), lipid peroxidation index (MDA), with substantial reduction in IL-1β expression compared to diabetic group. Significantly downregulating the VEGF and elevation of eNOS genes and GSH which suggest the effective role provided by BMMSCs and its derived exosomes for treatment of diabetic hepatopathy. Although, the results of both groups showed near average outcomes, the exosome treated group significantly enhanced liver function enzymes and triglyceride, cholesterol level compared to stem cells treated group. These findings were reinforced by the histopathological and immunohistochemistry examination. The latter showed slight but non-significant improvements in VEGF, eNOS, and IL-1β expression. These minor differences together with practical advantages of exosomes make it preferable over BMMSCs in treatment of diabetic hepatopathy.

Corticosteroids combined with low-dose methotrexate in the treatment of pemphigus vulgaris: A retrospective cohort study

The treatment of pemphigus vulgaris (PV) often requires long-term systemic corticosteroids. Although new biologicals like rituximab are changing the landscape, traditional immunosuppressants still prevail in many underdeveloped areas. One such medication is methotrexate (MTX), which has been widely used in autoimmune and autoinflammatory diseases, but its role in treating pemphigus remains somewhat unclear and controversial. This study aimed to evaluate the effect and safety profile of using low-dose MTX in PV patients receiving glucocorticoids. PV patients who visited the Department of Dermatology, Peking University First Hospital from January 2010 to December 2021 were retrospectively screened. Based on different treatment regimens, patients were automatically divided into a corticosteroid monotherapy group and a corticosteroid combined with low-dose MTX group (MTX was administered at a dose of no more than15 mg per week, with a minimum duration of 8 weeks). All patients were followed up for 1 year. A total of 142 patients with PV were eligible for the study (100 in the corticosteroid monotherapy group and 42 in the corticosteroid combined with low-dose MTX group). The Kaplan-Meier curve indicated that the corticosteroid combined with low-dose MTX group achieved a 50% reduction in glucocorticoid use faster, with a P value of 0.0132, especially among patients who initially received more than 60 mg of steroids per day. The inclusion of MTX reduced the occurrence of hyperpilidemia. There was not sufficient evidence to determine if the addition of MTX was associated with more bacterial infection cases for certain. The inclusion of low-dose MTX in the corticosteroid treatment regimen for patients with PV, particularly those receiving high doses, can facilitate the reduction of glucocorticoid dosages and lower the incidence of hyperlipidemia, without increasing the risk of other adverse effects.

Comparability of Randomized Controlled Trials Evaluating Pharmacological Interventions for Pemphigus Vulgaris and Pemphigus Foliaceus: A Systematic Mapping Review

INTRODUCTION

Pemphigus diseases are a family of chronic, autoimmune, blistering skin conditions. Despite advances in treatment approaches, more effective and safer therapies for pemphigus are urgently needed. Trials investigating novel therapeutics must be designed to yield evidence that can be compared to existing data, necessitating a comprehensive understanding of the clinical trial landscape. We aimed to perform a mapping review to assess the comparability of randomized controlled trials (RCTs) evaluating existing treatments for pemphigus vulgaris (PV) and pemphigus foliaceous (PF).

METHODS

Embase, MEDLINE, and Cochrane Library were systematically searched from inception to July 2023, supplemented with conference abstracts, clinical trial registries, and grey literature searches, for RCTs evaluating pharmacotherapies in adults with moderate-to-severe PV or PF. Comparability of study populations (demographic and clinical characteristics), interventions and comparators (dose, administration route, regimen), and outcomes (definition, time point, measure) across trials was assessed.

RESULTS

Fifteen RCTs were eligible for inclusion. Substantial heterogeneity was observed in participant age, sex, and disease duration at baseline, and none of the studies used the same criteria to assess illness severity. Doses and regimens differed across trials assessing the same interventions. Across 16 outcome measures extracted, clinical remission outcomes had limited comparability across studies and were often not defined according to published guidelines. Cumulative corticosteroid dose during the study period had the highest comparability. Health-related quality of life data and serious adverse events were infrequently reported.

CONCLUSIONS

The lack of comparability across studies has major implications for developers of new treatments for PV and PF and for decision-makers who must evaluate the efficacy, safety, and cost-effectiveness of these treatments relative to existing therapeutics.

Management of children and adolescents with chronic myeloid leukemia in chronic phase: International pediatric chronic myeloid leukemia expert panel recommendations

The treatment strategy for children and adolescents with chronic myeloid leukemia in the chronic phase (CML-CP) has evolved from allogeneic hematopoietic stem cell transplantation (HSCT) to tyrosine kinase inhibitors (TKIs). With the advent of next-generation TKIs and new targeted therapies in the CML field, an international pediatric CML expert panel provides recommendations based on the medical literature (including previous pediatric guidelines), national standards, and treatment principles used in adults with CML-CP. Recommendations include diagnosis of the disease and details on managing the initial steps of care of children and adolescents with newly diagnosed CML-CP, including complications such as leukostasis. The treatment recommendations are based on the initiation of therapy with a first- or second-generation TKI according to the allocated European Treatment and Outcome Study (EUTOS) long-term survival score risk group of the patient. The subsequent steps are based on the results of recommended monitoring which can justify a switch to another TKI or a drug in development if there is resistance or toxicity. The panel also provides recommendations regarding the discontinuation criteria for TKIs in children and adolescents in sustained deep molecular response. Allogeneic HSCT is not recommended as the first-line of treatment for children with CML-CP but is to be considered in case of progression to the advanced phase or failure of several lines of treatment. The present treatment and management recommendations are intended to provide advice to clinicians in view of optimizing the care and the outcome of children and adolescents with CML-CP.

Abnormal Glucose Metabolism and Body Composition Changes in Childhood Acute Lymphoblastic Leukemia Survivors During Their Adolescence

Childhood acute lymphoblastic leukemia survivors (ALL-S) face an increased risk of abnormal glucose metabolism (AGM). This study aimed to assess glucose metabolism in 141 ALL-S. All underwent an oral glucose tolerance test (OGTT) and were classified into AGM and normal glucose tolerance (NGT) groups. Insulin sensitivity and secretion indices were calculated from plasma glucose and serum insulin derived from the OGTT. Fat mass index (FMI) was derived from body composition analysis. Sixty-seven of 141 (48%) ALL-S had AGM. AGM was demonstrated in 33 of 98 nonobese ALL-S. ALL-S with AGM had a greater waist circumference percentile and FMI SD score than those with NGT. In addition, ALL-S with AGM had lower insulin sensitivity (greater homeostasis model assessment of insulin resistance: 2.3 [1.4, 3.3] vs. 1.0 [0.5, 1.4], P <0.001 and lower whole-body insulin sensitivity index: 3.5 [2.3, 4.1] vs. 7.9 [5.3, 10.9], P <0.001) and lower insulin secretion relative to insulin sensitivity (disposition index: 5.8 [4.2, 10.2] vs. 10.0 [6.1, 14.6], P <0.001) than those with NGT. Therefore, ALL-S could develop AGM regardless of their body mass index status. AGM in ALL-S stemmed from both insulin resistance and impaired insulin secretion.

Peripheral blood CD4+/CD8+ T cell ratio may have potential for predicting the treatment response of durvalumab plus tremelimumab therapy (STRIDE) for unresectable hepatocellular carcinoma: Preliminary report

BACKGROUND

This preliminary study evaluated the clinical impact of peripheral blood T lymphocyte differentiation patterns to predict the treatment response to durvalumab plus tremelimumab therapy (a regimen termed STRIDE).

METHODS

We investigated 21 patients with unresectable hepatocellular carcinoma (HCC) treated with STRIDE. The treatment response was evaluated 4-8 weeks after the initiation of STRIDE using the modified response evaluation criteria in solid tumors. The correlation between pretreatment peripheral blood T lymphocytes differentiation patterns, with a focus on the peripheral blood CD4+/CD8+ T cell ratio and response to STRIDE, was then investigated.

RESULTS

Of the 21 patients, 5 (24%) had an objective response (OR). The median peripheral blood CD4+/CD8+ T cell ratio (CD4/8-R) of the cohort was 1.4. A receiver operating characteristic curve showed the optimal cutoff value for predicting an OR to STRIDE determined by the Youden index to be 2.5. Of the seven patients with a CD4/8-R ≥2.5, four (57%) had an OR. In contrast, of the 14 patients with a CD4/8-R <2.5, only one patient (7%) had an OR. Finally, the OR rate (ORR) was significantly higher in the group with a CD4/8-R ≥2.5 at the time of STRIDE initiation (p = 0.025).

CONCLUSIONS

The peripheral blood CD4+/CD8+ T cell ratio is a potential predictive biomarker for the response to STRIDE therapy in HCC patients.

Vitamin D supplementation for managing COVID-19 in patients with vitamin D deficiency: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

Vitamin D deficiency is prevalent among the population. Previous studies have shown that vitamin D supplementation might be useful for treating COVID-19 infection. Therefore, we performed a meta-analysis to explore vitamin D supplementation efficacy in treating COVID-19 patients with vitamin D deficiency.

DESIGN

Systematic review and meta-analysis DATA SOURCES: PubMed, Cochrane Library, Embase and Web of Science.

ELIGIBILITY CRITERIA

Randomised controlled trials exploring vitamin D supplementation for patients with COVID-19 and vitamin D deficiency.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers employed standardised methods to search, screen and code the included studies. The primary outcomes included mortality during follow-up, 28-day mortality, need for mechanical ventilation and intensive care unit (ICU). The secondary outcome included length of stay in hospital and ICU. The risk of bias was assessed using the Risk of Bias 2 tool. Depending on the level of heterogeneity, either a random-effects model or a fixed-effects model was applied. The findings were summarised using Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles and synthesised qualitatively.

RESULTS

A total of nine studies, comprising 870 participants, were included in the analysis. The pooled results indicated that vitamin D supplementation was associated with a lower risk of mortality (risk ratio 0.76; 95% CI 0.60 to 0.97). However, this apparent benefit was not robust when examined through the leave-one-out method and trial sequential analysis. Regarding other outcomes, there was no statistically significant difference between vitamin D supplementation and no supplementation in terms of 28-day mortality, the need for mechanical ventilation and ICU admission. Vitamin D supplementation was associated with a 0.41 day shorter length of stay in the ICU (mean difference -0.41; 95% CI -1.09 to 0.28) and a 0.07 day shorter length of stay in the hospital (mean difference -0.07; 95% CI -0.61 to 0.46) compared with no supplementation; however, neither difference was statistically significant.

CONCLUSION

Based on evidence of low to moderate quality, vitamin D supplementation reduced the mortality rate during follow-up in COVID-19 patients with vitamin D deficiency. However, it did not improve 28-day mortality, nor did it reduce the need for mechanical ventilation and ICU admission, or the length of stay in the ICU and hospital.

PROSPERO REGISTRATION NUMBER

CRD42024573791.

Pivotal epitopes for islet antigen-specific CD8+ T cell detection improve classification of suspected type 1 diabetes with the HLA-A*0201 allele

A proportion of patients with new-onset diabetes share similar symptoms with type 1 diabetes (T1D) patients but they are negative for islet antigen-specific autoantibodies. This study was to develop an islet antigen-specific CD8+ T-cell assay to provide autoimmune evidence regarding these "suspected" T1D patients. HLA-A*0201 individuals with autoAbs+ T1D, autoAbs- suspected T1D, and type 2 diabetes, along with HLA-A*0201 healthy controls were recruited. Using interferon-γ enzyme-linked immunospot assays, the percentages of participants in each group with various islet antigen-specific CD8+ T cells were determined. Sixteen out of the 28 islet antigen-specific epitopes tested were T1D specific, meaning that there was a significantly (P < 0.05) greater epitope positivity rate in the autoAbs+ T1D cohort than in the healthy controls. Using a cutoff value of two positive epitopes, the 16-epitope panel led to a sensitivity of 75.0% and a specificity of 94.4% regarding the autoAbs+ T1D patients. Even when using an optimized five-epitope panel, the results were highly accurate. Notably, in the application phase of the study, 77.8% of a new cohort of autoAbs- suspected T1D patients exhibited positivity when using the five-epitope optimized panel. This highly accurate method, especially for pediatric patients, will improve clinical diagnosis and etiological classification of autoimmune T1D.

Multidimensional assessment of adverse events of finasteride：a real-world pharmacovigilance analysis based on FDA Adverse Event Reporting System (FAERS) from 2004 to April 2024

BACKGROUND

Finasteride is commonly utilized in clinical practice for treating androgenetic alopecia, but real-world data regarding the long-term safety of its 0adverse events(AEs) remains incomplete, necessitating ongoing supplementation. This study aims to evaluate the AEs associated with finasteride use, based on data from the US Food and Drug Administration Adverse Event Reporting System (FAERS), to contribute to its safety assessment.

METHODS

We reviewed AE reports associated with finasteride from the US Food and Drug Administration Adverse Event Reporting System database, covering the period from the first quarter of 2004 to the first quarter of 2024. We assessed the safety of finasteride medication and AEs using four proportional disproportionality analyses: reported odds ratio (ROR), proportionate reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPN), and Multi-Item Gamma Poisson Shrinkage (MGPS). These methods were used to evaluate whether there is a significant association between finasteride drug use and AEs. To investigate potential safety issues related to drug use, we further analyzed the similarities and differences in the onset time and AEs by sex, as well as the similarities and differences in AEs by age.

RESULTS

A total of 11,557 AE reports in which finasteride was the primary suspected drug were analysed. The majority of patients were male (86.04%) and a significant proportion were young adults aged 18-45 years (27.22%). A total of 73 different AEs were categorised into 7 system organ classes (SOCs), with common AEs including erectile dysfunction and sexual dysfunction. In addition, we identified previously unlisted AEs, including Peyronie's disease and post-5α reductase inhibitor syndrome. Of the reported AEs, 102 occurred in men and 7 in women, with depression and anxiety being significant AEs observed in both sexes. When analysed by age group, there were 17 AEs in patients aged ≤ 18 years, 157 in patients aged 18-65 years and 133 in patients aged ≥ 65 years. Common AEs in all age groups included erectile dysfunction, decreased libido, depression, suicidal ideation, psychotic disturbances and attention disorders. The median time to onset of all AEs was 61 days, with the majority occurring within the first month of treatment. Notably, a significant number of AEs persisted beyond one year of treatment.

CONCLUSION

The results of our study uncovered both known and novel AEs associated with finasteride medication. Some of these AEs were identical to the specification, and some of them signaled AEs that were not demonstrated in the specification. In addition, some AEs showed variations based on sex and age in our study. Consequently, our findings offer valuable insights for future research on the safety of finasteride medication and are anticipated to enhance its safe use in clinical practice.

Influence of military preventive policy for recruit training on COVID-19 seroconversion: the IMPACT-COVID-19 study

INTRODUCTION

Recruitment and training is vital to maintaining the size, deployability and effectiveness of armed forces, but was threatened early in the COVID-19 pandemic. Reports suggested asymptomatic seroconversion driving SARS-CoV-2 transmission in young adults. Potential association between lower vitamin D status and increased infection risk was also highlighted. We aimed to prospectively determine seroconversion and test the hypothesis that this would vary with vitamin D supplementation in representative populations.

METHODS

Two cohorts were recruited from Yorkshire, Northern England. Infantry recruits received daily oral vitamin D (1000 IU for 4 weeks, followed by 400 IU for the remaining 22 weeks of training) in institutional countermeasures to facilitate ongoing training/co-habitation. Controls were recruited from an un-supplemented University population, subject to social distancing and household restrictions. Venous blood samples (baseline and week 16) were assayed for vitamin D and anti-SARS-CoV-2 spike glycoprotein antibodies, with additional serology (weeks 4, 9, 12) by dried blood spot. The impact of supplementation was analysed on an intention-to-treat basis in volunteers completing testing at all time points and remaining unvaccinated against SARS-CoV-2. Variation in seroconversion with vitamin D change was explored across, and modelled within, each population.

RESULTS

In the military (n=333) and University (n=222) cohorts, seroconversion rates were 44.4% vs 25.7% (p=0.003). At week 16, military recruits showed higher vitamin D (60.5±19.5 mmol/L vs 53.5±22.4 mmol/L, p<0.001), despite <50% supplementation adherence. A statistically significant (p=0.005) effect of negative change in vitamin D (%) on seroconversion in recruits (OR of 0.991 and 95% CI of 0.984 to 0.997) was not evidenced in the University cohort.

CONCLUSION

Among unvaccinated populations, SARS-CoV-2 infection of infantry recruits was not reduced by institutional countermeasures, versus civilians subject to national restrictions. Vitamin D supplementation improved serum levels, but the implementation did not have a clinically meaningful impact on seroconversion during military training.

Effect of administration routes on the efficacy of human umbilical cord mesenchymal stem cells in type 2 diabetic rats

Background

Human umbilical cord mesenchymal stem cells (UCMSCs) are being investigated in various clinical trials for different conditions, including type 2 diabetes mellitus (T2DM). However, there is limited research on the optimal injection routes for UCMSCs in T2DM, particularly intravenous injection.

Objective

The objective of this study aims to investigate the efficacy of four different administration routes of UCMSCs in treating T2DM rats, including pancreas injection (DP), tail vein injection (DT), intraperitoneal injection (DI), and dorsal pancreatic artery injection (DPA).

Results

After two weeks of UCMSCs treatment, the fasting blood glucose levels in the DT group decreased significantly. The oral glucose tolerance test (OGTT) levels and the islet structure in the DT group almost recovered to normal. The contents of C-P and GLP-1 in serum increased significantly in all treatment groups, while the levels of INS, TNF-α, IL-6, IL-1β, IAA, and GSP decreased significantly. These improvements were further observed after four weeks of UCMSCs treatment. Histological analysis confirmed the progression of pancreatic recovery in all treatment groups, with the DT group showing the most significant improvement, correlating with the observed efficacy. Immunohistochemistry results further demonstrated increased insulin and PDX-1 expression, along with reduced glucagon levels in UCMSCs-treated rats. Additionally, liver and kidney function significantly improved across all treatment groups, with the DT group showing the best outcomes.

Conclusion

Overall, these findings suggest that the administration route significantly affected the efficacy of UCMSCs in treating T2DM, with tail vein injection showing the most effective results.

Impact of anti-peptic ulcer disease medications on type 2 diabetes mellitus risk in patients with PUD: a population-based retrospective cohort study

Background

The etiology of type 2 diabetes mellitus (T2DM) is complex, with environmental factors playing a significant role in its pathophysiology. Nonsteroidal anti-inflammatory drugs usage and Helicobacter pylori infection are the two most frequent causes of peptic ulcer disease (PUD). The link between PUD and T2DM is unclear, and comprehensive analyses of anti-PUD medications' impact on T2DM risk, especially in Asian populations, are lacking. This study aimed to determine the relationship between PUD, anti-PUD medications, and the likelihood of developing T2DM.

Objectives

Using a population-based cohort study conducted in Taiwan, we investigated the impact of PUD and anti-PUD medications on the risk of T2DM.

Design

This is a retrospective, population-based cohort study using the largest database used in Taiwan.

Methods

An 18-year follow-up period study was conducted on a cohort of patients with PUD diagnosed between 2001 and 2018 using the Taiwan National Health Insurance Research Database. The risk of PUD as well as anti-PUD medications use were examined using Cox proportional regression model.

Results

Based on multivariable Cox proportional hazards regression analysis, patients with PUD had a higher overall T2DM incidence (22.7 vs 21.3 per 1000 person-years) than patients without PUD. The adjusted hazard ratio was 1.12 (95% confidence interval = 1.10, 1.13). Patients with PUD have a higher risk of T2DM in both genders and age groups. Patients with anti-PUD medications, such as H2 receptor antagonists, proton-pump inhibitors, antibiotics, prostaglandin analogs, anticholinergics, and antacids usage, are associated with a lower risk of developing T2DM than those without. Patients with PUD who underwent surgery were found to have a higher risk of T2DM.

Conclusion

Patients with PUD are more likely to develop T2DM. Nevertheless, patients receiving anti-PUD medications have a lower incidence of T2DM.

Evidence-Based Recommendations for Managing Atopic Dermatitis in Pediatric Patients: A Systematic Review and Meta-Analysis From the Pediatric Dermatology Special Interest Group of IADVL

BACKGROUND

Atopic dermatitis (AD) is the most common inflammatory skin disease in the pediatric age group, affecting 15%-20% of children globally. Initial treatment modes include hydration, occlusive topical medicines, antimicrobial treatment, phototherapy, and systemic immune suppressants in the case of severe to moderate refractory AD. However, there is a lack of head-to-head studies on the choice of topical and systemic therapies for moderate to severe AD in the pediatric age group.

OBJECTIVE

This systematic review aimed to determine the efficacy and safety of topical and systemic treatments for moderate-to-severe AD in the pediatric age group.

METHOD

A systematic review was performed following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. A search of articles was done from PubMed and Google Scholar from 1975 to 2023.

RESULTS

We found a total of 1114 possible clinical trials. Of these, 68 articles fulfilled the eligibility criteria. Thirty-four articles discussed topical therapies, which included corticosteroids, calcineurin inhibitors, and emollients, and 34 articles were about systemic therapies, consisting of cyclosporine, dupilumab, upadacitinib, thymopentin, omalizumab, antihistamines, probiotics, and others. Out of 68 studies, 41 were randomized controlled trials.

CONCLUSION

Based on the study results, we conclude that topical steroids and calcineurin inhibitors are effective and safe in mild to moderate pediatric AD. It was also demonstrated that while systemic monotherapy with dupilumab (in age groups younger than 6 months) and JAK inhibitors (like abrocitinib and upadacitinib in those younger than 12 years) is highly effective in rapidly reducing severity scores, their high cost and limited availability restrict their use in countries like India. In such settings, cyclosporine (and sometimes oral prednisolone in tapering doses over 2 weeks) is still recommended as a first-line therapy in severe AD while planning for steroid-sparing agents.

Vitamin D: A Nutraceutical Supplement at the Crossroad Between Respiratory Infections and COVID-19

Even though in mid-2023 the World Health Organization declared the end of the public health emergency of international concern status for COVID-19, many areas of uncertainty about SARS-CoV-2 infection pathophysiology remain. Although in the last 4 years pharmaceutical industries widely invested in the development of effective antiviral treatments and vaccines, large disparities in their availability worldwide still exist, thus fostering the investigation of nutritional supplements as adjuvant therapeutic approaches for disease management, especially in resource-limited settings. During the COVID-19 pandemic, vitamin D has been widely used as an over-the-counter solution to improve disease evolution, thanks to its known immunomodulatory and anti-inflammatory actions. Ecological and observational studies support a relationship between hypovitaminosis D and COVID-19 negative outcomes and, according to this evidence, several research groups investigated the role of vitamin D supplementation in protecting from SARS-CoV-2 infection and/or improving disease evolution. This narrative review is intended to offer insights into the existing data on vitamin D's biological effects in respiratory infections, especially in COVID-19. Furthermore, it will also offer a brief overview of the complex interplay between vitamin D and vaccine-elicited immune response, with special attention to anti-COVID-19 vaccines.

Brazilian guideline for screening and diagnosis of type 2 diabetes: a position statement from the Brazilian Diabetes Society

BACKGROUND

Patients with type 2 diabetes (T2D) often experience prolonged periods of asymptomatic hyperglycemia, which significantly increases the risk of developing chronic complications related to diabetes. Screening programs for individuals at high risk for T2D provide valuable opportunities not only for early diagnosis but also for detecting intermediate hyperglycemic states, commonly referred to as prediabetes. Interventions aimed at preventing diabetes in this group can successfully delay or even avoid the onset of the disease and its associated burdens. This review is an update of the Brazilian Diabetes Society (Sociedade Brasileira de Diabetes [SBD]) evidence-based guideline for diagnosing diabetes and screening T2D.

METHODS

The methodology was previously published and defined by the internal institutional steering committee. The working group drafted the manuscript by selecting vital clinical questions for a narrative review, utilizing MEDLINE via PubMed to identify relevant studies. The review assessed the best available evidence, including randomized clinical trials (RCTs), meta-analyses, and high-quality observational studies related to the diagnosis of diabetes.

RESULTS AND CONCLUSIONS

Fifteen specific recommendations were formulated. Screening is recommended for adults aged 35 and older or younger individuals with obesity and additional risk factors. For children and adolescents, screening is recommended starting at age ten or the onset of puberty if they are overweight or obese and have additional risk factors. Fasting plasma glucose (FPG) and HbA1c are recommended as initial screening tests. The oral glucose tolerance test (OGTT) is recommended for high-risk individuals with normal HbA1c and FPG or those with prediabetes. The 1-h OGTT is preferred over the 2-h OGTT, as it is both more practical and a superior test. A structured approach to reevaluation intervals is provided.

Changing trends in clinical presentation of primary hyperparathyroidism across countries over time

Primary hyperparathyroidism (PHPT), the third most common endocrine disorder, was so eloquently described first by Fuller Albright as a polymorphic condition in his classic paper and monograph as early as 1934. Over the decades, the clinical presentation of PHPT in developed countries has shifted significantly from a disease primarily affecting the bones and kidneys to an asymptomatic condition often discovered incidentally. In developing countries, the high prevalence of vitamin D deficiency is one of the main factors influencing the clinical presentation of PHPT. In Europe and North America, PHPT is predominantly asymptomatic. In South America, China, and Eastern parts of Europe, such as Turkey, Bulgaria, and Russia, there is an ongoing transition from symptomatic to asymptomatic cases. Asia shows variability: symptomatic cases dominate in the Indian subcontinent, Middle East, and Southeast Asia, while transitional patterns with predominant asymptomatic cases have now been reported in China, and Japan reports mostly asymptomatic cases. Factors influencing these changes include advancements in diagnostic technologies, detection of incidental parathyroid adenomas during thyroid ultrasonography, regional differences in vitamin D deficiency, dietary habits, and genetic polymorphisms in vitamin D and calcium-sensing receptors. A higher prevalence of nephrolithiasis in certain climates contributes to regional variations. This review examines the dynamic nature of PHPT's clinical presentation, shaped by geographic, genetic, and environmental influences. Also, this review highlights the importance of addressing global disparities in an attempt to optimize patient outcomes.

Molecular basis of symptomatic sporadic primary hyperparathyroidism: New frontiers in pathogenesis

Primary hyperparathyroidism is a common endocrine disorder characterized by inappropriate elevation of parathyroid hormone and hypercalcemia. While predominantly an asymptomatic disease in Western populations, symptomatic presentations are more prevalent in Eastern countries. The molecular pathogenesis of sporadic PHPT primarily involves genetic and epigenetic alterations leading to abnormal parathyroid cell proliferation and altered calcium sensing mechanism. To date, MEN1 and cyclin D1 are the only established drivers of sporadic PHPT. Somatic MEN1 gene mutations occur in 30-40 % of sporadic parathyroid adenomas (PA), with a recent study on symptomatic cases reporting germline variants.Cyclin D1 overexpression in sporadic PA has been observed in 20-40 % of cases in Western populations and 80 % of cases in Eastern populations, with an inverse association with cyclin-dependent kinase inhibitors CDKN2A and CDKN2B expression. The calcium-sensing receptor expression was significantly lower in symptomatic compared to asymptomatic PHPT, strongly supported by epigenetic deregulation (promoter hypermethylation and histone methylation). Recent studies have highlighted the potential involvement of EZH2, a histone methyltransferase, in parathyroid tumorigenesis. Additionally, parathyroid-specific transcription factors like GCM2, PAX1, and GATA3 are emerging as putative tumor suppressors, especially from the symptomatic PHPT. Next-generation sequencing has identified novel potential drivers such as PIK3CA, MTOR, and NF1 in sporadic PC, alongside CDC73. The molecular landscape of sporadic PHPT appears to differ between Eastern and Western populations. This heterogeneity underscores the need for further large-scale studies, particularly in symptomatic cases from developing nations, to comprehensively elucidate the molecular drivers of parathyroid tumorigenesis.

Aberrant promoter methylation, expression and function of RASSF1A gene in a series of Italian parathyroid tumors

PURPOSE

Aberrant epigenetic features are key events involved in parathyroid tumorigenesis, including DNA methylation, histone methylation, and non-coding RNAs. Ras Association Domain Family Protein1 Isoform A (RASSF1A) and Adenomatous Polyposis of Colon (APC) are frequently downregulated in human cancers. Here, we investigated their deregulated expression and the potential role in parathyroid neoplasms.

METHODS

methylation of RASSF1A and APC promoters was analyzed in a series of parathyroid adenomas (PAds, n = 80) and parathyroid carcinomas (PCas, n = 9) from Italian patients with primary hyperparathyroidism, RESULTS: RASSF1A and APC promoter methylation occurred in about 90% of PAds samples. PCas displayed RASSF1A promoter methylation, while APC promoter was methylated only in 2 samples. Of note, RASSF1A promoter methylation negatively correlated with PAds tumor size. However, RASSF1A transcript and protein levels were reduced in PAds and PCas compared with parathyroid normal glands. Investigating the potential mechanism involved in RASSF1A promoter methylation, we found that DNA methyltransferases (DNMTs) activity was variable in PAds and inversely correlated with RASSF1A protein levels. In addition, the RASSF1A promoter methylation negatively correlated with long-non-coding Antisense Intronic Noncoding RASSF1A (ANRASSF1A) mRNA levels, excluding the involvement of ANRASSF1 in RASSF1A regulation. In HEK293A cells transfected with the calcium sensing receptor (CASR), loss of RASSF1A increased basal phosphorylated Extracellular signal-regulated kinase (pERK/ERK) levels blunting the CASR-induced increases.

CONCLUSION

RASSF1A and APC promoter methylation is a hallmark of parathyroid tumors; deregulation of DNMTs activity contributes to modulation of RASSF1A expression. Loss of RASSF1A may be involved in the tuning of ERK pathway in parathyroid tumors.

The Causal Relationship Between Acne Vulgaris and BMI: A Mendelian Randomization Study

BACKGROUND

As an inflammatory skin condition, acne usually presents with a complex pathogenesis. Recent studies suggest that BMI may relate to the incidence of acne. Mendelian randomization is a statistical method that is used to evaluate the causal effects of exposure factors on outcome variables.

METHODS

We applied the inverse-variance weighted (IVW) method to evaluate the causal effect as the primary analysis between BMI and acne in our two-sample Mendelian randomization study. We included 58 SNPs accounting for 2.5% (R2) of the BMI variation as instrumental variables (IVs) for BMI-acne causal estimations.

RESULT

The F-statistic obtained from the first stage of the MR regression model was 61. Importantly, the results from all three methods consistently indicated that an increase in BMI did not elevate the risk of acne, with each result reaching statistical significance. Cochran's Q test revealed no evidence of heterogeneity among the IV estimates for individual variants. Our I2 values suggested low heterogeneity, thereby reinforcing the reliability of the MR estimates. Additionally, the "leave-one-out" analysis confirmed that no single SNP disproportionately affected the IVW point estimate.

CONCLUSION

Our findings suggested that there is no causal relationship between BMI and acne.

Clinical Profile and Treatment Outcomes in Patient with Acromegaly Using 14th Acromegaly Consensus Criteria

Introduction

Acromegaly is a chronic systemic disease characterized by excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). This study reviews our experience with endoscopic transsphenoidal surgery (TSS) in acromegaly patients, focusing on remission rates according to the 2023 consensus criteria.

Methods

We conducted a hospital based, retrospective study involving 42 patients diagnosed with acromegaly who underwent endoscopic TSS, between January 2020 and June 2024. Clinical and hormonal profiles, comorbidities and outcome data were analysed. Remission was defined as age-adjusted IGF-1 levels 3 months post-surgery.

Results

Mean age at diagnosis was 36.43 ± 10.70 years. The two most frequent presenting symptoms were headache (64.28%) and visual deficits (47.61%). Common comorbidities included diabetes mellitus (23.8%) and hypertension (28.57%). Pre-operative hormonal evaluation revealed secondary hypogonadism in 41.66% of patients, followed by hypothyroidism (23.81%) and cortisol deficiency (21.43%). Biochemical remission was achieved in 18 out of 42 patients (42.85%), including all five patients with microadenomas and 35.13% of those with macroadenomas. Although Knosp grade, maximum tumour diameter and pre-operative post glucose growth hormone levels showed significant associations in univariate analyses, these associations were not significant after adjustment. On multivariate analysis, post-operative day 2 GH levels (≤2.75 ng/ml) emerged as a significant predictor of remission.

Conclusions

This study provides the comprehensive review of clinical presentations and outcomes of patients with acromegaly based on the latest acromegaly consensus guidelines. Notably, a post-operative day 2 GH less than 2.75 ng/ml emerged as a significant predictor of outcome.

Topical Therapy in Psoriasis: Clinical Benefits, Advances in Novel Drug Delivery Strategies, and Gene Therapy Regimen

Psoriasis is a chronic inflammatory disease with a complex pathogenesis, influenced by various factors involving environment, genes, and immunity. The main symptoms of psoriasis include erythema, scales, itching, etc. At present, therapeutic drugs for psoriasis are continually evolving towards enhancing treatment efficacy and reducing side effects. Firstly, the pathogenesis and characteristics of psoriasis were summarized. Then, the types and benefits of topical therapy were introduced, such as the aspects of avoiding systemic toxic effects, first pass effect, and gastrointestinal reactions with accelerating the onset time of the drugs and improving its efficacy, and were compared to systemic drugs. In the case of methotrexate, cyclosporin A, Janus kinase (JAK) inhibitors, and phosphodiesterase-4 (PDE-4) inhibitors, this review had a further discussion on the improvement and translation of these molecules from systemic therapy to topical therapy in clinical practice. To further augment the limitation of skin permeability, nanotechnology and novel topical drug delivery system including nanomedicines, hydrogels, ionic liquids, and microneedles were elaborated for psoriasis management. Also, exploration of topical targeting pathogenic genes through small interfering RNA (siRNA) using nanoparticles and ionic liquids (ILs) is of great significance for long-term treatment in psoriasis. Taken together, the development of numerous topical delivery platforms is expected to achieve enhanced penetration, and precise and efficient delivery of small molecule and RNA interference (RNAi) therapeutics in psoriasis with clinical translation prospects.

From Microbes to Metabolites: Advances in Gut Microbiome Research in Type 1 Diabetes

Background: Type 1 diabetes (T1D) is a severe chronic T-cell mediated autoimmune disease that attacks the insulin-producing beta cells of the pancreas. The multifactorial nature of T1D involves both genetic and environmental components, with recent research focusing on the gut microbiome as a crucial environmental factor in T1D pathogenesis. The gut microbiome and its metabolites play an important role in modulating immunity and autoimmunity. In recent years, studies have revealed significant alterations in the taxonomic and functional composition of the gut microbiome associated with the development of islet autoimmunity and T1D. These changes include reduced production of short-chain fatty acids, altered bile acid and tryptophan metabolism, and increased intestinal permeability with consequent perturbations of host (auto)immune responses. Methods/Results: In this review, we summarize and discuss recent observational, mechanistic and etiological studies investigating the gut microbiome in T1D and elucidating the intricate role of gut microbes in T1D pathogenesis. Moreover, we highlight the recent advances in intervention studies targeting the microbiota for the prevention or treatment of human T1D. Conclusions: A deeper understanding of the evolution of the gut microbiome before and after T1D onset and of the microbial signals conditioning host immunity may provide us with essential insights for exploiting the microbiome as a prognostic and therapeutic tool.

The Association of VDR/FokI Gene Polymorphism and Protein Expression With Histopathological Alterations in Patients With Thyroid Colloid Nodule

Objective: Colloid nodules are common and benign thyroid lesions that usually progress slowly and are asymptomatic. It requires follow-up because untreated colloid nodules may develop into malignant tumor. The study aimed to examine the contributions of vitamin D receptor (VDR) expression, VDR/FokI (rs2228570) genotypes, and serum vitamin D level to the susceptibility to colloid nodules. Methods: One hundred forty subjects (80 patients and 60 controls) were enrolled and VDR FokI was determined by PCR in formalin fixed paraffin embedded (FFPE) blocks of the patients and blood of controls. Moreover, VDR protein expression was evaluated by immunohistochemistry using specific VDR monoclonal antibody in the tissue sections of patients and serum vitamin D were measured simultaneously using enzyme-linked immunosorbent assay (ELISA). Results: Sixty-two (77.5%) cases showed strong immunoreactivity score (IRS) of cytoplasmic staining. Strong IRS were significantly observed in samples with larger nodule size (p value: 0.0094), multinodules (p value: 0.0054), and carriers of CC genotypes (p value: 0.0034). TT homozygous genotype revealed significantly (p value: 0.029 and odds ratio (OR): 0.11) protective factor for colloid nodules. In addition, nodule size was significantly (p value: 0.016) larger among CC carriers. Moreover, vitamin D level and category were nonsignificantly difference between patients and controls. Conclusion: Our results reveal prominent cytoplasmic VDR expression, suggesting a distinct distribution pattern and offering valuable insights into its potential role in colloid nodules. VDR expression increases with increasing size and number of nodules. Regarding FokI genotypes, TT genotype was less likely to develop colloid nodule. These findings contribute to our understanding of cellular characteristics of this condition and may have implications for future research and clinical management.

Body Composition Analysis Using DEXA-Scan and its Correlation with Arm-Anthropometry in Childhood Acute Lymphoblastic Leukemia Survivors

OBJECTIVE

To determine the body composition in childhood acute lymphoblastic leukemia survivors (cALLS) using dual-energy x-ray absorptiometry (DEXA) and correlate the same with mid-upper-arm circumference (MUAC) and triceps-skin-fold thickness (TSFT).

METHODS

A cross-sectional study was undertaken to assess body composition in cALLS aged >7 years. Patients who were lost to follow-up after completion of therapy, had relapsed acute lymphoblastic leukemia (ALL), undergone hematopoietic stem cell transplantation and those with neurological disabilities/syndromic diagnosis were excluded. Prevalence of high-adiposity (body fat % > 85th centile), sarcopenia (lean body mass < 5th centile) and sarcopenic obesity (positive fat mass index z-score with negative fat-free mass index z-score); and demographic, therapy-related and endocrine factors were noted.

RESULTS

Fifty-nine cALLS survivors with a median (IQR) age of 66 (38, 91) months at diagnosis were analyzed. At a median (IQR) duration of 14 (3, 43) months following completion of therapy, 36 children (61%) had deranged body composition; high adiposity (n = 28; 47%), sarcopenia (n = 20; 34%), sarcopenic obesity (n = 9; 15%). Metabolic syndrome was seen in 7 (12%). Survivors with lower mean-age at diagnosis and at enrolment had high-adiposity levels and sarcopenia. Sarcopenia was seen more commonly in females, pre-pubertal children and survivors with a lower mean-interval from therapy completion. Obesity, sarcopenia and sarcopenic obesity were not significantly associated with the type of ALL, steroid dose and cranial-irradiation. High leptin levels were seen in survivors with obesity and sarcopenic obesity. MUAC and TSFT correlated well with DEXA-generated markers.

CONCLUSION

The prevalence of deranged body composition in cALLs from a single centre in Northern India was high, indicating need for early and frequent screening. MUAC and TSFT are reliable surrogate measures for body composition.

Youth Who Control HIV on Antiretroviral Therapy Display Unique Plasma Biomarkers and Cellular Transcriptome Profiles Including DNA Repair and RNA Processing

Combination antiretroviral therapy (ART) suppresses detectible HIV-1 replication, but latent reservoirs and persistent immune activation contribute to residual viral-associated morbidities and potential viral reactivation. youth with HIV (YWH) virally suppressed on ART early in infection before CD4 T cell decline with fewer comorbidities compared to adults represent a critical population for identifying markers associated with viral control and predictors of viral breakthrough. This study employed a multi-omics approach to evaluate plasma biomarkers and cellular gene expression profiles in 52 participants, including 27 YWH on ART for 144 weeks and 25 youth with no infection (NI) (ages 18-24). Among the 27 YWH, 19 were virally suppressed (VS; <50 RNA copies/mL), while eight were non-suppressed (VNS; >50 RNA copies/mL). VS YWH displayed unique bioprofiles distinct from either VNS or NI. Early viral suppression mitigates inflammatory pathways and normalizes key biomarkers associated with HIV-related comorbidities. Genes upregulated in pathways linked to cellular homeostasis such as DNA repair, RNA processing, and transcription regulation may diminish viral breakthrough and maintain sustained HIV control on ART. Candidate markers and putative molecular mechanisms were identified, offering potential therapeutic targets to limit viral persistence, enhance HIV treatment strategies, and pave the way for improved clinical outcomes.