Enhancing the Design of Nutrient Clinical Trials for Disease Prevention-A Focus on Vitamin D: A Systematic Review

OBJECTIVES

This systematic review (SR) highlights principles for nutrient clinical trials and explore the diverse physiological functions of vitamin D beyond its traditional role in the musculoskeletal system related to clinical study designs.

BACKGROUND

Thousands of published research articles have investigated the benefits of vitamin D (a nutrient example taken in this SR) beyond the musculoskeletal system, including the immune, pulmonary, and cardiovascular systems; pregnancy; autoimmune disorders; and cancer. They illustrated vitamin D's molecular mechanisms, interactions, and genomic and nongenomic actions.

METHODS

This SR was designed to identify shortcomings in clinical study designs, statistical methods, and data interpretation that led to inconsistent findings in vitamin D-related publications. SR also highlights examples and insights into avoiding study design errors in future clinical studies, including randomized controlled clinical trials (RCTs). The SR adheres to the latest PRISMA statement, guidelines, and the PICOS process.

RESULTS

Inappropriate or flawed study designs were frequent in clinical trials. Major failures discussed here include too short clinical study duration, inadequate or infrequent doses, insufficient statistical power, failure to measure baseline and achieved levels, and recruiting vitamin D-sufficient participants. These design errors have led to misleading interpretations. Thus, conclusions from such studies should not be generalized or used in guidelines, recommendations, or policymaking.

CONCLUSION

Adequately powered epidemiological studies and RCTs with sufficient vitamin D and duration in individuals with vitamin D deficiency reported favorable clinical outcomes, enriching the literature, enabling to understand its physiology and mechanisms. Proper study designs with rigorous methodologies and cautious interpretation of outcomes are crucial in advancing the nutrient field. The principles discussed apply not only to vitamin D, but also other micro-nutrients and nutraceutical research. Adhering to them enhances the credibility and reliability of clinical trials, SRs, and meta-analysis outcomes. The study emphasizes the importance of focused, hypothesis-driven, well-designed, statistically powered RCTs to explore the diverse benefits of nutrients, conducted in index nutrient deficient participants, and avoidance of study design errors. Findings from such studies should be incorporated into clinical practice, policymaking, and public health guidelines, improving the health of the nation and reducing healthcare costs.

In silico evaluation of pramlintide dosing algorithms in artificial pancreas systems

Pramlintide's capability to delay gastric emptying has motivated its use in artificial pancreas systems, accompanying insulin as a control action. Due to the scarcity of pramlintide simulation models in the literature, in silico testing of insulin-plus-pramlintide strategies is not widely used. This work incorporates a recent pramlintide pharmacokinetics/pharmacodynamics model into the T1DM UVA/Padova simulator to adjust and validate four insulin-plus-pramlintide control algorithms. The proposals are based on an existing insulin controller and administer pramlintide either as independent boluses or as a ratio of the insulin infusion. The results of the insulin-pramlintide algorithms are compared against their insulin-alone counterparts, showing an improvement in the time in range between 3.00% and 10.53%, consistent with results reported in clinical trials in the literature. Future work will focus on individualizing the pramlintide model to the patients' characteristics and evaluating the implemented strategies under more challenging scenarios.

Glycation in Alzheimer's Disease and Type 2 Diabetes: The Prospect of Dual Drug Approaches for Therapeutic Interventions

As global life expectancy increases, the prevalence of neurodegenerative diseases like Alzheimer's disease (AD) continues to rise. Since therapeutic options are minimal, a deeper understanding of the pathophysiology is essential for improved diagnosis and treatments. AD is marked by the aggregation of Aβ proteins, tau hyperphosphorylation, and progressive neuronal loss, though its precise origins remain poorly understood. Meanwhile, type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia, leading to the formation of advanced glycation end products (AGEs), which are implicated in tissue damage and neurotoxicity. These AGEs can be resistant to proteolysis and, therefore, accumulate, exacerbating AD pathology and accelerating neurodegeneration. Insulin resistance, a hallmark of T2DM, further complicates AD pathogenesis by promoting tau hyperphosphorylation and Aβ plaque accumulation. Additionally, gut microbiome dysbiosis in T2DM fosters AGE accumulation and neuroinflammation, underscoring the intricate relationship between metabolic disorders, gut health, and neurodegenerative processes. This complex interplay presents both a challenge and a potential avenue for therapeutic intervention. Emerging evidence suggests that antidiabetic medications may offer cognitive benefits in AD, as well as in other neurodegenerative conditions, pointing to a shared pathophysiology. Thus, we posit that targeting AGEs, insulin signaling, and gut microbiota dynamics presents promising opportunities for innovative treatment approaches in AD and T2DM.

Therapeutic potential of fisetin in hepatic steatosis: Insights into autophagy pathway regulation and endoplasmic reticulum stress alleviation in high-fat diet-fed mice

Non-alcoholic fatty liver disease (NAFLD) is a common condition with limited FDA-approved treatments due to its complex pathogenesis. Metabolic stress-induced lipotoxicity triggers the unfolded protein response, leading to the development of NAFLD through inflammation and apoptosis. Moreover, metabolic dysregulation compromises autophagic capacity, impairing effective ERphagy and lipophagy in the liver. Fisetin (FSN), a flavonoid present in various fruits and vegetables, has demonstrated the ability to regulate the processes mentioned above and possesses a range of biological properties. In this study using a high-fat diet-induced NAFLD mouse model, treatment with FSN at a dosage of 80 mg/kg per day for eight weeks resulted in reduced hepatic lipid accumulation. This effect was mediated by modulating ER stress through enhancing autophagic activity, as indicated by decreased expression of GRP78, elf2a, ATF4, and CHOP genes, along with increased AMPK phosphorylation, decreased mTOR expression, and elevated levels of ULK1, ATG5, and Beclin1. Additionally, there was an increase in the LCII/LC3I ratio and a reduction in p62 levels in hepatic tissue. Our findings suggest that FSN exerts its effects by activating the AMPK/mTOR signaling pathway and its downstream targets, underscoring its potential therapeutic advantages in managing NAFLD by targeting autophagy and ER stress pathways.

Low-Calorie, High-Protein Ketogenic Diet Versus Low-Calorie, Low-Sodium, and High-Potassium Mediterranean Diet in Overweight Patients and Patients with Obesity with High-Normal Blood Pressure or Grade I Hypertension: The Keto-Salt Pilot Study

Background and Objective: Dietary interventions are the first-line treatment for overweight individuals (OW) and individuals with obesity (OB) with high-normal blood pressure (BP) or grade I hypertension, especially when at low-to-moderate cardiovascular risk (CVR). However, current guidelines do not specify the most effective dietary approach for optimising cardiovascular and metabolic outcomes in this population. This study aimed to compare the effects of a low-calorie, high-protein ketogenic diet (KD) vs. a low-calorie, low-sodium, and high-potassium Mediterranean diet (MD) on BP profiles assessed via ambulatory BP monitoring (ABPM), as well as on anthropometric measures, metabolic biomarkers, and body composition evaluated by bioelectrical impedance analysis (BIA). Methods: This prospective observational bicentric pilot study included 26 non-diabetic adult outpatients with central OW status or OB status (body mass index, BMI > 27 kg/m2) and high-normal BP (≥130/85 mmHg) or grade I hypertension (140-160/90-100 mmHg), based on office BP measurements. All participants had low-to-moderate CVR according to the second version of the systemic coronary risk estimation (SCORE2) and were selected and categorized as either KD (n = 15) or MD (n = 11). Comprehensive blood analysis, BIA, and ABPM were conducted at baseline and after three months. Results: At baseline, no significant differences were observed between the groups. Following three months of dietary intervention, both groups exhibited substantial reductions in body weight (KD: 98.6 ± 13.0 to 87.3 ± 13.4 kg; MD: 93.8 ± 17.7 to 86.1 ± 19.3 kg, p < 0.001) and waist circumference. Mean 24 h systolic BP (SBP) and diastolic BP (DBP) significantly declined in both groups (24 h mean SBP decreased from 125.0 ± 11.3 to 116.1 ± 8.5 mmHg (p = 0.003) and 24 h mean DBP decreased from 79.0 ± 8.4 to 73.7 ± 6.4 mmHg (p < 0.001)). Fat-free mass (FFM) increased, whereas fat mass (FM), blood lipid levels, and insulin concentrations decreased significantly. The ΔFM/ΔFFM correlates with ABP improvements. However, no significant between-group differences were detected at follow-up. Conclusions: The KD and the MD mediated weight loss and body composition changes, effectively improving bio-anthropometric and cardiovascular parameters in individuals with OW status or OB status and high BP. Although more extensive studies are warranted to elucidate potential long-term differences, our findings suggest the manner in which these two different popular dietary approaches may equally confer metabolic and cardiovascular benefits, emphasising the importance of weight and FM loss.

Effects of ketogenic diets on polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to evaluate the effects of ketogenic diet (KD) and very-low-energy ketogenic therapy (VLEKT) protocols on various health outcomes in patients with polycystic ovary syndrome (PCOS) and increased body weight.

METHODS

A systematic search was conducted across Scopus, PubMed, Cochrane, and Embase databases from their inception through January 2025, using a predefined search strategy. Studies were selected based on the PICOS criteria. Data extraction focused on anthropometric measures, glycometabolic and lipid profiles, and hormone levels. Controlled studies were analyzed to evaluate the effects of high-fat KDs and VLEKT compared to low calorie diets (LCDs). Additionally, uncontrolled studies were included, and the outcomes following high-fat KDs or VLEKT were compared to baseline values (before-after study design). A sub-analysis was also performed to compare VLEKT with high-fat KDs. We assessed the quality of the evidence, as well as heterogenity, sensitivity, and publication bias.

RESULTS

A total of 10 studies were included in the analyses, comprising three randomized controlle studies (RCTs), one non-randomized intervention study, four cohort studies, and two case series. Two RCTs comparing VLEKT and high-fat KDs with LCDs found no significant effect on body weight. However, both high-fat KDs and VLEKT were associated with reductions in body mass index (BMI) and fat mass percentage in patients with PCOS. Significant improvements in weight, BMI, fat mass, and lean mass were observed following high-fat KDs or VLEKT interventions compared to baseline values, with no substantial differences between the two diet types. Regarding glycometabolic outcomes, both high-fat KDs and VLEKT reduced serum glucose levels and the homeostatic model assessment index compared to LCDs, with VLEKT showing slightly more favorable effects. In terms of the lipid profile, both high-fat KDs and VLEKT lowered total cholesterol and triglyceride levels, and VLEKT showing greater efficacy in triglyceride reduction. Hormonal analyses from two RCTs showed that both high-fat KDs and VLEKT were associated with lower serum luteinizig hormone (LH) levels compared to LCDs. Additionally, both high-fat KDs and VLEKT led to reductions in LH and total testosterone levels relative to baseline, with VLEKT showing a slight advantage in lowering LH and follicle-stimulating hormone levels.

CONCLUSIONS

High-fat KDs and VLEKT show beneficial effects on weight, body composition, glycometabolic parameters, and hormone profile in women with PCOS. VLEKT may provide additional advantages, particularly in reducing fat mass and lowering triglyceride levels. Further studies with larger sample sizes and more robust study designs are needed to confirm these findings.

Scientific status analysis of exercise benefits for vascular cognitive impairment: Evidence of neuroinflammation

Vascular cognitive impairment (VCI) is a syndrome characterized by cognitive decline resulting from insufficient perfusion to the entire brain or specific brain regions. The lack of a clear understanding of the mechanisms linking cerebrovascular disease to cognitive impairment has impeded the development of targeted treatments for VCI. Increasing evidence indicates that exercise may offer significant benefits for patients with VCI. This study explores how neuroinflammatory mechanisms mediate the effects of exercise on VCI, focusing on the broader biological processes involved. Exercise plays a crucial role in mitigating vascular risk factors, reducing oxidative stress, and promoting neurogenesis. Furthermore, exercise influences neuroinflammatory mediators and central immune cells via various signaling pathways. Different types and intensities of exercise, including resistance and endurance training, have been shown to differentially modulate neuroinflammation during the progression of VCI. This paper summarizes the current mechanisms of action and proposes exercise interventions targeting neuroinflammatory pathways, along with biomarker studies, to enhance our understanding of VCI pathogenesis and inform clinical practice. A more in-depth understanding of the inflammatory mechanisms underlying VCI may facilitate the development of targeted therapeutic interventions.

Association between vitamin B12 deficiency and metformin use in type 2 diabetic patients: a cross-sectional study in a South Vietnam tertiary hospital

OBJECTIVES

Vitamin B12 deficiency is a common and neglected adverse effect experienced by type 2 diabetic patients treated with metformin. A lack of vitamin B12 may have severe consequences, such as fatigue, macrocytic anaemia and worsened peripheral diabetic neuropathy. This study aims to identify the rate of vitamin B12 deficiency and the associated factors in type 2 diabetic patients treated with metformin.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

This study involved 145 type 2 diabetic patients treated with metformin in Cho Ray hospital, a tertiary healthcare centre in South Vietnam. The levels of vitamin B12 and associated clinical and paraclinical parameters were measured and collected.

RESULTS

The study population's mean age was 61.5 years, of which 51.7% were women. The median duration of metformin use was 10 years, and the median metformin dose was 1700 mg. The vitamin B12 deficiency rate was 22.1%. HbA1c, duration of metformin use and metformin dose were independent factors statistically associated with vitamin B12 deficiency.

CONCLUSIONS

This study identified the rate of vitamin B12 deficiency and associated factors in type 2 diabetic patients treated with metformin. These findings can be helpful in screening patients and replacing vitamin B12 in high-risk populations with vitamin B12 deficiency.

TRIAL REGISTRATION NUMBER

Ethical Committee of Cho Ray Hospital (approval number 1711/CN-HĐĐĐ).

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 omega-3/6 polyunsaturated fatty acids with three cerebrovascular diseases: A Mendelian randomization study

Nutritional and dietary interventions are important in the prevention of stroke, but many of the factors influencing stroke remain undefined. Although omega-3/6 polyunsaturated fatty acids (PUFAs) have been suggested to be associated with cerebrovascular diseases, studies on this topic are lacking. This study extracted and screened independent single nucleotide polymorphisms of omega-3/6 PUFAs and 3 types of cerebrovascular diseases data from the IEU Open GWAS database. A two-sample Mendelian randomization (MR) was used to examine the association between omega-3/6 PUFAs with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (IS). The primary analysis method was the inverse variance weighting method, supplemented by the weighted median and MR-Egger methods. Sensitivity and multiplicity were assessed using Cochran Q test, MR-PRESSO, MR-Egger regression, and leave-one-out analysis. This study was conducted in full compliance with the STROBE guidelines throughout. The inverse variance weighting analysis revealed a negative correlation between omega-3 PUFAs and SAH (P = .0078). However, there was no correlation between omega-3 PUFAs and ICH (P = .3930) and IS (P = .2922). Additionally, there was no association between omega-6 PUFAs and SAH (P = .1399), ICH (P = .1399, 0.0660), and IS (P = .8571) using all 3 analytical methods. No heterogeneity or horizontal pleiotropy was observed. The study suggested that omega-3 PUFAs had a significant protective role in SAH. However, omega-3/6 PUFAs were not found to be associated with other types of cerebrovascular diseases.

Natural Compounds Exert Anti-Obesity Effects by Regulating Cytokines

Obesity, along with its associated health risks such as hypertension, hyperlipidemia, Type 2 diabetes, stroke, metabolic syndrome, asthma, and cancer, constitutes a significant global health burden, contributing substantially to morbidity and mortality. Cytokines, a group of secreted signaling proteins, are crucial in initiating, maintaining, and resolving immune and metabolic responses. Although cytokines have unique advantages in regulating immune and metabolic functions, their therapeutic application for obesity remains limited in clinical practice. Natural compounds, known for their structural diversity and low toxicity, have become a valuable resource for drug development. Many natural compounds have shown anti-obesity effects. This review comprehensively examines the mechanisms underlying obesity, with a specific focus on the roles of cytokines, such as inflammatory cytokines, adipokines, and growth factors. Additionally, it highlights the regulatory interactions between gut microbiota and cytokines in obesity. The review critically analyzes current anti-obesity pharmacological interventions and summarizes advanced methodologies for identifying potential natural compounds. Finally, it identifies promising natural compounds that modulate cytokine activity to prevent or treat obesity and assesses their potential as complementary or alternative therapies.

Navigating skeletal wellness after breast cancer

Breast cancer is the leading cause of death in the female population. Hormone receptor-positive cancers are usually treated with surgery in combination with endocrine therapy. The latter is known to lower estrogen levels, contributing, therefore, to loss of bone density (BMD) and higher risk of fracture. Bone-modifying agents (BMAs) can regulate the bone-related adverse effects of cancer treatment. In premenopausal women, intravenous zoledronate effectively prevents bone loss. However, the evidence regarding its ability to reduce disease recurrence remains inconclusive. In postmenopausal women, denosumab demonstrates the most substantial evidence for fracture prevention, supported by one well-powered randomized controlled trial, but has not been shown to confer anticancer benefits. While bisphosphonates effectively prevent and reduce clinical vertebra fractures, their impact on overall fracture risk is unclear. In clinical practice, management of bone health in this group of patients starts with stratification for the risk of fracture. This can be done using the FRAX algorithm; measurements of bone mineral density can help to optimize stratification for individuals at higher fracture risk. Caution is advised when interpreting the results, as the FRAX algorithm has been considered to underestimate the true fracture risk in this population, given that the algorithm has not been adjusted for the effect of anti-cancer agents. Nowadays, clodronate, ibandronate, and zoledronic acid are recommended for bone protection in this group of patients, while denosumab is not. Further research is required to highlight the optimal BMA according to patient characteristics.

An integrated view of the pathophysiological crosstalk between adipose tissue, bone and cardiovascular system in men and women

BACKGROUND

Obesity, bone-related and cardiovascular diseases (CVD) are among the leading global health concerns. Growing evidence suggests that these conditions share common pathophysiological pathways and disease outcomes. PATHOGENETIC INTERACTIONS OF OBESITY, CVD AND BONE-RELATED DISEASES: Obesity is a well-established risk factor for atherosclerotic CVD (ASCVD), as dysfunctional ectopic adipose tissue may produce endocrine/paracrine hormones modulating metabolic processes and inflammation, predisposing to ASCVD. Although obesityhas been considered a protective factor for bone loss, it may lead to osteoporosis development and increased fracture risk at specific sites. Biological and epidemiological evidence has demonstrated the existence of a dynamic relationship between ASCVD and osteoporosis, since atherosclerotic calcification and bone mineralization share common pathophysiological mechanisms. Therefore, addressing ASCVD, obesity, and bone-related diseases requires multiple-level approach, which involve accurate screening, lifestyle modifications and pharmacological interventions.The current evidence about the pathophysiological relationships between obesity, bone-related diseases and ASCVD is discussed herein, highlighting common risk factors, proposed biomolecular mechanisms, clinical outcomes, lifestyle changes and pharmacological treatments.

CONCLUSIONS

As populations become increasingly older and obese, understanding the correlation within this triad highlights an unmet clinical need. Applying this knowledge would help to reduce both societal and individual costs, while supporting the development of novel preventive, diagnostic and therapeutic strategies to reduce morbidity and disability associated with cardio-metabolic and bone-related diseases.

Impact of Metformin Therapy on Vitamin B12 Levels in Patients With Type 2 Diabetes Mellitus

INTRODUCTION

Diabetes mellitus (DM) is a serious health condition affecting people worldwide with a high prevalence rate. DM is classified according to its aetiology into type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM); several risk factors contribute to the development of T2DM, such as age, genetic predisposition and obesity. Metformin is a proven drug of choice, and it is used as a first-line treatment for patients with T2DM to improve their glycaemic levels. Vitamin B12 is an important water-soluble vitamin, and its deficiency can lead to megaloblastic anaemia.

MATERIAL AND METHODS

A Cross-sectional retrospective study was conducted on patients with T2DM in a Sedi Hussein diabetic polyclinic in Benghazi, Libya. The total sample was 381 patients: T1DM 15 (n), and T2DM 366 (n). T1DM was excluded from our results. Patients with T2DM were divided into two groups: the control group (not on metformin) consisted of 71 patients, and the group that received metformin (M group) consisted of 295 patients.

AIMS OF THE STUDY

To assess serum vitamin B12 levels in patients with T2DM and evaluate the prevalence of vitamin B12 deficiency among those receiving metformin treatment.

RESULTS

The M group significantly decreased vitamin B12 serum levels by 443.56 mg/mL versus the control group of 541.33 pg/mL (p = 0.003). The prevalence of patients with vitamin B12 deficiency under the metformin treatment was 23.84%. There was no significant difference in correlation between serum vitamin B12 levels and both doses of metformin and the duration of diabetes mellitus.

CONCLUSION

Vitamin B12 was significantly decreased in patients with T2DM receiving metformin.

Sensory Profiling of Burdekin Plum Leathers and Consumer Acceptability of Its Combination With Trail Mix

Pleiogynium timoriense is commonly referred to as Burdekin plums (BPs) in Australia. Despite BP fruits being traditionally consumed by Indigenous Australians, little research on their potential food applications is available. With the increasing demand for healthy snacks and the importance of sensory quality in consumer choice of food products, this study explored the sensory profiles and acceptability of five formulations of BP fruit leathers (20BP, 40BP, 60BP, 80BP, and 100BP, containing 20-100% BP). Sensory profiling of the five BP fruit leathers revealed that most attributes were correlated. Both 80BP and 100BP were similar and characterized by significantly (p < 0.05) higher dark fruit flavor, astringency, and firmness, while 20BP fruit leather was significantly (p < 0.05) higher in cooked yellow fruit flavor and dissolving texture. The acceptability taste test showed that 20BP, 40BP, and 60BP were the preferred formulations. 40BP was selected for further consumer study. The acceptability of 40BP when consumed with a commercial fruit and nut trail mix (TM) was studied. Then, 121 consumers rated the acceptability of three samples: 40BP, TMBP (40BP mixed with TM), and TM. The results showed that all three samples were liked. Moreover, the sensory acceptability and purchase intention of TMBP were comparable to TM, which was higher than 40BP alone. Furthermore, cluster analysis revealed that the cluster with higher liking scores consumed TM more often and had a higher willingness to consume Australian native fruits. The study showed the promising food applications and acceptability of BP leathers and their incorporation in a commercial TM.

Can supplementation with antioxidants improve cognitive functions in patients with multiple sclerosis? A literature review

Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease of the central nervous system (CNS) with a complex and multifactorial pathophysiology. Although these mechanisms are not yet fully elucidated, it is established that oxidative stress (OS) plays a key role in driving neurodegeneration in MS. These pathological mechanisms contribute to a wide range of symptoms, including motor and sensory deficits, as well as cognitive impairment. The impairments in cognitive functions can cause a major burden for these patients and significantly affect their quality of life. For example, memory is one of the most frequently impaired cognitive domains in MS. These deficits often correlate with biomarkers of neurodegeneration and disease progression. Despite the substantial burden of cognitive impairment in MS, no established treatments currently exist to prevent or mitigate cognitive decline in these patients, aside from the disease-modifying treatments. Several clinical trials have investigated the potential of antioxidant supplementation to improve cognitive outcomes in MS patients. However, their findings are often controversial. This review discusses trials evaluating the effects of supplementation with various antioxidants, including Ginkgo biloba, melatonin, omega-3 fatty acids, vitamins A, N-acetylcysteine, lipoic acid, xanthophylls, and crocin, on cognitive performance. We discuss the findings of these studies, highlight methodological limitations, and explore the underlying mechanisms by which these compounds may modulate cognition. These mechanisms range from mitigating OS, inflammation, and glutamate-induced neurotoxicity in the CNS to addressing secondary symptoms such as depression and fatigue, which are often linked to cognitive decline. By reviewing the current evidence, this review not only underscores the therapeutic potential and limitations of antioxidant supplementation but also provides guidance for future research to optimize study design and advance our understanding of cognitive preservation strategies in MS.

Diabetes mellitus secondary to endocrine diseases: a position statement of the working group of the club of the Italian society of endocrinology (SIE)-Nutrition hormones and metabolism

PURPOSE

This position statement addressed the limited scientific literature on the management of diabetes mellitus secondary to endocrinopathies, despite its frequent occurrence in hormonal diseases such as acromegaly, Cushing's syndrome, primary hyperaldosteronism, pheochromocytoma, hyperthyroidism, and neuroendocrine tumors. The aim was to review the pathophysiological mechanisms, clinical features, and management strategies, focusing on nutritional and pharmacological approaches.

METHODS

A comprehensive review of existing literature was conducted regarding studies on diabetes secondary to endocrinopathies and the effects of treatments for these conditions, such as somatostatin analogues and pancreatic surgery. Particular emphasis was placed on understanding glucose metabolism derangements and the interplay between endocrine excess and therapeutic interventions.

RESULTS

Secondary diabetes arises not only from hormone excess but also as a consequence of treatments for endocrine disorders. For instance, somatostatin analogues, while effective in resolving hormone hypersecretion, impair glucose metabolism by inhibiting pancreatic insulin secretion. Similarly, pancreatic surgery for neuroendocrine tumors often exacerbates glycemic disturbances. The management of secondary diabetes requires a multidisciplinary approach that includes treating the underlying endocrine disorder, tailoring antidiabetic therapy, and optimizing nutritional strategies to mitigate metabolic disruptions.

CONCLUSION

Diabetes secondary to endocrinopathies presents unique challenges due to its complex etiology and the metabolic effects of treatments. This position statement underscores the importance of an integrated management approach, offering guidance for clinicians in addressing this multifaceted condition. Further research is needed to develop evidence-based guidelines for optimal care.

The effects of ketone bodies and ketogenesis on the PI3K/AKT/mTOR signaling pathway: A systematic review

Ketogenesis and the PI3K/AKT/mTOR pathway are linked to metabolic imbalance and disease progression. While ketone metabolism and mTOR inhibition are mechanistically connected, their functional relationship across disease models remains unclear. Although ketogenesis can be induced by ketone ingestion, ketogenic diet, or fasting, their individual effects on this pathway require further clarification. This study systematically reviews the relationship between ketogenesis and PI3K/AKT/mTOR signaling, following PRISMA guidelines across 3 databases. Eligible studies that met the selection criteria were evaluated using the risk of bias tools. In most studies involving the ketogenic diet or ketone bodies, suppression of the signaling pathway may lead to positive outcomes in terms of survival rate, lifespan, improved metabolic homeostasis, enhanced neurovascular function and suppressed progression of tumors. By contrast, β-hydroxybutyrate supplementation is associated with the up-regulation of AKT and downstream markers. It may exert an anabolic activity by activating the mTOR signaling pathway in muscle atrophy models and is associated with muscle recovery. Although fasting increases p-AKT expression, this may not necessarily indicate activation of the downstream mTOR signaling cascade, as it could result from an insulin response or regulatory feedback mechanisms. Regulation of the mTOR signaling by ketogenesis may be tissue-specific. Inhibition of PI3K/AKT/mTOR in ketogenesis-induced circumstances may justify the importance of a ketogenic-based diet regimen in combating metabolic diseases. However, future studies should consider standardizing factors such as the duration of fasting, timing, composition of the ketogenic diet and target tissues as these factors may affect study outcomes.

Ketogenic diet improves disease activity and cardiovascular risk in psoriatic arthritis: A proof of concept study

OBJECTIVES

Very low-calorie ketogenic diet (VLCKD) is a low-carbohydrate, low-calorie regimen that leads to rapid weight loss and may reduce inflammation. This study assessed the impact of VLCKD on anthropometric measurements, inflammatory biomarkers, metabolic health, and cardiovascular risk in psoriatic arthritis (PsA) patients moderately overweight or in class I obesity.

METHODS

A proof-of-concept single-arm monocentric study involved PsA patients undergoing a 9-week VLCKD treatment. Patients with Body Mass Index (BMI) ≥27 and <35, in stable (≥6 months) remission or low disease activity, as defined by Disease Activity in PSoriatic Arthritis (DAPSA) score, were included and underwent nutritional evaluations every 3 weeks. The study analyzed changes after the VLCKD intervention and the association between changes of anthropometric parameters and clinical and laboratory variables.

RESULTS

Twenty patients were enrolled since April 2022 and completed the study in May 2023. Median baseline BMI was 30.9 (interquartile range 29.1-33) kg/m². All participants exhibited low baseline disease activity, which correlated with BMI (Spearman's correlation coefficient (rs)=0.59,p=0.007). Following VLCKD, significant improvements were observed in all anthropometric measures (BMI -3.5[-4;-2.6]), PsA activity (DAPSA -6.1[-16.8;3.7]), cardiovascular parameters (SCORE2 index -0.2[-0.7;0.1]), insulin resistance (Homeostatic Model Assessment-Insuline Resistance -2.1[-1.1;-3.0]), and lipid profile. Most inflammatory biomarkers remained within normal limits. BMI reduction correlated with changes in DAPSA scores (rs=0.52,p=0.020). Patients with higher baseline weight or clinical activity experienced more pronounced improvements.

CONCLUSIONS

VLCKD significantly improved PsA activity and metabolic health. Patients with a higher BMI and less controlled disease are particularly motivated and could benefit more from VLCKD compared to those with lower BMI or better disease control.

Research progress on risk prediction models for the diabetic foot

OBJECTIVE

This study aimed to comprehensively review the latest advancements in diabetic foot risk prediction models over the past four years to address the severe challenges posed by diabetic foot ulcers, which are among the leading causes of disability and mortality among diabetic patients. Diabetic foot ulcers are characterized by their complex aetiology, pose a grave threat to life and impose enormous social and economic burdens, thus becoming a critical issue in public health that urgently requires attention. By accurately predicting the risk of diabetic foot and implementing early intervention strategies, this study aimed to reduce its incidence and mortality rates.

METHODS

This study employed a systematic review and comprehensive analysis framework, conducted extensive searches of electronic databases (including PubMed, EMBASE, the Cochrane Library, CNKI, etc.) and supplemented these searches with manual literature collection to ensure comprehensive information coverage. During the literature screening and evaluation phase, strict adherence to the predetermined inclusion and exclusion criteria was maintained to guarantee the high quality of the included studies. Further detailed quality assessments, data extraction, and analysis of the selected literature were conducted, with a focus on exploring the construction strategies of risk prediction models, the selection of key variables, the evaluation indicators of model performance, and the validation methods.

RESULTS

By comparing and analysing the differences among studies in terms of methodology, model effectiveness, and practical application potential, this study summarized the development trends of diabetic foot risk prediction models and anticipated future research directions. These findings indicate that with the assistance of advanced diabetic foot risk prediction models, potential risk factors can be identified and addressed early on, thereby effectively reducing the incidence of diabetic foot and significantly improving patients' quality of life.

CONCLUSION

This study revealed that diabetic foot risk prediction models have significant effects on accurately identifying risk factors and guiding early interventions, serving as effective tools to reduce the incidence of diabetic foot. Through early identification and intervention, the prognosis and quality of life of patients can be significantly improved, providing important references and guidance for the field of public health.

The Potential Role of Bio Extra Virgin Olive Oil (BEVOO) in Recovery from HPV 16-Induced Tonsil Cancer: An Exploratory Case Study

The human papillomavirus type 16 (HPV 16) is a high-risk human papillomavirus strain commonly associated with oropharyngeal cancers, including lymph node involvement. The treatment for HPV 16-related tonsil cancer, commonly involving surgery, radiation, and chemotherapy, presents significant challenges. Complications such as oral mucositis, xerostomia, dysphagia, dysgeusia, hypogeusia, impaired gustatory function, and significant weight loss frequently arise, leading to reduced nutritional intake, impaired healing, and recovery progression. These challenges underscore the need for supportive interventions to enhance rehabilitation and the post-recovery period, improve treatment tolerance, and maintain quality of life. Objective: This single-subject study examines a 67-year-old male patient diagnosed with a T1N3b (small primary tumor with advanced lump node involvement) associated with HPV 16 positivity, indicating a virus-associated oncogenesis. Methods: The patient underwent radiation therapy and chemotherapy, leading to treatment-associated side effects. After having dietary drinks for daily nourishment, the patient routinely incorporated oral bio extra virgin olive oil (BEVOO) to cope with indicated challenges. Results: Body composition and metabolic parameters showed treatment-induced declines, followed by substantial but not complete recovery during follow-up examination. Visual Analog Scale (VAS) scores reflected gradual improvements in dysphagia, xerostomia, mucositis, and subtle but ongoing enhancement of the dysgeusia, gustatory perception, and oral palatability. The BEVOO supplementation and mindfulness were associated with positive recovery trends. Additional variables could have impacted the outcomes, preceding and throughout treatment, including the patient's cognitive and somatic health, environmental conditions, dietary habits, individual attitudes toward recovery, physical activity, and patient way of life. Conclusions: These results emphasize the need for additional research employing a comprehensive, multi-factorial framework that accounts for the complex interplay of physiological, psycho-social, and environmental contributors. More extensive, more diverse studies are essential to confirm these observations and substantiate the role of BEVOO as a supportive intervention in cancer recovery.

Closed-loop therapy: recent advancements and potential predictors of glycemic outcomes

INTRODUCTION

Hybrid closed-loop systems have become the standard of care for managing type 1 diabetes (T1D). Both clinical trials and real-world data have demonstrated that these systems improve glycemic control without increasing the risk of hypoglycemia, while also reducing the overall burden of T1D management. A systematic literature search was conducted using PubMed for studies including individuals with T1D that were published until the end of 2024.

AREAS COVERED

In this review, we summarize the safety and efficacy of currently available hybrid closed-loop systems, drawing from key clinical trials and real-world data analyses. We also highlight recent advancements in closed-loop systems, discuss their limitations and barriers to access, and explore future directions for automated insulin delivery. Finally, we explore potential predictors of outcomes for people with T1D to better understand why some individuals respond better to closed-loop systems than others.

EXPERT OPINION

Closed-loop systems are advancing rapidly, with a growing focus on enhancing automation through fully closed-loop systems to improve glycemic control and further reduce the burden of management. Identifying the predictors that influence how individuals respond to closed-loop therapy will enable these systems to be optimized. It is crucial to ensure widespread and equitable access to this advanced technology.

Hydroxychloroquine dose-dependently reduces the risk of incident diabetes in primary Sjögren syndrome patients on glucocorticoids: a nationwide population-based cohort study

BACKGROUND

Hydroxychloroquine (HCQ) is commonly used to treat Sjögren syndrome (SS). Glucocorticoids, which are commonly applied for managing primary SS (pSS), can disrupt glucose metabolism and increase diabetes mellitus (DM) risk. HCQ reduces DM risk in systemic lupus erythematosus and rheumatoid arthritis.

OBJECTIVE

This study aimed to investigate the relationship between HCQ and glucocorticoids in the incidence of new-onset diabetes in pSS.

METHODS

This nationwide population-based cohort study identified patients diagnosed with pSS from the Taiwan's National Health Insurance Research Database from 2006 to 2015. Multivariate and stratified analyses, Kaplan-Meier method, and Cox proportional hazard regression were used to evaluate DM risk associated with the use of HCQ and glucocorticoid, both individually and in combination.

RESULTS

Among pSS patients (4,874 HCQ users and 2,437 HCQ nonusers), 497 patients developed DM over an average follow-up of 4.89 years. Multivariate analysis revealed significantly lower adjusted hazard ratios (aHRs) for DM in HCQ users in the 151-350 cumulative defined daily dose (cDDD) and ≥ 351 cDDD subgroups (0.600, 95% CI: 0.454-0.794 and 0.326, 95% CI: 0.246-0.433, respectively) compared with HCQ nonusers. High-dose glucocorticoids (≥ 151 cDDD) were linked to increased DM risk (aHR: 1.833, 95% CI: 1.410-2.383). However, high-dose HCQ (> 350 cDDD) mitigated this risk, even the risk caused by the use of high-dose glucocorticoids (≥ 151 cDDD) (aHR: 0.632, 95% CI: 0.421-0.948, P < 0.01).

CONCLUSIONS

Our study demonstrated that HCQ exposure significantly reduces the risk of developing diabetes in patients with pSS. While higher doses of glucocorticoids are associated with an increased diabetes risk, concurrent HCQ use mitigates this risk in a dose-dependent manner.

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

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

Dose dependent relationship of metformin use and diabetic peripheral neuropathy risk in patients with type 2 diabetes mellitus

This study investigated the correlation between metformin use and diabetic peripheral neuropathy (DPN) risk in patients with type 2 diabetes mellitus (T2DM) and its dose-dependent relationship. The study included new-onset T2DM patients from 2002 to 2013. Patients were divided into two groups based on metformin treatment, and DPN risk was assessed at 2- and 5-year follow-ups. After adjusting for various factors, two logistic models, metformin cumulative defined daily dose (cDDD) and metformin treatment intensity (defined daily dose [DDD]/month), evaluated the metformin-DPN risk association. Results showed that patients with metformin cDDD < 300, 300-500, and > 500 had higher DPN risk at both follow-ups. Odds ratios (ORs) and confidence intervals (CIs) for DPN were 1.74 (1.69-1.79), 2.05 (1.81-2.32), and 2.36 (1.34-4.16) at 2 years and 1.63 (1.60-1.65), 1.82 (1.69-1.96), and 2.17 (1.56-3.03) at 5 years. Similarly, patients with < 10, 10-25, and > 25 DDD/month had higher DPN risk at both follow-ups. Metformin use correlated with DPN risk in T2DM patients, with a dose-dependent relationship. Higher metformin cDDD or treatment intensity increased DPN risk. However, the absence of vitamin B12 data limits the understanding of the underlying mechanisms. Well-designed, large-scale studies are required to evaluate the potential risks of metformin therapy for DPN in patients with T2DM.

OzMALDI: A Gas-Phase, In-Source Ozonolysis Reaction for Efficient Double-Bond Assignment in Mass Spectrometry Imaging with Matrix-Assisted Laser Desorption/Ionization

Lipids make up an important class of biomolecules with diverse structures and varied chemical functions. This diversity is a major challenge in chemical analysis and limits our understanding of biological functions and regulation. A major way lipid isomers differ is by double-bond (db) position, and analyzing db-isomers is especially challenging for mass spectrometry imaging (MSI). Ozonolysis can be used to determine the db-position and has been paired with MSI before. However, previous techniques require increased analysis time to allow for gas-phase reactions within an ion trap or ion mobility cell or additional sample preparation time to allow for offline ozonation. Here, we introduce a new ozonolysis method inside the matrix-assisted laser desorption-ionization (MALDI) source, termed OzMALDI, that simultaneously produces ozonides from all unsaturated lipids. This allows us to determine db-positions without adding additional reaction time while maintaining the high mass resolution provided by Orbitrap MS. This new technique is especially effective at determining multiple db-positions in lipids containing polyunsaturated fatty acids, which is a limitation of many previous techniques. OzMALDI-MSI was applied to the analysis of rat brain and genetically engineered Camelina and soybean seed samples, demonstrating the utility of this method and uncovering novel biological information.

Ketogenic Diet in Steatotic Liver Disease: A Metabolic Approach to Hepatic Health

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver dysfunction worldwide, characterized by hepatic steatosis that may progress to nonalcoholic steatohepatitis and cirrhosis. Owing to its strong association with metabolic disorders, current management focuses on weight reduction via lifestyle modifications. Recently, the very-low-calorie ketogenic diet (VLCKD) has emerged as a promising intervention due to its potential for rapid weight loss and reduction in liver fat. This review aims to evaluate the clinical evidence regarding the impact of ketogenic diets on hepatic steatosis. We conducted an extensive MEDLINE literature search in databases including PubMed, Scopus, and Web of Science up to December 2024. Studies assessing the effects of ketogenic or low-carbohydrate high-fat diets on liver fat, evaluated by imaging, histology, or biochemical markers, were included. The analysis indicates that ketogenic diets significantly reduce hepatic fat content and improve metabolic parameters, including insulin sensitivity and liver enzyme levels. Evidence further suggests that substituting saturated fats with unsaturated fats or replacing carbohydrates with proteins may enhance these benefits. However, considerable variability exists among studies and long-term data remain limited. Although short-term outcomes are encouraging, potential adverse effects such as dyslipidaemia, gastrointestinal disturbances, and transient 'keto flu' symptoms require careful clinical monitoring. Future research should focus on elucidating underlying mechanisms, optimizing dietary composition, and assessing long-term safety to establish ketogenic diets as a robust strategy for managing MASLD.

Impact of a very low-calorie ketogenic diet on metabolic and microbiota outcomes in post-bariatric patients and bariatric-Naïve individuals: A comparative pilot study

AIMS

To date, bariatric surgery (BS) is the most effective long-term treatment for obesity, but weight regain (WR) is common. The very low-calorie ketogenic diet (VLCKD) is effective for weight loss and may influence gut microbiota (GM) composition, but it has been scarcely evaluated in post-bariatric patients. This study compared the efficacy and safety of a VLCKD in patients with WR post-bariatric surgery (BS+) and in bariatric surgery-naïve patients (BS-).

METHODS

In this prospective, case-control study, 33 patients (15 BS+, 18 BS-) underwent an 8-week-long VLCKD. Outcomes included weight loss, metabolic profile, safety and GM composition.

RESULTS

Both groups achieved significant weight loss (BS+: -6.9%, BS-: -8.3%), but the BS+ group showed slightly less metabolic improvement, particularly in insulin resistance and triglycerides. GM composition differed at baseline, reflecting the lasting effects of BS, and VLCKD led to significant changes in both groups. Microbial diversity and specific taxonomic shifts were more pronounced in BS- patients. Mild renal function changes were noted in BS+ patients, though these remained within clinically acceptable ranges.

CONCLUSION

VLCKD is effective in both BS+ and BS- patients, though metabolic and microbial responses may be less robust post-surgery, possibly due to anatomical and physiological changes. Tailored approaches may be therefore needed to optimize outcomes in post-bariatric patients.

Very low-calorie ketogenic diet reduces central blood pressure and cardiometabolic risk in post-menopausal women with essential hypertension and obesity: a single-center, prospective, open-label, clinical study

BACKGROUND AND AIMS

Obesity represents a crucial modifiable risk factor for cardiovascular complications. Two dietary approaches, Very Low-Calorie Ketogenic (VLCKD) and Intermittent Fasting (IFD) diets, have demonstrated to reduce blood pressure (BP) and produce cardiovascular and metabolic advantages. We aimed to evaluate the effects of VLCKD or IFD compared to Free Diet (FD) on office brachial and central systolic BP levels. Secondary outcomes included changes from baseline of diastolic BP and several weight-related indexes.

METHODS AND RESULTS

In this single-center, open-label, prospective clinical study, post-menopausal women with treated uncomplicated hypertension and obesity were assigned to 3 dietary programs: VLCKD, IF, and FD. All patients underwent BP measurements, dietary consultation with personalized dietary program, and blood tests for metabolic parameters. All outcome variables were measured at baseline (T0), two (T1) and six months (T2). We included 18 patients in the VLCKD, 16 in the IFD and 9 in the FD groups, respectively. At T2 VLCKD patients showed significantly lower brachial systolic (p = 0.005) and diastolic (p = 0.038), central systolic (p = 0.02) and diastolic (p = 0.03) BP levels than those in other groups. VLCKD also induced reductions in weight (p = 0.03), WC (p < 0.01), WHR (p < 0.01), BFP (p < 0.01); TOT-C (p = 0.01), LDL-C (p < 0.01), and triglycerides (p = 0.02). No relevant changes were observed in IF and FD groups.

CONCLUSIONS

KD emerged as the clear front-runner in reducing brachial and central office systolic/diastolic BP levels and weight-related parameters in post-menopausal women with treated hypertension and obesity.

Impact of vitamin D and zinc sufficiency on immune responses following COVID-19 vaccinations among healthcare workers

Introduction

Vitamin D and zinc sufficiency are theoretically acclaimed to influence immune-boosting potentials following various immunizations. Herein, we explored the impact of these micronutrients on immune responses following Oxford-AstraZeneca coronavirus disease 2019 (COVID-19) vaccination among Nigerians.

Methods

Two hundred healthcare workers (HCs) who presented at the Rivers State University Teaching Hospital were recruited during the first dose and followed up 4 weeks post-first and post-second doses. Data (serum vitamin D/zinc, COVID-19 anti-spike immunoglobulin G [ASIgG]) were determined on the day of the first dose and repeated 4 weeks post-first dose and 4 weeks post-second dose. Vitamin D (VitD) status, assessed using serum 25(OH)D, was categorized as sufficient (≥50 nmol/L) or insufficient/deficient (<50 nmol/L) while zinc status was categorized as sufficient (≥11.3 µmol/L) or insufficient (<11.3 µmol/L). Post-second dose ASIgG titer status was categorized as optimal (>7,352 AU/mL) or sub-optimal (<7,352 AU/mL) as defined by the World Health Organization. Statistical significance was defined as p<0.05.

Results

HCs with both VitD and zinc sufficiency (n=97) had higher ASIgG titer levels (4 weeks post-first dose=15,977±367.88 AU/mL; 4 weeks post-second dose=22,603±451.18 AU/mL) after the first and second doses compared to only the VitD sufficient (n=58) cohorts (4 weeks post-first dose=4,680±154.77 AU/mL; 4 weeks post-second dose=7,850±200.60 AU/mL) and the zinc-sufficient (n=63) cohorts (4 weeks post-first dose=5,770±160.41 AU/mL; 4 weeks post-second dose=8,100±206.91 AU/mL) (p<0.05). The VitD and zinc-sufficient HCs were also more likely to achieve optimal ASIgG titer levels (odds ratio, 2.97; 95% confidence interval, 2.11-4.123; p<0.001) 4 weeks post-second dose following adjustment for confounders.

Conclusion

VitD and zinc sufficiency had a positive impact on immune responses following AstraZeneca COVID-19 vaccination.

The direct targets of metformin in diabetes and beyond

Metformin, an oral antihyperglycemic drug that has been in use for over 60 years, remains a first-line therapy for type 2 diabetes (T2D). Numerous studies have suggested that metformin promotes health benefits beyond T2D management, including weight loss, cancer prevention and treatment, and anti-aging, through several proposed mechanistic targets. Here we discuss the established effects of metformin and the progress made in identifying its direct targets. Additionally, we emphasize the importance of elucidating the structural bases of the drug and its direct targets. Ultimately, this review aims to highlight the current state of knowledge regarding metformin and its related emerging discoveries, while also outlining critical future research directions.

Vegetal oil-based ketogenic diet improves inflammation and fibrosis in experimental metabolic dysfunction-associated steatohepatitis

BACKGROUND AND AIMS

Metabolic dysfunction-associated steatohepatitis (MASH) represents a growing cause of liver cirrhosis and hepatocellular carcinoma (HCC). However, effective therapy for MASH is still lacking. Despite recent studies suggest that ketosis might improve MASH evolution, the mechanisms involved have not been explored since common ketogenic diets cause severe steatohepatitis in mice. In this study, we have investigated the capacity of a new-formulated ketogenic diet (KD) containing vegetal fat in improving liver alterations associated with experimental MASH.

METHODS

MASH was induced in C57BL/6 mice by feeding a cholesterol-enriched Western Diet (WD) for up to 16 weeks, followed by switching animals to KD for an additional eight weeks.

RESULTS

We observed that KD administration greatly increased ketone body production and significantly reduced liver and body weights. Moreover, liver proteomic analysis and functional tests evidenced an improved glucose and lipid metabolism along with insulin resistance in KD-fed mice. These metabolic effects were associated with an amelioration in MASH-associated gut dysbiosis and with an improvement of hepatic steatosis, parenchymal injury and liver fibrosis. From the mechanistic point of view mice receiving KD showed a significant reduction in liver TREM2-positive monocyte-derived macrophages forming crown-like aggregates along with a lowering in the hepatic expression of pro-inflammatory/pro-fibrogenic markers such as CCL2, IL-12, CD11b, α1-procollagen, TGF-β1, osteopontin, and galectin-3. Consistently, in vitro experiments showed that β-hydroxybutyrate supplementation reduced TREM2 and galectin-3 expression by cultured Raw 264.7 macrophages.

CONCLUSIONS

Altogether, these results indicate that ketogenic diet based on vegetal fat effectively improves MASH metabolic derangements and steatohepatitis, and it might represent a potential therapeutic strategy in this disease.

The Expression Profile of the RANK/RANKL/OPG Pathway in Breast Cancer Stem Cells Isolated From Breast Cancer Cell Lines

The RANK/RANKL/OPG signaling pathway plays a crucial role in breast cancer progression and metastasis. However, its expression patterns and potential implications in breast cancer stem cells remain poorly understood. This study aimed to characterize the expression profile of this pathway in breast cancer stem cells isolated from two distinct breast cancer cell lines: MDA-MB-231 and MCF-7. Mammospheres (MS), representing breast cancer stem cells, were generated using agar-coated 6 well tissue culture plates in suitable mammospheres culture conditions. Flow cytometric analysis showed enrichment of the CD44+/CD24- subpopulations in the mammospheres cultures, with MDA-MB-231 exhibiting a higher percentage compared to MCF-7. The isolated MS from both cell lines showed upregulation of stemness markers OCT4 and SOX2, with MS. MDA-MB-231 demonstrating higher expression levels. Analysis of the RANK/RANKL/OPG axis revealed differential expression patterns between the two cell lines. RANK expression was significantly upregulated in MS. MDA-MB-231 but not in MS. MCF-7. Interestingly, while OPG mRNA levels were elevated in mammospheres from both cell lines, secreted OPG protein levels were paradoxically reduced in the mammospheres conditioned media. Additionally, RUNX2, an osteoblastic marker, and a downstream target of RANK signaling, showed a decreased expression in both mammospheres compared to adherent cells. These findings suggest a complex, context-dependent regulation of the RANK/RANKL/OPG pathway in breast cancer stem cells, potentially contributing to the aggressive nature and metastatic propensity of triple-negative breast cancer. This study provides novel insights into the molecular characteristics of breast cancer stem cells and underscores the complexity of OPG/RANK/RANKL axis expression in them; a role yet to be fully elucidated.

Regulatory T cell-based therapies for type 1 diabetes: a narrative review

Type 1 diabetes (T1D) is an autoimmune disease caused by the destruction of pancreatic insulin-secreting beta cells, resulting in hyperglycemia and a lifelong need for exogenous insulin therapy. Regulatory T cells (Tregs) are essential for maintaining immune tolerance and preventing autoimmune reactions. It has been shown that dysfunctional Tregs participate in the pathophysiology of T1D. Therapeutic approaches designed to enhance Treg stability, survival, and function have progressively emerged as a promising treatment strategy for T1D. This narrative review explores the potential of Treg cell-based therapy as a therapeutic tool to alter the natural history of T1D. It discusses different pharmacological strategies to enhance Treg stability and function, as well as the latest advances in Treg cell-based therapies, including adoptive Treg cell therapy and genetic engineering of Tregs. It also outlines current challenges and future research directions for integrating Treg cell-based therapy into clinical practice, aiming to provide a comprehensive overview of its potential benefits and limitations as an innovative therapeutic intervention for T1D.

The combined effects of omega-3 polyunsaturated fatty acid supplementation and exercise training on body composition and cardiometabolic health in adults: A systematic review and meta-analysis

INTRODUCTION

We performed a systematic review and meta-analysis to investigate the effects of combining omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation with exercise training, as compared to exercise training alone, on body composition measures including body weight, body mass index (BMI), fat mass, body fat percentage, and lean body mass. Additionally, we determined the effects on cardiometabolic health outcomes including lipid profiles, blood pressure, glycemic markers, and inflammatory markers.

METHOD

Three primary electronic databases including PubMed, Web of Science, and Scopus were searched from inception to April 5th, 2023 to identify original articles comparing n-3 PUFA supplementation plus exercise training versus exercise training alone, that investigated at least one of the following outcomes: fat mass, body fat percentage, lean body mass, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic (SBP) and diastolic (DBP) blood pressures, fasting glucose and insulin, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Standardized mean differences (SMD) or weighted mean differences (WMD), and 95 % confidence intervals (CIs) were calculated using random-effects models.

RESULTS

A total of 21 studies involving 673 participants with BMIs ranging from 24 to 37 kg.m2 and ages ranging from 30 to 70 years were included in the meta-analysis. Overall, the results indicated that as compared with exercise training alone, adding omega-3 supplementation to exercise training decreased fat mass [WMD: -1.05 kg (95 % CI: -1.88 to -0.22), p = 0.01], TG [WMD: -0.10 mmol/L (95 % CI: -0.19 to -0.02)], SBP [WMD: -4.09 mmHg (95 % CI: -7.79 to -2.16), p = 0.03], DBP [WMD: -4.26 mmHg (95 % CI: -6.46 to -2.07), p = 0.001], and TNF-α [SMD: -0.35 (95 % CI: -0.70 to -0.00), p = 0.04], and increased LDL [WMD: 0.14 mmol/L (95 % CI: 0.02 to 0.26), p = 0.01] and lower-body muscular strength [SMD: 0.42 (95 % CI: 0.01 to 0.84), p = 0.04]. However, omega-3 supplementation with exercise training had no additional effects compared with training alone, for other body composition or cardiometabolic outcomes.

CONCLUSION

This systematic review and meta-analyses suggestes that adding omega-3 supplementation to exercise training may augment some effects of exercise training on body composition and cardiometabolic health in adults, although such effects appear to be modest.

Epigenomic mechanisms of dietary prescriptions for obesity therapy

Dietary modification is a cornerstone and a primary goal for weight loss, whose effects may be related to epigenetic phenomena. In this literature review, a comprehensive search without time restriction was performed in PubMed/Medline, Cochrane, SciELO, and Scopus databases to identify epigenetic signatures related to obesity outcomes upon dietary advice. In this context, experimental studies and clinical trials have identified certain DNA methylation marks, miRNA expression profiles and histone modifications putatively associated with adiposity outcomes after different nutritional interventions. These include traditional dietary patterns, diets with different macronutrient compositions, and supplementation with fatty acids, amino acids and derivatives, methyl donors, vitamins and minerals, probiotics and prebiotics, and bioactive food compounds. Some of these epigenetic signatures have been mapped to genes involved in food intake control, adipogenesis, lipolysis, fatty acid oxidation, body fat deposition, and gut microbiota modulation. However, additional studies are still required to address dosage and follow-up variability, validation of epigenetic marks, genome-wide approaches, and appropriate statistical settings. Although more investigation is required, these insights may contribute to the characterization of epigenetic biomarkers of body weight regulation toward the prescription of tailored dietary strategies targeting the epigenome for a more precise obesity management and control.

The Role of the Receptor Activator of Nuclear Factor Kappa-B Ligand/Osteoprotegerin Ratio in Vascular Diseases: A Therapeutic Approach

Cardiovascular and bone diseases contribute independently to mortality and global health. The exact mechanisms involved in the pathophysiology shared between bone and vascular diseases are not well defined. Endothelial cells and osteoblasts communicate during osteogenesis, thus establishing a connection between angiogenesis and osteogenesis. One shared mechanism may involve osteoprotegerin (OPG) and its ligand Receptor Activator of NF-κB Ligand (RANKL). The RANKL/OPG ratio is an important modulator for the skeletal, immunological, and vascular systems. OPG levels are elevated due to either osteogenic causes or inflammatory responses in the vasculature. The data obtained from clinical and in vitro studies support the role of the RANKL/OPG ratio as a potential marker for the progression of endothelial damage. Therefore, determining the therapeutic approaches for the targeting RANKL/OPG ratio and evaluating its usage as a biomarker in cardiovascular and bone pathophysiology are needed. By integrating the protective and disease-causing role of OPG with its ligand, this review outlines the role of the RANKL/OPG ratio at the molecular level. We also consider targeted therapeutic approaches.

HbA1c and the Risk of Lower Limb Ulcers Among Diabetic Patients: An Observational and Genetics Study

Aims: A lower limb ulcer is a serious complication of diabetes. The association between glycated hemoglobin (HbA1c) and lower limb ulcers needs further clarification. We aimed to comprehensively evaluate the relationship between HbA1c and lower limb ulcer risk in diabetic patients through multivariable-adjusted observational analyses and Mendelian randomization (MR) approaches. Methods: This prospective cohort study included 23,434 individuals with prevalent diabetes in the UK Biobank. The Cox proportional hazard model was used to evaluate the association between HbA1c levels and lower limb ulcer risk. Furthermore, a one-sample MR analysis was conducted to explore the potential causal effect. Results:Over a follow-up period of 290,677 person-years (median length: 13.3 years), 1101 lower limb ulcers cases were documented. The multivariable-adjusted hazard ratios across categories of HbA1c of ≤ 42, 42-53, 53-64, 64-75, 75-86, and > 86 mmol/mol were 0.93 (0.76-1.15), 1.00, 1.24 (1.05-1.46), 1.98 (1.65-2.39), 2.68 (2.13-3.37), and 4.52 (3.62-5.65), respectively. The restrictive cubic spline model showed that lower limb ulcer risk increased steeply when HbA1c concentration exceeded 53 mmol/mol. One-sample linear and nonlinear MR analyses provided a positive but not significant association between genetically proxied HbA1c and lower limb ulcer risk among diabetic patients. Conclusions: High HbA1c levels increase the risk of lower limb ulcers in diabetic patients. MR analyses validated the positive but not significant association between genetically proxied HbA1c levels and lower limb ulcer risk. The results recommended an HbA1c goal of < 53 mmol/mol to decrease the incidence of diabetic ulcers.

Treatment of endothelial cell dysfunction in atherosclerosis: a new perspective integrating traditional and modern approaches

Atherosclerosis (AS), a prime causative factor in cardiovascular disease, originates from endothelial cell dysfunction (ECD). Comprising a vital part of the vascular endothelium, endothelial cells play a crucial role in maintaining vascular homeostasis, optimizing redox balance, and regulating inflammatory responses. More evidence shows that ECD not only serves as an early harbinger of AS but also exhibits a strong association with disease progression. In recent years, the treatment strategies for ECD have been continuously evolving, encompassing interventions ranging from lifestyle modifications to traditional pharmacotherapy aimed at reducing risk factors, which also have demonstrated the ability to improve endothelial cell function. Additionally, novel strategies such as promising biotherapy and gene therapy have drawn attention. These methods have demonstrated enormous potential and promising prospects in improving endothelial function and reversing AS. However, it is essential to remain cognizant that the current treatments still present significant challenges regarding therapeutic efficacy, long-term safety, and ethical issues. This article aims to provide a systematic review of these treatment methods, analyze the mechanisms and efficacy of various therapeutic strategies, with the goal of offering insights and guidance for clinical practice, and further advancing the prevention and treatment of cardiovascular diseases.

Global knowledge mapping of receptor activator of nuclear factor kappa-B ligand in osteoporotic fractures: a bibliometric analysis (2001-2024)

Background

Receptor activator of nuclear factor kappa-B ligand (RANKL) plays a critical role in bone metabolism and the pathogenesis of osteoporotic fractures. This study aims to conduct a bibliometric analysis of global research pertaining to RANKL and osteoporotic fractures to identify key trends, influential studies, and collaborative networks.

Methods

A literature search was conducted to identify articles found in the Web of Science Core Collection database regarding RANKL and osteoporotic fractures from 2001 to 2024. A bibliometric analysis was performed using VOSviewer, CiteSpace, and R 4.3.3 for the publication volume, country and institution contributions, journal impact, author influence, and research hotspots.

Results

A total of 214 articles were analyzed. Publication rates have steadily increased, with a peak of 21 papers in 2020. The U.S., China, and South Korea were the top contributing countries, and leading institutions included Harvard University and Dankook University. The Journal of Bone and Mineral Research, Osteoporosis International, and Bone were the journals of highest impact. At the level of authors, Heiss-Christian published the highest number and Christiansen-Claus had the strongest citation impact (1,368 citations). Research evolved from basic biological mechanisms (2001-2010) through clinical applications (2011-2017) to recent renewed interest in fundamental RANKL biology (2018-2024). Key research hotspots included postmenopausal osteoporosis, bone mineral density, and osteoclast differentiation, with emerging focus on RANKL's role beyond skeletal metabolism.

Conclusion

This bibliometric analysis provides a comprehensive overview of RANKL research in osteoporotic fractures, highlighting key priorities for future investigation. Future studies should prioritize understanding RANKL's broader physiological roles, developing better predictive markers, and optimizing personalized treatment strategies.

Role and application prospective of non-steroidal MRA in the treatment of diabetic kidney disease

Chronic kidney disease (CKD) has diverse etiologies and complex pathogenesis, and is prone to recurrent episodes and prolonged illness. In recent years, the prevalence of CKD has been increasing year by year, and the global prevalence in the general population has reached 14.3%. Diabetic kidney disease (DKD) is a common complication of diabetes mellitus (DM), and about 20-40% of DM patients have combined DKD, which is also the main cause of CKD and end-stage renal disease (ESRD). DM catalyzes CKD in approximately 30-50% of global cases, affecting around 285 million individuals. It primarily triggers diabetic nephropathy (DN), the leading cause of end-stage renal disease worldwide. Research indicates that activation of the mineralocorticoid receptor (MR) plays a role in the onset and progression of DKD. Counteracting MR overactivation offers antioxidative, anti-inflammatory, and anti-fibrotic benefits, thereby ameliorating target organ damage. MR antagonists (MRAs) such as spironolactone and eplerenone have been validated for renal protection. However, their clinical application is hindered by adverse effects including hyperkalemia, gynecomastia in males, erectile dysfunction, and menstrual irregularities in females. Finerenone, a novel non-steroidal MRA, exhibits a unique mechanism of action, binding to MR and inhibiting the recruitment of transcription co-factors involved in gene expression, effectively slowing the progression of diabetic nephropathy (DN). In addition, finerenone demonstrates improved safety and efficacy in treating heart failure and chronic kidney disease. It also plays a significant role in the management of atrial fibrillation and myocardial infarction. This article reviews recent studies on finerenone, summarizing its mechanism of action in treating DN, evidence from clinical trials, adverse reactions, combined use with other inhibitors, and future prospective, aiming to provide insights for the prevention and treatment of DN.

Best practices in islet transplantation in mice

Islet transplantation in mice serves as a crucial preclinical model for understanding alloimmune and autoimmune mechanisms, optimizing immunosuppressive strategies, and developing novel therapies for diabetes. This review provides a comprehensive overview of best practices in murine islet transplantation, including diabetes induction models, technical aspects of islet transplantation, and criteria for transplant graft and rejection. We discuss the immunological challenges posed by major histocompatibility complex disparities, the impact of various transplantation sites, and the limitations of murine models in translating findings to clinical settings. Special emphasis is placed on emerging strategies such as stem cell-derived insulin-producing cells, immune tolerance induction, and alternative transplantation sites. Although mouse models have significantly advanced our understanding of diabetes and β-cell replacement, their inherent differences from human physiology necessitate careful interpretation of findings. The review also highlights novel imaging modalities, immunosuppressive protocols, and biomarkers for graft monitoring, underscoring the need for further refinement of these models to bridge the gap between experimental research and clinical application. By standardizing methodologies and addressing translational limitations, murine islet transplantation studies remain a key model in transplantation and can continue to shape the future of β-cell replacement therapies for insulin-dependent diabetes.

Declining trends in sweetness of the diet in the United Kingdom: 2008/9-2018/19

Sugar reduction is a major public health priority. Due to the assumed correlation between dietary sweetness and sugars intake, some organizations suggest minimizing dietary sweetness regardless of source. Data describing the trends/patterns in the sweetness of the diet may inform dietary recommendations. This cross-sectional study utilized dietary data from 2008/09 to 2018/19, including 15,655 individuals ≥1.5 year from the United Kingdom's National Diet and Nutrition Survey Rolling Program. Products sweetened with low-calorie sweeteners (LCS) were matched to their sugar-sweetened pair (e.g., regular cola vs. diet cola), which was used to estimate the sugar equivalents from LCS-sweetened products and estimate dietary level sweetness, defined as grams of approximate sugar equivalent (ASE) per day. Foods and beverages that underwent reformulation during the study period through the use of LCS were also identified. From 2008/9 through 2018/19, the ASE of the overall UK diet declined by about 10%. LCS products contributed 13% of ASE. There was evidence of a non-linear trend, with ASE levels relatively stable until 2014/15 and then declining. Overall, the decline in ASE was larger for beverages than foods (ASE values declined 20.7% for beverages vs. 4.4% for foods), although both decreased significantly (p-value < 0.01). Dietary sweetness has changed in the UK, due to a combination of consumer behavior, reformulations, policies, public health awareness programs, and media campaigns, emphasizing its multifactorial nature.

Food sweeteners: Angels or clowns for human health?

With the global prevalence of obesity and diabetes continuing to rise, metabolic diseases caused by excessive sugar intake have become a significant public health issue. In this context, various sweeteners as sugar substitutes have been widely used in the food industry. Sweeteners are highly favored for their good safety profile, cost-effectiveness, low-calorie properties, and potential blood sugar regulation effects, and their applications have extended to fields such as pharmaceuticals and daily chemicals. However, recent studies indicate that the impact mechanisms of sweeteners on human health are more complex than previously understood, and the long-term safety of their use has sparked widespread concern in both academia and the public. This review systematically examines relevant literature from the past three decades, employing evidence-based medicine methods for screening and meta-analysis, aiming to comprehensively assess the potential effects of sweeteners on human metabolic indicators (including blood glucose homeostasis and body fat composition) and cancer risk. The discussion will unfold in the following four sections: (1) Definition and classification of sweeteners; (2) Application areas of various sweeteners; (3) Beneficial effects of sweetener use on human health; (4) Adverse effects of sweetener use on health issues in different population groups. Current evidence suggests that the rational use of specific types of sweeteners within recommended dosage ranges can effectively improve blood glucose control, promote weight management, and play a positive role in maintaining oral health. However, excessive or long-term use of certain sweeteners may disrupt gut microbiota balance, affect glucose and lipid metabolism homeostasis, increase cardiovascular disease risk, and potentially be associated with the occurrence of certain malignant tumors. Notably, sweetener exposure during pregnancy may affect the fetus through mechanisms such as epigenetic modifications, necessitating special caution in sweetener selection for pregnant women. This review aims to provide clinicians, nutritionists, and food science professionals with the latest evidence-based medical evidence, guiding consumers to make informed sweetener choices by weighing health benefits against potential risks. It also offers scientific basis for formula optimization and product development in the food industry, thereby promoting public health.

Exploring the Causal Effects of Micronutrient Supplementation on Susceptibility to Viral Pneumonia: A Mendelian Randomization Study

Viral infections have been a severe challenge for global public health, and viral pneumonia is becoming increasingly critical in the post-pandemic era. Observational and basic studies have demonstrated a strong link between host nutrient status and anti-viral immune responses, and nutritional supplements were shown to improve the prognosis of viral infectious diseases. However, there is limited research on the relationship between essential micronutrients and the susceptibility to viral pneumonia. In addition, current studies are often confounded by biases and reverse causality, undermining their reliability. In this study, to fill the gap, we employed Mendelian randomization to investigate the causal relationship between supplementation of vitamins and minerals and the susceptibility to viral pneumonia. Our analysis found that vitamin B6 is a protective factor against viral pneumonia, while selenium supplementation is a risk factor. These findings provide insights for the use of dietary supplements and the prevention and control of viral pneumonia, especially when micronutrient supplementation is used as an adjunctive therapy for viral infections.

Role of endosomal RANKL-LGR4 signaling during osteoclast differentiation

Leucine-rich repeat-containing G-protein-coupled receptor 4 (LGR4, also known as GPR48) is a membrane receptor that negatively regulates the RANK signaling cascade during osteoclastogenesis. Traditionally, cell signaling and endocytic membrane trafficking via membrane receptors have been considered distinct processes; however, they are now recognized to be closely and bidirectionally linked. The present study investigated the difference between membrane-bound and endosomal LGR4 signaling and whether the LGR4 signaling pathway influences RANK-RANKL signaling during RANKL-induced osteoclastogenesis. We used CRISPR-Cas9 to create LGR4 conditional knock-out (CKO) in RAW 264.7 cells and Drg2 knockout (KO) in mice to study the impacts of LGR4 and DRG2 on osteoclastogenesis. LGR4 was endocytosed into endosomes after binding to RANKL in RAW 264.7 s osteoclast precursor cells. Within the early endosomes, internalized LGR4 activates LGR4-RANKL signaling. When bound to RANKL, LGR4 is endocytosed and localized in the RAB5-positive endosomes. In Lgr4 CKO RAW 264.7 cells, early endosome signaling was increased and the inhibitory phosphorylation of GSK-3β was decreased, both in the whole lysate and endosome fraction. RANKL treatment increased nuclear translocation of NFATC1 in Lgr4 CKO RAW 264.7 cells and Drg2 KO mice. Overall, our results suggested that RANKL-LGR4 signaling is regulated by membrane-to-endosomal trafficking during osteoclastogenesis. KEY MESSAGES: Bone resorption by osteoclasts is essential for bone homeostasis and remodeling. However, the mechanisms underlying the regulation of osteoclastogenesis are not yet fully understood. The present study investigated the difference between membrane-bound and endosomal LGR4 signaling, and whether the LGR4 signaling pathway influences RANK-RANKL signaling during RANKL-induced osteoclastogenesis. Our results suggested that RANKL-LGR4 signaling is regulated by membrane-to-endosomal trafficking during osteoclastogenesis.

Elucidating emerging signaling pathways driving endothelial dysfunction in cardiovascular aging

The risk for developing cardiovascular diseases dramatically increases in older individuals, and aging vasculature plays a crucial role in determining their morbidity and mortality. Aging disrupts endothelial balance between vasodilators and vasoconstrictors, impairing function and promoting pathological vascular remodeling. In this Review, we discuss the impact of key and emerging molecular pathways that transduce aberrant inflammatory signals (i.e., chronic low-grade inflammation-inflammaging), oxidative stress, and mitochondrial dysfunction in aging vascular compartment. We focus on the interplay between these events, which contribute to generating a vicious cycle driving the progressive alterations in vascular structure and function during cardiovascular aging. We also discuss the primary role of senescent endothelial cells and vascular smooth muscle cells, and the potential link between vascular and myeloid cells, in impairing plaque stability and promoting the progression of atherosclerosis. The aim of this summary is to provide potential novel insights into targeting these processes for therapeutic benefit.

Bioengineered yeast for preventing age-related diseases

The aging process entails a multifaceted decline in the capacity to restore homeostasis in response to stress. A prevalent characteristic of many age-related diseases is the presence of low-grade chronic inflammation, a risk factor contributing significantly to morbidity and mortality in the elderly population. Specific lifestyle interventions, such as regular physical activity, targeted diet, and supplementation, can delay the accumulation of chronic age-associated conditions by mitigating inflammation processes. Bioengineered yeast-producing compounds with distinctive bioactivities, including anti-inflammatory properties, have the potential to provide rich dietary alternatives for the prevention of age-related diseases. This review highlights recent achievements in engineering effective yeast platforms, namely Saccharomyces cerevisiae and Yarrowia lipolytica, that hold promise in retarding the onset of aging and age-related ailments.

Metformin as a potential antidepressant: Mechanisms and therapeutic insights in depression

Depression is one of the most disabling psychiatric disorders, whose pathophysiology has not been fully understood. Increasing numbers of preclinical studies have highlighted that metformin, as the first-line hypoglycaemic agent, has a potential pleiotropic effect on depression. Moreover, there is emerging evidence that metformin shows antidepressant activity and improves depressive symptoms in rodent models of depression. However, the exact role and underlying mechanism of metformin in depression remain unclear and still need to be investigated. Recent studies suggest that metformin not only improves neuronal damage and structural plasticity in the hippocampus but also enhances the antidepressant effect of antidepressants. Therefore, in this review, we summarize the existing evidence for the use of metformin as a psychopharmaceutical and elaborate on the underlying mechanisms of metformin in mitigating the onset and progression of depression, as well as the associated biochemical signaling pathways and targets involved in the pathogenesis of depression. After reviewing several studies, we conclude that metformin helps reduce depressive symptoms by targeting multiple pathways, including the regulation of neurotransmitters, enhanced neurogenesis, anti-inflammatory effects, and changes in gut microbiota. We aim to gain a deeper understanding of the mechanism of action of metformin and provide new insights into its clinical value in the prevention and therapy of depression.

Disease-modifying pharmacological treatments of type 1 diabetes: Molecular mechanisms, target checkpoints, and possible combinatorial treatments

After a century of extensive scientific investigations, there is still no curative or disease-modifying treatment available that can provide long-lasting remission for patients diagnosed with type 1 diabetes (T1D). Although T1D has historically been regarded as a classic autoimmune disorder targeting and destroying pancreatic islet β-cells, significant research has recently demonstrated that β-cells themselves also play a substantial role in the disease's progression, which could explain some of the unfavorable clinical outcomes. We offer a thorough review of scientific and clinical insights pertaining to molecular mechanisms behind pathogenesis and the different therapeutic interventions in T1D covering over 20 possible pharmaceutical intervention treatments. The interventions are categorized as immune therapies, treatments targeting islet endocrine dysfunctions, medications with dual modes of action in immune and islet endocrine cells, and combination treatments with a broader spectrum of activity. We suggest that these collective findings can provide a valuable platform to discover new combinatorial synergies in search of the curative disease-modifying intervention for T1D. SIGNIFICANCE STATEMENT: This research delves into the underlying causes of T1D and identifies critical mechanisms governing β-cell function in both healthy and diseased states. Thus, we identify specific pathways that could be manipulated by existing or new pharmacological interventions. These interventions fall into several categories: (1) immunomodifying therapies individually targeting immune cell processes, (2) interventions targeting β-cells, (3) compounds that act simultaneously on both immune cell and β-cell pathways, and (4) combinations of compounds simultaneously targeting immune and β-cell pathways.