Noninvasive tests and diagnostic pathways to MASH diagnosis in the United States: a retrospective observational study

AIM

Although liver biopsy is considered the most reliable diagnostic tool for metabolic dysfunction-associated steatohepatitis (MASH), it is invasive and can be costly. Clinicians are increasingly relying on routine biomarkers and other noninvasive tests (NITs) for diagnosis. We examined real-world diagnostic pathways for patients newly diagnosed with MASH with a primary focus on NITs.

MATERIALS AND METHODS

This retrospective, observational study analyzed healthcare claims data (Merative MarketScan Commercial and Medicare Databases) from patients in the United States newly diagnosed with MASH from October 1, 2016, to March 31, 2023. Patients ≥18 years old with ≥12 months of continuous enrollment with medical and pharmacy benefits prior to diagnosis were included. Diagnostic pathways leading up to MASH diagnosis, including NITs (blood-based and imaging-based tests) and liver biopsies were assessed. Prevalence of comorbid conditions, MASH-associated medication use, and the diagnosing physician specialty were also examined.

RESULTS

A total of 18,396 patients were included in the analysis. Routine laboratory tests (alanine aminotransferase [ALT], albumin, aspartate aminotransferase [AST], cholesterol, complete blood count, and hemoglobin A1c) were performed among ≥70% of patients prior to MASH diagnosis, including 89% of patients with a liver enzyme test (ALT and/or AST). More than 75% of patients had necessary laboratory tests to calculate AST to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores. The most common imaging performed was ultrasound (62%); liver biopsy was only performed in 10% of patients. There was a high prevalence of cardio metabolic risk factors such as hyperlipidemia (66%), hypertension (62%), obesity (58%), type 2 diabetes (40%), and cardiovascular disease (21%). Nearly half of the patients (49%) were diagnosed by a primary care physician.

LIMITATIONS AND CONCLUSIONS

This study highlights real-world diagnostic pathways among patients newly diagnosed with MASH, supporting previous findings that liver biopsies are infrequently used in favor of noninvasive methods.

Machine learning-based analyses of contributing factors for the development of hypertension: a comparative study

OBJECTIVES

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

METHODS

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

RESULTS

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

CONCLUSIONS

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

Calcium Imaging in Vivo: How to Correctly Select and Apply Fiber Optic Photometric Indicators

Fiber-photometric is a novel optogenetic method for recording neural activity in vivo, which allows the use of calcium indicators to observe and study the relationship between neural activity and behavior in free-ranging animals. Calcium indicators also convert changes in calcium concentration in cells or tissues into recordable fluorescent signals, which can then be observed using the system of fiber-photometric. To date, there is a paucity of relevant literature on the proper selection and application of fiber-photometric indicators. Therefore, this paper will detail how to correctly select and apply fiber-photometer indicators in four sections: the basic principle of optical fiber photometry, the selection of calcium fluorescent probes and viral vector systems, and the measurement of specific expression of fluorescent proteins in specific tissues. Therefore, the correct use of suitable fiber optic recording indicators will greatly assist researchers in exploring the link between neuronal activity and neuropsychiatric disorders.

Camellia Japonica Radix modulates gut microbiota and 9(S)-HpODE-mediated ferroptosis to alleviate oxidative stress against MASLD

BACKGROUND

Camellia japonica radix (CJR), derived from the root of Camellia japonica L., has the potential to function as an herbal tea substitute for the prevention and intervention of metabolic dysfunction-associated steatotic liver disease (MASLD). It can provide systemic therapeutic benefits, boast a favorable safety profile, facilitate convenient consumption, and support long-term applicability. Despite its potential, research on CJR remains limited.

PURPOSE

The aim of this study aims is to elucidate the therapeutic mechanisms of CJR in MASLD, thereby providing evidence to support its clinical application.

METHODS

The therapeutic effects of CJR were evaluated using a water-supplementation model in MASLD mice. Integrated microbiome, transcriptome, proteome, and metabolome analyses were employed to comprehensively explore the mechanisms involved. A drug-target pull-down assay was performed to identify specific protein targets of small molecule metabolites in vitro. Fecal microbiota transplantation in antibiotic-treated ABX mice was conducted to confirm the critical role of gut microbiota and its metabolites. Furthermore, customized medicated feed supplemented with linoleic acid was used to explore the intervention effect of its metabolite, 9(S)-HpODE, as well as to evaluate its dietary intervention potential.

RESULTS

This present study explicitly elucidates the efficacy of CJR extract in alleviating hepatic inflammation and steatosis in a MASLD model mice, with its pharmacological mechanism associated with gut microbiota, linoleic acid metabolism, and GPX4-mediated ferroptosis. Notably, 9(S)-HpODE was discovered to be a key metabolite of linoleic acid, which could target both KEAP1 and SLC7A11, bidirectionally regulating GPX4-mediated ferroptosis, while acting as a signaling molecule at low doses to induce redox adaptation via oxidative preconditioning, thus ameliorating oxidative stress in MASLD.

CONCLUSION

Our findings indicate that both CJR and linoleic acid exhibit significant potential as dietary interventions for the management of MASLD, offering promising avenues for future research and clinical application.

A mitochondria-targeted nanozyme with enhanced antioxidant activity to prevent acute liver injury by remodeling mitochondria respiratory chain

Developing nanomedicines with enhanced activity to scavenge reactive oxygen species (ROS) has emerged as a promising strategy for addressing ROS-associated diseases, such as drug-induced liver injury. However, designing nanozymes that not only remove ROS but also accelerate the repair of damaged liver cells remains challenging. Here, a two-pronged black phosphorus/Ceria nanozyme with mitochondria-targeting ability (TBP@CeO2) is designed. TBP@CeO2 nanozymes exhibit multienzyme activities and display significantly enhanced ROS scavenging capacity. They can effectively mitigate acetaminophen (APAP)-induced liver injury by scavenging excessive ROS and restoring mitochondrial complex II activity to promote energy-dependent liver cell repair. The in vitro experiments reveal that TBP@CeO2 nanozymes can effectively eliminate ROS and restore mitochondrial function, thereby decreasing the cytotoxicity on BRL 3A cells exposed to APAP/H2O2. The in vivo studies show that TBP@CeO2 nanozymes can improve the complex II activity and mitochondrial function in the liver, decreasing ROS and ensuring sufficient adenosine triphosphate (ATP) production, which helps protect the liver tissue against oxidative damage. This research introduces an innovative design strategy for nanozymes in the treatment of ROS-related diseases.

Validation of Two Prognostic Gene Scores in Patients Undergoing Liver Resection for Hepatocellular Carcinoma

Background/Aims

Several prognostic gene signatures have been proposed as predictors of the prognosis of hepatocellular carcinoma (HCC), yet none are implemented in the clinical setting. We aimed to validate two gene scores previously derived from European cohorts.

Methods

The patients who underwent liver resection for HCC at Copenhagen University Hospital, Rigshospitalet from 2014 to 2018 were included. RNA sequencing determined the expression of genes in the '5-gene score' (HN1, RAN, RAMP3, KRT19, TAF9B) and 'HepatoPredict' (CLU, DPT, SPRY2, CAPSN1). Univariable Cox regression assessed associations with overall and disease-free survival. These parameters were also analyzed in the The Cancer Genome Atlas Liver Hepatocellular Carcinoma (TCGA-LIHC) (n = 359) and National Institute of Health (NIH) (n = 178) cohorts.

Results

Among 51 patients (88% male), 59% had no underlying liver disease and 25% had cirrhosis. No individual genes were significantly associated with overall survival in the Danish cohort. In the TCGA-LIHC cohort, CLU was linked to better overall survival, and in the NIH cohort, high expression of SPRY2 was associated with poorer overall survival. In the TCGA-LIHC cohort, HN1, RAN, and TAF9B were associated with poorer overall survival, while RAMP3 was linked to better overall survival. No genes were associated with disease-free survival.

Conclusion

Few individual genes significantly predicted survival in the larger cohorts, and none in the Danish cohort. However, the clinical implication of this needs further investigation.

Metabolic dysfunction-associated steatotic liver disease and malignancies: Unmasking a silent saboteur

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Insights into noncanonical and diversified functions of ABCF1: from health to disease

The ATP-binding cassette (ABC) family is one of the largest and most ancient classes of transporters found in nearly all living organisms. However, ABCF1 lacks a transmembrane domain and therefore does not function as a transporter. Recent studies point to an unexpectedly diverse role of ABCF1 in regulating cell-essential processes from mRNA translation, innate immune response, and phagocytosis in somatic cells, to transcriptional regulation in embryonic stem cells. ABCF1's functional plasticity is in part mediated by its disordered low-complexity domain (LCD) to enable dynamic biomolecular interactions. In this review, we discuss how ABCF1 takes advantage of the LCD to expand its functional repertoire and highlight fundamental principles of biomolecular assembly driving biological reactions. We also discuss the functions and mechanisms of ABCF1 in development and tissue homeostasis, and how dysregulation of ABCF1 contributes to diseases such as inflammatory disease and cancer.

HMGCR Inhibitor Restores Mitochondrial Dynamics by Regulating Signaling Cascades in a Rodent Alzheimer's Disease Model

Atorvastatin an HMGCR inhibitor may play a role in enhancing spatial and long-term memory and combating anxious behavior deficits induced by Aβ1-42. Behavioral deficit studies, immunoblotting for the antioxidant/apoptotic protein expression, flow cytometry (FACS) for mitochondrial ROS, membrane potential (▲ψm), and histopathological alterations were performed against Aβ1-42 toxicity. Aβ1-42 was infused directly into the brain through i.c.v for the establishment of the AD model. Atorvastatin (ATOR) was administered orally and was used to treat AD in adult male Wistar rats aged between 200 and 250 g. We confirmed that ATOR administration significantly attenuates the Aβ1-42-induced cognitive decline targeted mitochondrial-mediated age-dependent disease progression. Nrf2 stabilizes to interact SOD2 antioxidant enzyme, allowing transcriptional activity by the steep increase in ▲ψm and a reduction in ROS by activating mitochondrial superoxide scavenger and Nrf2-dependent pathway. These findings confirmed that ATOR has the potential efficacy to modulate the interference in cognitive decline induced by Aβ1-42.

Ran drives pancreatic cancer metastasis by activating the osteopontin-PI3K/AKT-androgen receptor signaling cascade

The small GTPase Ran has emerged as a key player in cancer metastasis. Our previous studies demonstrated that Ran drives pancreatic cancer metastasis by modulating androgen receptor (AR) expression. However, the detailed mechanisms by which Ran regulates AR expression remain unclear. This study aimed to elucidate the regulatory mechanisms through which Ran influences AR expression in the context of pancreatic cancer metastasis. We observed elevated levels of Ran, osteopontin (OPN), and AR in metastatic lymph node tissues, with OPN positively correlated with either Ran or AR expression. Ran silencing led to decreased levels of OPN and AR, whereas Ran upregulation increased their expression. Notably, OPN overexpression restored AR levels in Ran-silenced cells, whereas OPN knockdown diminished the inductive effect of Ran on AR expression. Additionally, OPN knockdown decreased AR expression and was associated with reduced activation of the PI3K/AKT signaling pathway. Functional assays revealed that silencing OPN significantly impaired the mobility and invasion of pancreatic cancer cells and restricted hepatic metastasis. Conversely, OPN overexpression restored the impaired metastasis caused by Ran knockdown. Furthermore, inhibiting PI3K/AKT signaling abolished the promoting effects of either Ran or OPN on pancreatic cancer metastasis. Importantly, re-expressing AR reversed the inhibitory effects of Ran or OPN silencing on the mobility and invasion of pancreatic cancer cells. In summary, Ran induces AR expression through the regulation of the OPN-PI3K/AKT signaling cascade. The Ran-OPN-PI3K/AKT-AR signaling pathway is crucial for driving pancreatic cancer metastasis.

TIPE2 protein restrains invariant NKT activation and protects against immune-mediated hepatitis in mice

BACKGROUND AND AIMS

Concanavalin A (ConA) administration induces rapid and severe liver injury in mice, and invariant natural killer T (iNKT) cells are recognized to be the key effector cells in this process. However, the underlying regulatory mechanisms are not well defined.

APPROACH AND RESULTS

We found that iNKT cells constitutively expressed TIPE2 (tumor necrosis factor-α-induced protein 8-like 2, or TNFAIPL2). Genetic TIPE2 ablation strongly sensitized mice to ConA-induced hepatitis, accompanied by hyperactivation of iNKT cells. Moreover, Tipe2-/- mice were also more susceptible to α-galactosylceramide-induced liver injury, with elevated serum ALT levels and enhanced proinflammatory cytokine production. CD1d signaling blockade or iNKT cell elimination through antibodies reduced the effect of TIPE2 deficiency on liver injury. Mechanistic studies revealed that TIPE2 in iNKT cells functioned as a negative regulator, limiting iNKT cell activity and cytokine production through PIP3- AKT/mTOR pathway. TIPE2-mediated protection from liver injury was further validated by the administration of adeno-associated viruses expressing TIPE2, which effectively ameliorated ConA-induced hepatic injury. However, TIPE2 was dispensable in 2 other liver injury models, including D-GalN/LPS and acetaminophen-induced hepatitis.

CONCLUSIONS

Our findings reveal a new role of TIPE2 in the attenuation of iNKT cell-mediated hepatic injury. We propose that TIPE2 serves as an important regulator of immune homeostasis in the liver and might be exploited for the therapeutic treatment of autoimmune liver diseases.

Discovery of a novel quinoline RIP1 inhibitor and its treatment of acute liver injury in mice

Necroptosis is closely associated with the development of inflammatory diseases, including acute liver injury. However, the precise role of necroptosis-related signature proteins in acute liver injury remains incompletely understood. Previously, our group investigated Compound o1, a RIP1 inhibitor, but its antinecroptosis activity and RIP1 binding affinity were suboptimal. In this study, we sought to address these two critical scientific challenges. Through a scaffold-hopping strategy, we identified a series of novel quinoline-like RIP1 inhibitors, among which N-1 exhibited the most potent antinecroptosis activity and the strongest RIP1 binding affinity. N-1 effectively inhibited necrosome formation by blocking phosphorylation in the RIP1/RIP3/MLKL signaling pathway. In a TNF-induced hypothermia mouse model of systemic inflammatory response syndrome (SIRS), N-1 significantly improved the survival rate of mice in a dose-dependent manner. Our study further revealed that RIP1, RIP3, and MLKL are expressed in normal liver tissues, whereas their phosphorylated forms (pRIP1, pRIP3, and pMLKL) are absent. In contrast, liver tissues from mice with CCl4-induced acute liver injury exhibited high expression levels of pRIP1, pRIP3, and pMLKL, indicating that necroptosis is associated with liver injury. N-1 significantly inhibited the phosphorylation of RIP1, RIP3, and MLKL, while restoring key liver damage markers such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). These findings suggest that targeting necroptosis may represent a promising therapeutic strategy for the treatment of acute liver injury.

Impaired mitochondrial degradation of CHCHD2 promotes metabolic dysfunction-associated steatohepatitis-related hepatocellular carcinoma by upregulating VEGFA

Metabolic dysfunction-associated steatohepatitis (MASH) is the fastest-growing cause of liver cancer. The liver microenvironment of patients with MASH supports the development of hepatocellular carcinoma (HCC). Coiled-coil-helix-coiled-coil-helix domain-containing 2 (CHCHD2), which is located in both the mitochondria and nucleus, is increased in MASH liver. Its role in the development of MASH-HCC remain unknown. In this study, we found CHCHD2 protein levels were elevated in both tumor and para-tumor tissues of patients with MASH-HCC and diethylnitrosamine- and high-fat diet-induced MASH-HCC mice. Chchd2-knockout mice were generated. CHCHD2 was overexpressed in hepatocytes using AAV with TBG promoter. Chchd2 knockout inhibited the progression of MASH-HCC in mice. CHCHD2 protein-targeted ChIP-sequencing data revealed that CHCHD2 target genes encoding secretory proteins were enriched in cancer pathways. Among these genes, vascular endothelial growth factor A (VEGFA) level increased in CHCHD2-overexpressing livers and hepatocytes. Chchd2 knockdown reduced palmitate-induced VEGFA expression. Palmitate-treated hepatocyte increased the angiogenic activity of endothelial cells in a paracrine manner, and this was suppressed by Chchd2 knockdown in hepatocytes. CHCHD2-overexpressing hepatocytes promoted the angiogenic activity of endothelial cells. We futher employed an orthotopic murine model of HCC to demonstrate that elevated CHCHD2 protein levels in para-tumor tissues support HCC growth. In addition, we found that the degradation of CHCHD2 was primarily mediated by mitochondrial protease ClpXP, which was repressed in the MASH liver. In conclusion, the mitochondrial degradation of CHCHD2 is impaired in MASH, and elevated CHCHD2 levels in hepatocytes promote VEGFA transcription and support the growth of HCC.

Furan fatty acids supplementation in obese mice reverses hepatic steatosis and protects against cartilage degradation

Obesity is a major global health problem associated with numerous metabolic dysfunctions, an increased risk of developing Metabolic Associated Steatotic Liver Disease (MASLD) and osteoarthritis. Recently, we demonstrated that in Diet-induced-Obesity (DIO) mouse model, preventive furan fatty acids (FuFA-F2) supplementation, a natural compounds found in many foods, reduced the onset of metabolic disorders and increased muscle mass. Here, we aimed to determine whether a short FuFA-F2 supplementation is capable of providing beneficial health effects in obese mice, notably by reversing metabolic disorders and limiting cartilage degradation. 6-month-old obese C57Bl/6 J mice were fed for four additional weeks on a high-fat and high-sucrose (HFHS) diet, supplemented or not with FuFA-F2 (40 mg/day/kg of body weight). Liver triglyceride content and histologic analysis revealed that 4 weeks of FuFA-F2 supplementation fully reversed hepatic steatosis in obese mice. Liver RNA-sequencing analysis highlighted that FuFA-F2 partly reversed the gene expression signature induced by the HFHS diet and favorably changed the expression of many genes known to be involved in the development of hepatic steatosis such as Pcsk9, Stard4, Insig1 and Sulf2. We also found that FuFA-F2 supplementation increased skeletal muscle mass and protected against cartilage degradation and synovitis induced by obesity. Our findings demonstrated that FuFA-F2 supplementation for 4 weeks in obese mice was enough to reverse the development of MASLD, promote an increase in skeletal muscle mass and protect against cartilage degradation induced by the HFHS diet. This study highlights that nutritional supplementation with FuFA-F2 could be an effective approach to treat obesity-related disorders.

Integration of bioinformatics and identification of the role of m6A genes in NAFLD

Non-alcoholic fatty liver disease (NAFLD) is prevalent worldwide and seriously affects health. M6A methylation is crucial in its pathogenesis. In this study, a thorough analysis of three gene expression datasets identified nine key differentially expressed genes DEGs associated with m6A methylation in NAFLD that are involved in important biological processes. Subsequently, functional enrichment analysis, weighted gene co-expression network analysis (WGCNA), gene set variation analysis (GSVA) and immune infiltration analysis were conducted to explore the molecular mechanism and gene expression patterns. The LASSO risk model contains a total of 5 m6A-related differentially expressed genes (m6A-RDEGs)(RBM15, IGF2BP2, EIF3B, YTHDC1, WTAP), and the diagnostic model based on these key genes has high accuracy. Among them, YTHDC1 and WTAP are used as prominent biomarkers. In addition, an interaction network between mRNA and miRNA, RNA-binding protein (RBP), transcription factor (TF) and drugs is also constructed. Finally, the animal model of NAFLD was successfully established and validated by RT-qPCR and western blot. This study provides a valuable tool for clinical diagnosis and drives the progress of NAFLD research.

Lenvatinib Is Highly Effective in Patients with Hepatocellular Carcinoma Related to Both Metabolic Dysfunction-Associated Steatohepatitis and Alcoholic Etiology: A Propensity Score Analysis

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD)-related hepatocellular carcinoma (HCC) may have distinct biological characteristics influencing systemic treatment response. However, the prognostic impact of MASLD vs. alcohol-related HCC in patients receiving lenvatinib remains unclear. This study aimed to assess lenvatinib's effectiveness and safety in these populations. Methods: A multicenter cohort of 378 HCC patients treated with lenvatinib (2019-2024) was analyzed. Propensity score matching was performed based on age, sex, tumoral stage, alpha-fetoprotein levels and Child-Pugh class. Survival was estimated using Kaplan-Meier analysis and compared with the log-rank test. Results were expressed as HR and 95% CI. Results: After matching, 115 patients per group were compared. Median OS was 21 months (95% CI: 20-23) in the group with metabolic dysfunction-associated steatohepatitis (MASH) and 19 months (95% CI: 18-21) in the group with alcohol etiology (p = 0.18). In multivariate analysis, only Child-Pugh class (HR 2.67, 95% CI: 1.84-5.41) and tumor stage (HR 2.18, 95% CI: 1.57-6.93) resulted as significant predictors of OS. Median PFS was 9 months (95% CI: 8-9) in patients with MASH and 9 months (95% CI: 7-10) in patients with alcohol etiology (p = 0.33). Only the Child-Pugh class was a significant predictor of PFS in univariate analysis (HR 1.56, 95% CI: 1.15-3.41; p = 0.03). No difference in terms of adverse event rate was observed between the two groups. Conclusions: Lenvatinib is effective in patients with both MASH- and alcohol-related HCC, with no difference in oncological outcomes between the two groups.

Hsa-miR-194-5p regulates TRAF6-mediated M1 macrophage apoptosis in recurrent spontaneous abortion

Recurrent spontaneous abortion (RSA) is linked to pro-inflammatory responses driven by macrophage M1 polarization. miR-194-5p can affect the migration and infiltration of macrophages, and significantly inhibit the release of pro-inflammatory cytokines. However, whether miR-194-5p can affect RSA through M1 macrophage-related pathway remains to be further explored. To induce human monocytic leukemia THP-1 into M1 macrophages, PMA and LPS were used. Then detect the effects of transfection with miR-194-5p mimics on the migration, invasion, cell cycle and apoptosis of M1 macrophages. Two databases, DIANA-microT and miRDB, were first used to predict the target gene of miR-194-5p, and TRAF6 was selected as the target gene of miR-194-5p, and then the binding sites of the two were predicted and verified by dual luciferase assay. Transfection of inhibitors, with or without TRAF6 siRNA (si-TRAF6), was performed on M1 macrophages to assess changes in viability, migration, aggressiveness, cell cycle, and apoptosis, as well as TRAF6, NF-κB, and Wnt5a mRNA and protein levels. Compared with the miR-NC group, transfection with the miR-194-5p mimic significantly reduced the viability, migration, and invasion abilities of M1 macrophages, arrested them in the S phase, and promoted apoptosis. miR-194-5p bound to TRAF 3'UTR-WT and reduced the viability, migration ability, and aggressiveness of M1 macrophages, increased apoptosis, and blocked the S phase. miR-194-5p negatively regulated TRAF6, resulting in decreased mRNA and protein levels of NF-κB and Wnt5a. miR-194-5p inhibitors and mimics had opposite effects, but miR-194-5p inhibitor effects could be reversed by si-TRAF6. There is a close association between RSA and M1 macrophage polarization. Furthermore, miR-194-5p inhibits the NF-κB and Wnt5a signaling pathways by negatively regulating TRAF6, thereby impeding the function of M1 macrophages and affecting the occurrence of RSA. These findings provide new therapeutic targets for the prevention, diagnosis, and treatment of RSA.

Association between Triglyceride-Glucose index and onset of type 2 diabetes in metabolic Dysfunction-Associated steatotic liver disease population

Previous studies have demonstrated a strong correlation between the Triglyceride-Glucose Index(TyG) index and diabetes mellitus; however, limited research has focused on the relationship between the TyG index and the incidence of diabetes mellitus in the Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) population. This study aims to investigate the association between the TyG index and the occurrence of diabetes mellitus in the MASLD population in Japan. This retrospective cohort study included 2,741 patients with MASLD from Murakami Memorial Hospital in Japan, spanning the years 2004 to 2015. The primary method employed to investigate the relationship between the TyG index and the occurrence of diabetes was Cox proportional hazards regression. Additionally, a Generalized Additive Model and a two-piecewise linear regression model were utilized to assess whether a linear relationship exists between the TyG index and the development of diabetes, as well as to calculate threshold effects. After adjusting for variables that may potentially influence the occurrence of diabetes, we found that the TyG index was positively correlated with diabetes incidence (HR = 1.43, 95% CI: 1.03, 1.98) in MASLD population overall. Further in-depth analysis revealed a nonlinear relationship between the TyG index and the occurrence of diabetes. When the TyG index was less than 7.95, it exhibited a negative correlation (HR = 0.22, 95% CI: 0.07, 0.66); however, when the TyG index exceeded 7.95, it showed a positive correlation (HR = 1.68, 95% CI: 1.20, 2.36). Additionally, we conducted a subject working curve analysis on the TyG index and the two components used to calculate it, fasting blood glucose and triglycerides, and found that the TyG index demonstrated higher sensitivity and specificity in predicting the occurrence of diabetes in the MASLD population. TyG index exhibits a nonlinear relationship with the incidence of diabetes in the MASLD population, and its sensitivity and specificity are superior to those of fasting blood glucose and triglycerides.

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

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

Palmitoylation enhances the stability of porcine epidemic diarrhea virus spike protein by antagonizing its degradation via chaperone-mediated autophagy to facilitate viral proliferation

Porcine epidemic diarrhea (PED) is a highly pathogenic and infectious intestinal disease caused by the PED virus (PEDV) and has inflicted substantial economic losses on the global swine industry. Therefore, it is imperative to explore appropriate targets to restrain PEDV infection. PEDV spike (S) protein is crucial for viral infection and is regarded as an ideal target for the development of vaccines and antiviral therapeutics. Palmitoylation is a significant post-translational modification implicated in multiple viral replication cycles. Despite the fact that palmitoylation of certain coronavirus S proteins has been reported, the specific biological significance and underlying molecular mechanisms of PEDV S protein palmitoylation have not been fully defined. In the present study, we uncover that palmitoylation enhances the stability of PEDV S protein to promote viral proliferation. Mechanistically, we identify that a cysteine-rich region within the cytoplasmic tail of PEDV S protein is palmitoylated by the zinc finger Asp-His-His-Cys domain palmitoyltransferase 5 (ZDHHC5). We further illustrate that palmitoylation prevents the recognition of Lys-Phe-Glu-Arg-Gln (KFERQ)-like motif in PEDV S protein by heat shock cognate protein of 70 kDa (HSC70), thereby antagonizing its degradation via chaperone-mediated autophagy (CMA). Collectively, our findings underscore the importance of palmitoylation for PEDV pathogenesis and provide prospective targets for the development of antiviral interventions.IMPORTANCEPEDV poses a serious threat to pig farming worldwide. As a consequence, a comprehensive investigation of PEDV pathogenesis is of great significance for the prevention and control of the virus. Here, we verify that ZDHHC5-mediated palmitoylation of PEDV S protein enhances its stability through impeding recognition by HSC70 and antagonizing degradation via CMA to facilitate viral propagation. Our findings highlight the important role of palmitoylation in PEDV proliferation and support palmitoylation as a promising target for the development of antiviral strategies.

n-3 polyunsaturated fatty acids-enriched fish oil attenuates chronic alcohol-induced liver injury via a mechanism involving the upregulation of Retsat

This study aimed to delineate the protective role of fish oil against alcoholic liver disease (ALD), identify the principal active component between eicosapentaenoic acid (EPA, C20:5 n-3) and docosahexaenoic acid (DHA, C22:6 n-3), and elucidate the molecular mechanisms. C57BL/6J mice were randomly assigned to receive either an alcohol-fed (AF) or pair-fed control (PF) diet, enriched with fish oil (FO) or corn oil (CO) for four weeks. Additionally, a series of in vitro experiments were performed using AML-12 cells to further investigate potential mechanisms. The results showed that plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly lower in the AF-FO group compared to the AF-CO group, indicating that fish oil alleviated alcohol-induced liver damage. Hepatic antioxidant markers, including glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were also higher in the AF-FO group than in the AF-CO group. Transcriptomic analysis revealed FO supplementation significantly affected genes involved in oxidoreductase activity and lipid metabolism pathways, with Retsat being the most up-regulated gene. The in vitro experiments indicated that DHA, but not EPA, markedly increased Retsat expression, cell viability, and the expression of genes related to oxidoreductase activity and lipid metabolism, compared to linoleic acid (LA, C18:2 n-6). Notably, knocking down Retsat abolished the protective effects of DHA. In conclusion, dietary fish oil mitigated chronic alcohol-induced liver injury primarily through DHA by upregulating Retsat and downstream genes associated with oxidoreductase function and lipid metabolism.

The Potential Contribution of the IL-37/IL-18/IL-18BP/IL-18R Axis in the Pathogenesis of Sjögren's Syndrome

The objective of this study was to explore the expression profile of the Interleukin (IL)-37/IL-18/IL-18BP/IL-18R axis in patients with primary Sjögren's syndrome (pSS). This study included 36 patients diagnosed with pSS, 13 patients presenting with sicca symptoms without confirmed pSS, and 14 healthy controls. Serum concentrations of IL-37, IL-18, IL-18BP, and IL-18R were measured using a sandwich ELISA. These levels were then correlated with relevant clinical and biological parameters. Furthermore, expression of the same cytokines was assessed in salivary gland biopsies via immunohistochemistry. No significant difference in serum IL-37 levels was observed among the three groups (p = 0.1695). However, serum levels of IL-18 and IL-18BP were significantly elevated in pSS patients compared to healthy controls (p < 0.0001), and these levels were strongly correlated. Immunohistochemical analysis revealed significantly higher expression of IL-37 in both the excretory ducts and inflammatory infiltrates of salivary glands in pSS patients compared to sicca patients. No correlation was found between IL-37 expression and the histological severity of glandular infiltration as assessed by the Chisholm score. In addition, an enhanced expression of IL-18, IL-18BP, and IL-18Rα was observed in the salivary glands of pSS patients. These findings suggest the potential contribution of the IL-37/IL-18/IL-18BP/IL-18R signaling axis in the pathogenesis of Sjögren's syndrome, particularly through its increased expression in salivary glands and correlation with disease-specific inflammatory markers. These findings may contribute to a better understanding of pSS immunopathology and suggest new avenues for biomarker development or therapeutic targeting.

Causal relationship between metabolic dysfunction-associated fatty liver disease and endotoxin biomarkers: A Mendelian randomization study

Although the relationship among lipopolysaccharides (LPS), LPS-binding proteins, and metabolic dysfunction-associated fatty liver disease (MAFLD) is widely studied, no conclusive evidence is available. In this study, we used mendelian randomization (MR) to study the causal relationship of LPS, LPS-binding proteins, and MAFLD. Using bidirectional two-sample MR method, we evaluated data from the genome wide association study; for this analysis, nonalcoholic fatty liver disease (NAFLD), liver fat percentage, and other metabolic syndromes were employed as outcomes. Furthermore, MR analysis mainly involved the inverse variance weighted method. Heterogeneity and pleiotropy tests were also conducted. LPS was found to have a causal relationship with NAFLD, obesity, high density lipoprotein cholesterol, and TG levels. Furthermore, TG levels and LBP had significant causal relationships. This study mainly concluded that LPS is a risk factor for NAFLD, obesity, high density lipoprotein cholesterol, and TG, corroborating it's the LPS role in MAFLD pathogenesis. Hence, optimizing the gut microbiota using proper diet, probiotics, or fecal microbiota transplantation may help to reduce inflammation and (IR), thereby improving lipid and glucose metabolism disorders. Although a causal relationship between TG and LBP was observed, further studies are required to determine a specific mechanism.

Tumor-associated macrophages remodel the suppressive tumor immune microenvironment and targeted therapy for immunotherapy

Despite the significant advances in the development of immune checkpoint inhibitors (ICI), primary and acquired ICI resistance remains the primary impediment to effective cancer immunotherapy. Residing in the tumor microenvironment (TME), tumor-associated macrophages (TAMs) play a pivotal role in tumor progression by regulating diverse signaling pathways. Notably, accumulating evidence has confirmed that TAMs interplay with various cellular components within the TME directly or indirectly to maintain the dynamic balance of the M1/M2 ratio and shape an immunosuppressive TME, consequently conferring immune evasion and immunotherapy tolerance. Detailed investigation of the communication network around TAMs could provide potential molecular targets and optimize ICI therapies. In this review, we systematically summarize the latest advances in understanding the origin and functional plasticity of TAMs, with a focus on the key signaling pathways driving macrophage polarization and the diverse stimuli that regulate this dynamic process. Moreover, we elaborate on the intricate interplay between TAMs and other cellular constituents within the TME, that is driving tumor initiation, progression and immune evasion, exploring novel targets for cancer immunotherapy. We further discuss current challenges and future research directions, emphasizing the need to decode TAM-TME interactions and translate preclinical findings into clinical breakthroughs. In conclusion, while TAM-targeted therapies hold significant promise for enhancing immunotherapy outcomes, addressing key challenges-such as TAM heterogeneity, context-dependent plasticity, and therapeutic resistance-remains critical to achieving optimal clinical efficacy.

The association between lifelines diet score and metabolic associated fatty liver disease: a case-control study

Introduction

Adherence to a healthy dietary pattern is a fundamental recommendation for the prevention of Metabolic Associated Fatty Liver Disease (MAFLD); however, conclusive evidence regarding the optimal dietary pattern remains elusive.

Objectives

The Lifelines Diet Score (LLDS) is a novel, evidence-based scoring system designed to evaluate diet quality. However, despite the extensive research on dietary patterns and liver health, the specific relationship between the LLDS and MAFLD remains underexplored. This study aims to investigate the association between LLDS and MAFLD, providing insights into how dietary adherence, as measured by LLDS, may influence the risk and prevalence of MAFLD.

Methods

This case-control study enrolled 215 individuals who had recently been diagnosed with MAFLD and 430 healthy controls at King Khalid University Hospital. All participants were aged between 20 and 60 years, with data collection occurring from February 2023 to January 2025. The dietary intake of the participants was assessed through the utilization of a validated semi-quantitative food frequency questionnaire, which comprised a total of 168 distinct food items. Logistic regression was used to estimate the association between LLDS and MAFLD.

Results

Out of 645 participants, 215 newly diagnosed MAFLD patients and 430 healthy controls were analyzed. After stratifying participants based on LLDS tertiles, those in the highest LLDS group had a 78% lower odds of MAFLD than those in the lowest tertile (odds ratio (OR): 0.22; 95% Confidence interval (CI): 0.12-0.36, p for trend <0.001). The association remained robust even after adjustment for major confounders. These findings highlight a novel and robust association between LLDS and MAFLD, providing evidence for dietary pattern assessment in liver health research.

Conclusion

Our study strengthens the evidence that adherence to a healthy dietary pattern (as measured by LLDS) is associated with a lower MAFLD risk, even after accounting for major confounders. However, further research integrating genetic and molecular data is needed to refine personalized dietary recommendations for MAFLD prevention.

Comprehensive bioinformatics analysis of MEX3 family genes in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a highly lethal malignancy associated with poor prognosis due to late-stage diagnosis and high recurrence rates. The MEX3 family genes has been implicated in various cancers; however, their roles in HCC remain largely unexplored. This study aims to systematically analyze the expression patterns, prognostic significance, and immune-related functions of MEX3A, MEX3B, MEX3C, and MEX3D in HCC using comprehensive bioinformatics approaches. We conducted a multi-level bioinformatics analysis to investigate the expression, prognostic significance, clinicopathological correlations, genetic alterations, immune associations, and functional mechanisms of MEX3 family members in HCC. Transcriptomic data from TCGA and GEO databases, along with experimental validation via qRT-PCR and Western blotting, were used to assess expression profiles. Kaplan-Meier, ROC curve, and Cox regression analyses were employed for prognostic evaluation. Co-expression, enrichment, and immune infiltration analyses further elucidated the functional and immunological relevance of MEX3 family genes. A prognostic model based on co-expressed genes was constructed and validated using LASSO and time-dependent ROC analyses. MEX3A, MEX3B, MEX3C, and MEX3D were significantly upregulated in HCC tissues compared to normal liver tissues (P < 0.05). ROC curve analysis demonstrated high diagnostic accuracy, particularly for MEX3A (AUC = 0.915). Kaplan-Meier survival analysis indicated that elevated MEX3A and MEX3C expression was associated with poorer overall survival (OS) and disease-specific survival (DSS) (P < 0.05). Mutation analysis revealed that MEX3A exhibited the highest alteration frequency (11%), primarily through gene amplifications. Immune infiltration analysis demonstrated significant correlations between MEX3 expression and multiple immune cell populations, including regulatory T cells (Tregs), cytotoxic T cells, and macrophages. Moreover, MEX3B, MEX3C, and MEX3D expression correlated with key immune checkpoint genes, including PDCD1, CD274, and CTLA4. Functional enrichment analysis revealed that MEX3 co-expressed genes were significantly involved in RNA metabolism, immune response regulation, and oncogenic signaling pathways. A 17-gene MEX3 co-expression-based prognostic model stratified patients into high- and low-risk groups with significantly different survival outcomes (AUC = 0.791 at 1 year). This study highlights the oncogenic potential of MEX3 family members in HCC and their associations with immune regulation. The findings suggest that MEX3 family genes could serve as potential biomarkers for HCC prognosis and immunotherapy responsiveness. Further experimental validation is warranted to elucidate the mechanistic roles of MEX3 family genes in HCC progression and immune evasion.

Association between dietary amino acid intake and the risk of metabolic dysfunction-associated steatotic liver disease

INTRODUCTION

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is becoming the major chronic liver disease, and diet plays crucial role in MASLD prevention.

OBJECTIVES

The study aimed to explore the association between dietary amino acids with MASLD risk.

METHODS

Utilizing data from the U.S. NHANES (2017-2020) and UK Biobank (2006-2010), we investigated the association between dietary intake of combined or specific amino acids, and the risk of MASLD, severe MASLD and MASLD-related events. And we identified MASLD-risk amino acid intake patterns and their primary food sources.

RESULTS

The study included 5,568 participants from the U.S. NHANES and 48,261 from the UK Biobank, with MASLD prevalence of 34.3 % and 28.4 %, respectively. In QGC model, each quartile increase in combined amino acid intake was associated with a higher MASLD risk in the U.S. NHANES (aOR = 1.17, 95 % CI: 1.01-1.37, P = 0.035) and UK Biobank (aOR = 1.07, 95 % CI: 1.002-1.15, P = 0.042). Increased lysine intake was particularly linked to elevated MASLD risk in U.S. NHANES (aOR = 1.49, 95 % CI: 1.08-2.05, P = 0.023) and UK Biobank (aOR = 1.12, 95 % CI: 1.01-1.24, P = 0.032). Substituting lysine with other amino acids was associated with reduced MASLD risk. Lysine intake was also associated with a higher risk of severe MASLD (aHR = 1.13, 95 % CI: 1.04-1.23, P = 0.002) but not liver cirrhosis or HCC. The 'Lys-Met' pattern was identified as a MASLD-risk pattern, with red meats being a representative food source.

CONCLUSION

Lysine plays a major role in the association between amino acid intake and risk of MASLD. Dietary patterns rich in lysine, such as red meat, could be key targets for MASLD prevention strategies.

Bridging the gap in obesity research: A consensus statement from the European Society for Clinical Investigation

BACKGROUND

Most forms of obesity are associated with chronic diseases that remain a global public health challenge.

AIMS

Despite significant advancements in understanding its pathophysiology, effective management of obesity is hindered by the persistence of knowledge gaps in epidemiology, phenotypic heterogeneity and policy implementation.

MATERIALS AND METHODS

This consensus statement by the European Society for Clinical Investigation identifies eight critical areas requiring urgent attention. Key gaps include insufficient long-term data on obesity trends, the inadequacy of body mass index (BMI) as a sole diagnostic measure, and insufficient recognition of phenotypic diversity in obesity-related cardiometabolic risks. Moreover, the socio-economic drivers of obesity and its transition across phenotypes remain poorly understood.

RESULTS

The syndemic nature of obesity, exacerbated by globalization and environmental changes, necessitates a holistic approach integrating global frameworks and community-level interventions. This statement advocates for leveraging emerging technologies, such as artificial intelligence, to refine predictive models and address phenotypic variability. It underscores the importance of collaborative efforts among scientists, policymakers, and stakeholders to create tailored interventions and enduring policies.

DISCUSSION

The consensus highlights the need for harmonizing anthropometric and biochemical markers, fostering inclusive public health narratives and combating stigma associated with obesity. By addressing these gaps, this initiative aims to advance research, improve prevention strategies and optimize care delivery for people living with obesity.

CONCLUSION

This collaborative effort marks a decisive step towards mitigating the obesity epidemic and its profound impact on global health systems. Ultimately, obesity should be considered as being largely the consequence of a socio-economic model not compatible with optimal human health.

Correlation between prognostic markers and clinical parameters in hepatocellular carcinoma: Pathophysiological aspects to therapeutic targets

One of the main causes of cancer-related morbidity and mortality globally is hepatocellular carcinoma (HCC). At every stage of the disease, HCC may now be treated using a variety of therapy techniques. Nevertheless, despite the abundance of effective therapeutic choices, the prognosis for patients with HCC is still typically dismal. Prognostic indicators are crucial when assessing prognosis and tracking tumor metastases or recurrence. There are many prognostic markers in HCC. We mainly focused on newly reported prognostic markers such as MEX3A, apolipoprotein B, alpha-fetoprotein, circulating tumor cells, SAMD13, Agrin, and Glypican-3 in the pathogenesis of HCC. Further, we highlighted how these prognostic markers correlated to clinical parameters such as tumor node metastasis, tumor diameter, differentiation, hepatocirrhosis, vascular invasion, and others in HCC. Therefore, identifying specific prognostic biomarkers of HCC helps to provide a great opportunity to improve the prognosis in patients with HCC and provide therapeutic targets.

Unraveling the Metabolic Pathways Between Metabolic-Associated Fatty Liver Disease (MAFLD) and Sarcopenia

Metabolic-Associated Fatty Liver Disease (MAFLD) is a public health concern that is constantly expanding, with a fast-growing prevalence, and it affects about a quarter of the world's population. This condition is a significant risk factor for cardiovascular, hepatic, and oncologic diseases, such as hypertension, hepatoma, and atherosclerosis. Sarcopenia was long considered to be an aging-related syndrome, but today, it is acknowledged to be secondarily related to chronic diseases such as metabolic syndrome, cardiovascular conditions, and liver diseases, among other comorbidities associated with insulin resistance and chronic inflammation, besides inactivity and poor nutrition. The physiopathology involving MAFLD and sarcopenia has still not been solved. Inflammation, oxidative stress, mitochondrial dysfunction, and insulin resistance seem to be some of the keys to this relationship since this hormone target is mainly the skeletal muscle. This review aimed to comprehensively discuss the main metabolic and physiological pathways involved in these conditions. MAFLD and sarcopenia are interconnected by a complex network of pathophysiological mechanisms, such as insulin resistance, skeletal muscle tissue production capacity, chronic inflammatory state, oxidative stress, and mitochondrial dysfunction, which are the main contributors to this relationship. In addition, in a clinical analysis, patients with sarcopenia and MAFLD manifest more severe hepatitis fibrosis when compared to patients with only MAFLD. These patients, with both disorders, also present clinical improvement in their MAFLD when treated for sarcopenia, reinforcing the association between them. Lifestyle changes accompanied by non-pharmacological interventions, such as dietary therapy and increased physical activity, undoubtedly improve this scenario.

A review of the progress and challenges of developing dendritic-based vaccines against hepatitis B virus (HBV)

Hepatitis B virus (HBV) infections that last a long time are a significant public health problem worldwide. About 254 million people around the world are chronically sick with HBV. Each year, 1.2 million new cases occur, and in 2022, 1.1 million people will die from the disease. So, it has been essential to work on finding ways to treat and avoid HBV. The process of therapeutic vaccination involves giving people a non-infectious form of a virus to start or improve immune reactions specific to HBV. This helps keep HBV infections under control. Dendritic cells (DCs) play a significant part in beginning the adaptive immune response, which could decide how well an HBV infection is treated. DC-based treatment has been looked into for people with chronic HBV (CHB) infection and has shown some sound effects. Vaccines for CHB that use DCs boost antiviral immunity by improving T cells and breaking the immune system's resistance against HBV. In these vaccines, DCs are loaded with HBV antigens (like HBsAg, HBcAg, or peptides) outside of the body and then put back into the patient to make the immune system work better. In conclusion, this DC treatment is a biological therapy method with a good chance of being used. This study examined the different DC-based medicines that can treat and prevent HBV. Finally, we've talked about clinical studies, the current problems, how to fix them, and the future of this vaccine for treating and preventing HBV.

Insights into the mechanisms of angiogenesis in hepatoblastoma

Hepatoblastoma (HB), the most common pediatric liver malignancy, is characterized by aggressive growth and metastasis driven by complex angiogenic mechanisms. This review elucidates the pivotal role of angiogenesis in HB progression, emphasizing metabolic reprogramming, tumor microenvironment (TME) dynamics, and oncogenic signalling pathways. The Warburg effect in HB cells fosters a hypoxic microenvironment, stabilizing hypoxia-inducible factor-1α (HIF-1α) and upregulating vascular endothelial growth factor (VEGF), which synergistically enhances angiogenesis. Key pathways such as the Wnt/β-catenin, VEGF, PI3K/AKT, and JAK2/STAT3 pathways are central to endothelial cell proliferation, migration, and vascular maturation, whereas interactions with tumor-associated macrophages (TAMs) and pericytes further remodel the TME to support neovascularization. Long noncoding RNAs and glycolytic enzymes have emerged as critical regulators of angiogenesis, linking metabolic activity with vascular expansion. Anti-angiogenic therapies, including VEGF inhibitors and metabolic pathway-targeting agents, show preclinical promise but face challenges such as resistance and off-target effects. Future directions advocate for dual-target strategies, spatial multiomics technologies to map metabolic-angiogenic crosstalk, and personalized approaches leveraging biomarkers for risk stratification. This synthesis underscores the need for interdisciplinary collaboration to translate mechanistic insights into durable therapies, ultimately improving outcomes for HB patients.

Navigating the Paradox of IL-22: Friend or Foe in Hepatic Health?

Interleukin-22 (IL-22), a cytokine from the IL-10 family produced by T cells and innate lymphoid cells, plays a crucial role in immune responses and tissue regeneration. Its association with liver disease has garnered significant attention; however, its exact impact remains controversial. This review aims to enhance the current understanding of the dual role of IL-22 in liver disease by exploring its protective and pathogenic effects. First, we provide an overview of IL-22 biology, including its source, receptors, and signaling pathways. Subsequently, we offer a comprehensive overview of the dual function of IL-22 in non-neoplastic liver disease, emphasizing its antiapoptotic and regenerative properties. We also discuss the applicability of the conclusions drawn from studies on nonalcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease. Furthermore, we elaborate on the intricate role of IL-22 in hepatocellular carcinoma, particularly its influence on the tumor microenvironment, proliferation, and immune evasion. In conclusion, IL-22 is paradoxical in liver disease, acting as a friend and foe. It is imperative to understand this paradox to develop targeted therapies that capitalize on the beneficial effects of IL-22 while mitigating its detrimental effects.

Reduced murine double minute-2 methylation from peripheral blood mononuclear cells correlates with enhanced oxidative stress in hepatitis b virus-related hepatocellular carcinoma

Background

Hepatitis B virus-related hepatocarcinogenesis (HBV-related HCC) involves a variety of causes including oncogene hypomethylation, oxidative stress and HBV itself. Oxidative stress induces an alternation in the DNA methylation status. We aimed to study the relationship between oxidative stress and murine double minute-2 (MDM2) methylation status in HBV-related HCC patients and healthy controls (HCs).

Methods

A total of 135 patients with HBV-related HCC and 26 healthy controls (HCs) were recruited. The MDM2 methylation status was detected by methylation-specific PCR. The expression of MDM2 mRNA was assessed using quantitative real-time PCR. The plasma malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), nuclear factor erythroid 2-related factor 2 (NRF2), heme Oxygenase-1 (HO-1), and glutathione peroxidase 4 (GPX4) were measured by enzyme-linked immunosorbent assay (ELISA). Thirty-six patients with HBV-related HCC and 11 HCs were selected and the serum metabolism was analyzed by ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS).

Results

Compared with HCs, the MDM2 promoter methylation frequency was significantly decreased in HBV-related HCC. The MDA levels were increased, whereas the GSH, SOD, NRF2, HO-1, and GPX4 levels were decreased in the HBV-related HCC patients relative to HCs. There were 216 differential metabolites between HBV-related HCC and HCs in plasma, which belongs to amino acids, bile acids, fatty acids, phospholipids, and other compounds. The cysteine and methionine metabolism were the most significant metabolic pathways associated with differential metabolites between MDM2 methylated group and MDM2 unmethylated group in HBV-related HCC.

Conclusion

Our results suggested that oxidative stress may cause MDM2 hypomethylation, in which cysteine and methionine pathway might play an important role in.

Multi-omic analysis reveals a CAF-stemness-governed classification in HCC liver transplant recipients beyond the Milan criteria

In patients with hepatocellular carcinoma (HCC) meeting the Milan criteria, liver transplantation (LT) is an effective therapy. This study aims to define the survival-related molecular biological features helping precisely identifying the patients with HCC beyond the Milan criteria who have acceptable outcomes. In the derivation cohort, integrated analyses of tumor tissues are conducted using RNA sequencing (RNA-seq), proteomic landscape, and transposase-accessible chromatin sequencing (ATAC-seq). Based on transcriptomics, three subgroups that significantly differ in overall survival were identified in the derivation cohort, and these findings are validated in an independent cohort. In-depth bioinformatics analysis using RNA-seq and proteomics reveals that the promotion of cancer stemness by cancer-associated fibroblasts (CAFs) can be responsible for the negative biological characteristics observed in high-risk HCC patients. The ATAC-seq identifies key factors regulating transcription, which may bridge CAF infiltration and stemness. Finally, we demonstrate that the CAF-derived CXCL12 sustains the stemness of HCC cells by promoting XRCC5 through CXCR4.

Protein lipidation in the tumor microenvironment: enzymology, signaling pathways, and therapeutics

Protein lipidation is a pivotal post-translational modification that increases protein hydrophobicity and influences their function, localization, and interaction network. Emerging evidence has shown significant roles of lipidation in the tumor microenvironment (TME). However, a comprehensive review of this topic is lacking. In this review, we present an integrated and in-depth literature review of protein lipidation in the context of the TME. Specifically, we focus on three major lipidation modifications: S-prenylation, S-palmitoylation, and N-myristoylation. We emphasize how these modifications affect oncogenic signaling pathways and the complex interplay between tumor cells and the surrounding stromal and immune cells. Furthermore, we explore the therapeutic potential of targeting lipidation mechanisms in cancer treatment and discuss prospects for developing novel anticancer strategies that disrupt lipidation-dependent signaling pathways. By bridging protein lipidation with the dynamics of the TME, our review provides novel insights into the complex relationship between them that drives tumor initiation and progression.

Recent advances on gene-related DNA methylation in cancer diagnosis, prognosis, and treatment: a clinical perspective

Recent advances in screening programs and the development of innovative therapeutic strategies have significantly improved the clinical outcomes of cancer patients. However, many patients still experience treatment failure, primarily due to inherent or acquired drug resistance mechanisms. This challenge underscores the urgent need for novel therapeutic targets for the effective treatment of malignancies, as well as cancer-specific biomarkers to enhance early diagnosis and guide interventions. Epigenetic mechanisms, including DNA methylation, have recently garnered growing interest as key regulators of gene expression under both physiological and pathological conditions. Although epigenetic dysregulations are reliable tumor hallmarks, DNA methylation is still not routinely integrated into clinical practice, highlighting the need for further research to translate preclinical findings from the bench to the bedside. On these bases, the present review aims to illustrate the state of the art regarding the role of DNA methylation in cancer, describing the technologies currently available for DNA methylation profiling. Furthermore, the latest evidence on the application of DNA methylation hotspots in cancer diagnosis and prognosis, as well as the impact of epidrugs in cancer care, is discussed to provide a comprehensive overview of the potential clinical relevance of DNA methylation in advancing personalized medicine.

Characteristics of serum bile acid profiles among individuals with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the predominant chronic liver condition globally. Bile acid (BA) metabolism contributes significantly to MASLD progression. In this multicenter clinical study, we aimed to characterize serum BA profiles in patients with MASLD and identify specific alterations compared to healthy controls.

METHODS

All MASLD cases were sourced from the gastroenterology outpatient departments of Shanghai Baoshan Hospital of Integrated Chinese and Western Medicine, Shanghai Baoshan District Songnan Community Health Service Center, and Lianyungang Oriental Hospital between June 2015 and December 2019. The data were analyzed using SPSS version 26.0, with a p-value of less than 0.05 considered significant.

RESULTS

A total of 215 participants (35.3% women) with MASLD and 49 controls (44.9% women), aged 18-65 years, were included. MASLD patients showed higher levels of serum total BA (TBA), cholic acid (CA), chenodeoxycholic acid (CDCA), and ursodeoxycholic acid (UDCA) (p < 0.05, p < 0.01) when compared to controls. Furthermore, women patients with MASLD demonstrated notably higher levels of lithocholic acid (LCA), glycolithocholic acid (GLCA), and taurolithocholic acid (TLCA) than men patients with MASLD (p < 0.025, p < 0.01). Compared to women, men exhibited a higher proportion of primary to secondary BAs. Additionally, in men patients with MASLD, the serum concentrations of CA, CDCA, glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and taurochenodeoxycholic acid (TCDCA) exhibited significant negative correlations with ALT levels, while deoxycholic acid (DCA) and TLCA showed negative correlations with BMI.

CONCLUSIONS

Patients with MASLD exhibited notable variations in BA profiles, including sex-specific differences. This study provides corresponding evidence on the association between BAs and MASLD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, NO: ChiCTR-OOC-15006157, registration date: March 25, 2015.

Product Oriented Upcycling of Waste Polyethylene Terephthalate Plastic and Carbon Dioxide via Decoupled Electrolysis

End-of-life plastics and carbon dioxide (CO2) are anthropogenic waste carbon resources; it is imperative to develop efficient technologies to convert them to value-added products. Here we report the upcycling of polyethylene terephthalate (PET) plastic and CO2 toward valuable potassium diformate, terephthalic acid, and H2 fuel via decoupled electrolysis. This product-oriented process is realized by two electrolyzers: (1) a solid-state-electrolyte based CO2 electrolyzer and (2) a solid-polymer-electrolyte-based PET electrolyzer. Using a bismuth-based catalyst, the CO2 electrolyzer showed more than 140 h continuous operation at current of 250 mA, resulting in 850 mL pure HCOOH solution with a concentration of 683 mM. Furthermore, we constructed a solid-polymer-electrolyte electrolyzer with an electrode area of 50 cm2 for the electrooxidation of ethylene glycol to formate, achieving 30 A of current at ~1.9 V cell voltage and 80 % formate Faradaic efficiency. With this electrolyzer, we demonstrated the efficient transformation of PET hydrolysate to a mixture of terephthalate and formate. Additionally, combining CO2 derived HCOOH and PET electrolyte, we obtained recycled terephthalic acid and potassium diformate. This work provides an integrated strategy for the valorization of waste carbon resources with less using external resources.

Weissella viridescens Attenuates Hepatic Injury, Oxidative Stress, and Inflammation in a Rat Model of High-Fat Diet-Induced MASLD

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder globally. Probiotic supplementation has shown promise in its prevention and treatment. Although Weissella viridescens, a lactic acid bacterium with immunomodulatory effects, has antibacterial and anti-inflammatory activities, there is a lack of direct evidence for its role in alleviating MASLD. This study aimed to investigate the protective effects of W. viridescens strain Wv2365, isolated from healthy human feces, in a high-fat diet (HFD)-induced rat model of MASLD. Methods: Rats were randomly assigned to a normal chow diet (NC), high-fat diet (HFD), and HFD supplemented with W. viridescens Wv2365 (Wv2365) groups. All groups were fed their respective diets for 8 weeks. During this period, the NC and HFD groups received a daily oral gavage of PBS, while the Wv2365 group received a daily oral gavage of Wv2365. Results: Wv2365 supplementation significantly reduced HFD-induced body weight gain, improved NAFLD activity scores, alleviated hepatic injury, and restored lipid metabolism. A liver transcriptomic analysis revealed the downregulation of inflammation-related pathways, along with decreased serum levels of TNF-α, IL-1β, IL-6, MCP-1, and LPS. Wv2365 also activated the Nrf2/HO-1 antioxidant pathway, enhanced hepatic antioxidant enzyme activities and reduced malondialdehyde levels. A gut microbiota analysis showed the enrichment of beneficial genera, including Butyricicoccus, Akkermansia, and Blautia. Serum metabolomic profiling revealed increased levels of metabolites including indole-3-propionic acid, indoleacrylic acid, and glycolithocholic acid. Conclusions: Wv2365 attenuates hepatic injury, oxidative stress, and inflammation in a rat model of high-fat-diet-induced MASLD, supporting its potential as a probiotic candidate for the modulation of MASLD.

Clinical Insights on Resmetirom: Clinical Indications, Patient Selection, and Monitoring Response to Therapy

The recent conditional approval by the Food and Drug Administration of resmetirom for treating metabolic dysfunction-associated steatohepatitis (MASH) with significant or advanced fibrosis represents a pivotal milestone in the history of metabolic dysfunction-associated steatotic liver disease (MASLD) treatment. As the first liver-directed pharmacological therapy option for MASLD, resmetirom offers a novel approach that specifically targets liver pathology, marking a transformative step forward in managing this widespread and challenging condition. For initiating therapy with resmetirom, a liver biopsy is not required. Consequently, accurately excluding patients with less severe liver histology or cirrhosis using noninvasive tests (NITs) is essential. In addition, monitoring the therapy response should be conducted using NITs. Given the recent approval, our current clinical understanding of resmetirom is primarily informed by phase 3 clinical trials. The long-term effects of the drug should be evaluated in further studies by encouraging the use of the drug in eligible patients. This review highlights key aspects of clinical resmetirom use, including identifying the target population, monitoring therapeutic response, determining appropriate discontinuation criteria, and strategies to prevent unnecessary treatment interruptions.

A Mutual Interaction Between GSTP1 and p53 Improves the Drug Resistance and Malignant Biology of Pancreatic Cancer

Glutathione S-transferase P1 (GSTP1), a classic tumor biomarker, plays a controversial role in cancer progression. However, its specific role in pancreatic cancer (PC) has rarely been investigated. In the present study, we investigated the function and relationship between GSTP1 and mutant/wild-type p53 (mtp53/wtp53) in PC in vitro and in vivo. Compared with paired adjacent normal pancreas tissue, GSTP1 was downregulated in PC tissue, which was closely correlated with lymph node metastasis, Union for International Cancer Control (UICC) stage, and a better outcome of PC patients, processes dependent on wtp53 rather than mtp53. Moreover, a mutual regulation between GSTP1 and p53 was found in wtp53 PC cells. GSTP1 overexpression inhibited cell proliferation and chemotherapy resistance in vitro via wtp53/p21 and Bax/Bcl2 signaling, which was significantly reversed by wtp53 silencing, and vice versa. Similarly, the coordination of GSTP1 and p53 regulated the invasion and migration of PC cells, which was accompanied by changes in epithelial-mesenchymal transition (EMT) signaling (E-cad, ZO-1 and MMP9). Moreover, GSTP1 overexpression inhibited tumor growth and liver metastasis in vivo, as did high wtp53 and low ki67 expression. Interestingly, GSTP1 did not coimmunoprecipitate with either mtp53 or wtp53 in vitro. However, the wtp53 protein, as a transcription factor, could bind to the GSTP1 DNA promoter to transactivate GSTP1 mRNA expression as demonstrated via a Chip assay. Additionally, GSTP1 promoted the translocation of wtp53 into the nucleus but not mtp53. These results suggest that the positive feedback regulation of GSTP1 and wtp53 plays a significant role in cell proliferation, drug resistance, cell invasion and metastasis in PC.

Recent prevalence and trends of obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) among US adolescents: 1999 to 2020

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is understudied among US adolescents despite rising obesity rates.

METHODS

This study analysed the prevalence and trends of obesity and MASLD among US adolescents aged 12-17 using data from the National Health and Nutrition Examination Survey (NHANES). We developed a new screening model utilizing FibroScan-measured controlled attenuation parameter (CAP) scores, body measurements and blood chemistry data from 2017 to 2020 to assist in analysing MASLD trends from 1999 to 2020.

RESULTS

Between 2017 and 2020, the prevalence of obesity and MASLD was approximately 20%, with about 70% of obese adolescents affected by MASLD. The condition was more common in boys, particularly among Mexican American adolescents. Additionally, 97.2% of those with NAFLD also had MASLD. Adolescents with MASLD had significantly higher body weight, waist circumference, triglyceride levels and alanine transaminase (ALT) levels, along with lower high-density lipoprotein (HDL) cholesterol and an increased risk of liver fibrosis. Insufficient physical activity and poor diet quality were key risk factors for developing MASLD. From 1999 to 2020, the prevalence of MASLD rose significantly, paralleling the increasing rates of obesity.

CONCLUSIONS

The study underscores the pressing need to screen at-risk adolescents for metabolic issues associated with steatotic liver diseases, given the rising obesity rates among adolescents. The high overlap between MASLD and NAFLD diagnoses indicates that the transition from NAFLD to MASLD can be effectively integrated into paediatric practice.

Charge-transfer dynamics in S-scheme photocatalyst

Natural photosynthesis represents the pinnacle that green chemistry aims to achieve. Photocatalysis, inspired by natural photosynthesis and dating back to 1911, has been revitalized, offering promising solutions to critical energy and environmental challenges facing society today. As such, it represents an important research avenue in contemporary chemical science. However, single photocatalytic materials often suffer from the rapid recombination of photogenerated electrons and holes, resulting in poor performance. S-scheme heterojunctions have emerged as a general method to enhance charge transfer and separation, thereby greatly improving photocatalytic efficiencies. This Perspective delves into the electron transfer dynamics in S-scheme heterojunctions, providing a comprehensive overview of their development and key characterization techniques, such as femtosecond transient absorption spectroscopy, in situ irradiated X-ray photoelectron spectroscopy and Kelvin probe force microscopy. By addressing a critical research gap, this work aims to trigger further understanding and advances in photo-induced charge-transfer processes, thereby contributing to green chemistry and the United Nations sustainable development goals.

Outcomes of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux Disease in Patients with Severe Obesity: A Propensity Score-Matched Analysis

BACKGROUND

Hiatal hernia (HH) is frequent in patients with obesity who have undergone bariatric surgery, but there is controversy about HH repair (HHR) during bariatric surgery. This study aimed to analyze the safety and efficacy of concomitant laparoscopic sleeve gastrectomy (LSG) and HHR in patients with severe obesity.

METHODS

A propensity score-matched analysis was conducted for patients who underwent LSG. Preoperative barium meal, upper endoscopy, and intraoperative findings were used to diagnose HH. The GERD health-related quality of life (GERD-HRQL) questionnaire was used to diagnose gastroesophageal reflux disease (GERD). Patients were divided into two groups: one underwent concomitant LSG with HHR and the other underwent LSG only. HHR was performed by cruroplasty and reconstruction of the phrenoesophageal ligament (PEL). Gastropexy was performed by fixing the gastric tube to the omentum and peripancreatic fascia. Outcomes included blood loss, operative time, postoperative complications, GERD, and percent excess weight loss.

RESULTS

Of the 406 patients included in the study, 203 patients with HH underwent LSG with HHR, while 203 underwent LSG alone. There was significantly longer operative time in the LSG with HHR group, but no statistical difference between the groups regarding postoperative complications, except postoperative GERD. De novo GERD symptoms developed significantly in the LSG only group. These results indicate that concomitant LSG with HHR leads to improvement of GERD and decreases the rate of de novo GERD symptoms.

CONCLUSIONS

HH should be repaired by cruroplasty and reconstruction of the PEM during LSG. HHR helps to improve postoperative GERD symptoms.

Dual-Driven Activation of High-Valence States in Prussian Blue Analogues Via Graphene-Quantum Dots and Ozone-Induced Surface Restructuring for Superior Hydrogen Evolution Electrocatalyst

Electrochemical water splitting is a pivotal process for sustainable hydrogen energy production, relying on efficient hydrogen evolution reaction (HER) catalysts, particularly in acidic environments, where both high activity and durability are crucial. Despite the favorable kinetics of platinum (Pt)-based materials, their performance is hindered under harsh conditions, driving the search for alternatives. Due to their unique structural characteristic, Prussian blue analogs (PBAs) emerge as attractive candidates for designing efficient HER electrocatalysts. However, modulating their properties and functionalities is crucial to overcome their conductivity issue. Herein, a reconfiguration strategy for the dual-driven surface restructuring of the CoFe PBA involving graphene quantum dots (GQD) and UV/ozone is proposed. X-ray absorption spectroscopy (XAS) analysis revealed that dual-driven reconstruction plays a pivotal role in promoting the high-valence metal ions, effectively reducing charge transfer resistance-a key limitation in HER. The optimized CoFe PBA/GQD-UV exhibits remarkable electrocatalytic performance toward HER, with a low overpotential of 77 mV to reach a current density of 10 mA cm-2 with excellent durability for 12 h under an extremely high current density of 500 mA cm-2 in an acidic solution. This dual-combination strategy offering a new pathway to develop highly active electrocatalysts.