Public Policy and Health System Responses to Diabetes Mellitus in Nigeria: A Call for Reform

Diabetes mellitus, once a rare diagnosis in precolonial and early post-colonial Nigeria, now has the highest prevalence and fatality rates in sub-Saharan Africa. This increased prevalence is attributed to rising population affluence characterized by sedentary lifestyles and higher consumption of processed and ultra-processed foods. The burden is further exacerbated by a poorly responsive healthcare system. Currently, less than 50% of affected individuals are aware of their condition. Factors such as misconceptions about the disease, a preference for unproven traditional herbal treatments, and the high cost of treatment hinder effective secondary responses. Health system challenges in diabetes management in Nigeria include inadequate implementation of existing policies and guidelines, high out-of-pocket payments, poor quality of healthcare, and limited public education about the disease. To address these issues, we recommend a policy focus on:  1) Implementing actionable policies and guidelines for diabetes prevention and care; 2) Improving the pre-paid care system to reduce out-of-pocket payments; 3) Enhancing the quality of services at all healthcare levels, with the establishment of centers of excellence for specialized diabetes management; 4) Continuing the training, retraining, motivation, and expansion of the workforce responsible for diabetes care; and 5) Health promotion and health awareness aimed at the public to address inaccurate beliefs and practices about diabetes. Addressing these multifaceted factors will help to reduce the rising incidence of diabetes in Nigeria.

Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study

There are approximately 220 million (about 12% regional prevalence) adults living with diabetes mellitus (DM) with its related complications, and morbidity knowingly or unconsciously in the Western Pacific Region (WP). The estimated healthcare cost in the WP and Malaysia was 240 billion USD and 1.0 billion USD in 2021 and 2017, respectively, with unmeasurable suffering and loss of health quality and economic productivity. This urgently calls for nothing less than concerted and preventive efforts from all stakeholders to invest in transforming healthcare professionals and reforming the healthcare system that prioritizes primary medical care setting, empowering allied health professionals, improvising health organization for the healthcare providers, improving health facilities and non-medical support for the people with DM. This article alludes to challenges in optimal diabetes care and proposes evidence-based initiatives over a 5-year period in a detailed roadmap to bring about dynamic and efficient healthcare services that are effective in managing people with DM using Malaysia as a case study for reference of other countries with similar backgrounds and issues. This includes a scanning on the landscape of clinical research in DM, dimensions and spectrum of research misconducts, possible common biases along the whole research process, key preventive strategies, implementation and limitations toward high-quality research. Lastly, digital medicine and how artificial intelligence could contribute to diabetes care and open science practices in research are also discussed.

How Health Systems World-wide Fail Type 2 Diabetics

For over 50 years, health systems the world over have failed people with type 2 diabetes mellitus (T2DM). The WHO documents a quadrupling of people with diabetes in a 34-year period to 422 million in 2014, the overwhelming majority of whom were T2DM. This happened despite extensive scientific literature on the causes of, as well as proven treatments for, this disease. Using a health systems prism to review the extensive medical and nutritional T2DM published research, we identified three main shortcomings of health systems in T2DM: (i) failure in early detection; (ii) failure in understanding the actionable lifestyle drivers; and (iii) subsidizing the causes of the disease. Although small-scale success stories in T2DM control exist, the lack of documented evidence of any country-wide health system's successful attempt to address this epidemic is alarming. The immense and ever-growing health and economic burdens of T2DM should provide all the motivation needed for national and global efforts to counteract the political-economy constraints standing in the way of successful whole-of-system approaches to T2DM.

TGF-β: elusive target in diabetic kidney disease

Transforming growth factor-beta (TGF-β), a cytokine with near omnipresence, is an integral part of many vital cellular processes across the human body. The family includes three isoforms: Transforming growth factor-beta 1, 2, and 3. These cytokines play a significant role in the fibrosis cascade. Diabetic kidney disease (DKD), a major complication of diabetes, is increasing in prevalence daily, and the classical diagnosis of diabetes is based on the presence of albuminuria. The occurrence of nonalbuminuric DKD has provided new insight into the pathogenesis of this disease. The emphasis on multifactorial pathways involved in developing DKD has highlighted some markers associated with tissue fibrosis. In diabetic nephropathy, TGF-β is significantly involved in its pathology. Its presence in serum and urine means that it could be a diagnostic tool while its regulation provides potential therapeutic targets. Completely blocking TGF-β signaling could reach untargeted regions and cause unanticipated effects. This paper reviews the basic details of TGF-β as a cytokine, its role in DKD, and updates on research carried out to validate its candidacy.

Bidirectional causality of physical exercise in retinal neuroprotection

Physical exercise is recognized as an effective intervention to improve mood, physical performance, and general well-being. It achieves these benefits through cellular and molecular mechanisms that promote the release of neuroprotective factors. Interestingly, reduced levels of physical exercise have been implicated in several central nervous system diseases, including ocular disorders. Emerging evidence has suggested that physical exercise levels are significantly lower in individuals with ocular diseases such as glaucoma, age-related macular degeneration, retinitis pigmentosa, and diabetic retinopathy. Physical exercise may have a neuroprotective effect on the retina. Therefore, the association between reduced physical exercise and ocular diseases may involve a bidirectional causal relationship whereby visual impairment leads to reduced physical exercise and decreased exercise exacerbates the development of ocular disease. In this review, we summarize the evidence linking physical exercise to eye disease and identify potential mediators of physical exercise-induced retinal neuroprotection. Finally, we discuss future directions for preclinical and clinical research in exercise and eye health.

Related factors for kidney disease and high chronic kidney disease progression risk in adult-onset type 1 diabetes mellitus patients from China: a multi-center cross-sectional study

BACKGROUND/AIM

Concerning the related factors for kidney disease and high chronic kidney disease (CKD) progression risk, there is still a lack of study in the adult-onset type 1 diabetes mellitus (T1DM) patients from China.

METHODS

Four hundred and eighty-one adult-onset T1DM patients from the Guangdong T1DM translational medicine study were included. Logistic regression analysis (Forward: LR) was utilized to identify glycemic- and nonglycemic-related factors associated with moderate albuminuria, severe albuminuria, mildly reduced estimated glomerular filtration rate (eGFR), decreased eGFR, and high CKD progression risk, and to calculate the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

High CKD progression risk was positively associated with males (OR = 3.13, 95% CI:1.20 - 8.14, p = 0.019), duration of T1DM (OR =1.13, 95% CI:1.05 - 1.21, p < 0.001), triglyceride (OR =1.52, 95% CI:1.11 - 2.08, p = 0.008), and systolic blood pressure (SBP) (OR =1.04, 95% CI:1.02 - 1.07, p = 0.001), and negatively correlated with BMI (OR = 0.80, 95% CI:0.68 - 0.95, p = 0.011). Meanwhile, moderate albuminuria, severe albuminuria, mildly reduced eGFR and decreased eGFR had different each of glycemic- and nonglycemic-related factors.

CONCLUSIONS

Hyperglycemia, hypertension, hyperuricemia, and BMI may be associated with different stages of kidney disease in adult-onset T1DM patients. Early-stage adult-onset T1DM patients with male, low BMI, prolonged diabetes duration, and comorbid hypertension and dyslipidemia should undergo a thorough evaluation of albuminuria and renal function to detect those at high CKD progression risk, who should be timely transferred to the nephrology specialty to receive professional treatment for kidney disease.

Long non-coding RNA in IgA nephropathy: a comprehensive review

Immunoglobulin A nephropathy (IgAN) stands as the most prevalent primary glomerulonephritis globally, almost half of patients progress to end-stage kidney disease (ESKD). However, the precise pathogenesis of IgAN remains elusive. Long non-coding RNAs (lncRNAs), non-protein-coding transcripts that regulate gene expression, have been found to exhibit distinct expression patterns in various disease states. Comprehensive bioinformatic analyses from IgAN patients have uncovered differential expression of lncRNAs such as HOTAIR, H19, and MALAT1. Furthermore, a single nucleotide polymorphism in MIR31HG has been linked to IgAN susceptibility and correlated with clinical markers like urinary red blood cells and hemoglobin levels. Lnc-TSI and lnc-CHAF1B-3, specifically expressed in the kidneys of IgAN patients, exhibit associations with renal fibrosis indices and the degree of kidney function deterioration, influencing the progression of renal fibrosis through distinct signaling pathways. Additionally, renal intercellular adhesion molecule 1 (ICAM-1) related long noncoding RNA (ICR) levels positively correlate with IgAN severity and contribute to renal fibrosis, whereas serum H19 serves as an independent protective factor against IgAN. Notably, experiments have validated the involvement of PTTG3P, lnc-CHAF1B-3, and CRNDE in the pathogenesis of IgAN. Nevertheless, data on the roles of lncRNAs in IgAN pathogenesis and their potential as biomarkers remain limited, and effective therapeutic options for IgAN are similarly rare. Therefore, there is an urgent need to bridge this knowledge gap. This article presents a review of current literature on lncRNAs related to IgAN, aiming to consolidate existing findings and identify future research avenues.

Bibliometric study and visual analysis of postoperative diabetes mellitus in kidney transplant recipients based on WoSCC database

BACKGROUND

In recent years, the increase of the post-transplantation diabetes mellitus (PTDM) after renal transplantation encourages people to do a lot of research on the disease. This paper conducted a bibliometric study on PTDM related literature to explore the risk factors of diabetes after kidney transplantation, as well as the current status, hotspots and development trends of PTDM research, so as to provide reference for researchers in related fields.

METHODS

We searched the Web of Science Core Collection (WoSCC) database for PTDM literature from January 1, 1990, to August 20, 2023, and used VOSviewer, CiteSpace, and the R package 'bibliometrix' to do bibliometric analysis.

RESULTS

Obesity, 3 months after transplantation tacrolimus concentration >10 ng/mL, temporary hyperglycemia, delayed graft function, acute rejection is specific risk factors related to PTDM in renal transplant recipients. In addition, 74 countries led by China and the United States published 1546 papers, and the number of PTDM-related publications is increasing every year. Primary institutions included the University of California, Los Angeles, Mayo Clinic, University of Oslo, and University of Toronto. The Journal of Transplantation is the most widely read journal in the subject. The authors with the most published literature are Trond Jenssen and Adnan Sharif, and the most cited author is Kasiske BL. Expectations for continued growth in global PTDM research are increasingly high. Future studies will mainly focus on exploring the risk factors of PTDM and identifying new therapeutic approaches and targets.

Exploring NamiRNA networks and time-series gene expression in osteogenic differentiation of adipose-derived stem cells

BACKGROUND

Adipose-derived stem cells (ADSCs) are a type of stem cell found in adipose tissue with the capacity to differentiate into multiple lineages, including osteoblasts. The differentiation of ADSCs into osteoblasts underlies osteogenic and pathological cellular basis in osteoporosis, bone damage and repair.

METHODS

Focused on ADSCs osteogenic differentiation, we conducted mRNA, microRNA expression and bioinformatics analysis, including gene differential expression, time series-based trend analysis, functional enrichment, and generates potential nuclear activating miRNAs (NamiRNA) regulatory network. The screened mRNAs in NamiRNA regulatory network were validated with correlation analysis.

RESULTS

The NamiRNA Regulatory Network reveals 4 mRNAs (C12orf61, MIR31HG, NFE2L1, and PCYOX1L) significantly downregulated in differentiated group and may be associated with ADSCs stemness. Furthermore, the significantly upregulated 10 genes (ACTA2, TAGLN, LY6E, IFITM3, NGFRAP1, TCEAL4, ATP5C1, CAV1, RPSA, and KDELR3) were significantly enriched in osteogenic-related pathways, and negatively correlated with ADSCs cell stemness in vitro.

CONCLUSION

These findings uncover potential genes related to ADSCs osteogenic differentiation, and provide theoretical basis for underlying ADSCs osteogenic differentiation and related diseases.

Risk factors influencing fall risk in geriatric patients with type 2 diabetes: a comprehensive analysis

BACKGROUND AND OBJECTIVES

Type 2 diabetes mellitus (T2DM) is a common chronic disease in the elderly. Comorbidities, especially neuropathy and retinopathy, significantly increase fall risk in this group. This study aimed to identify fall risk factors in older adults with T2DM.

MATERIALS AND METHODS

From January to June 2024, 242 T2DM patients aged 65 and older were followed at the internal medicine outpatient clinic. Fall risk was assessed using the Performance Oriented Mobility Assessment (POMA), Hendrich II Fall Risk Model (HIIFRM), Barthel Activities of Daily Living Index, and Clinical Frailty Scale (CFS).

RESULTS

Among the patients (median age = 70 years), 41.3% had experienced at least one fall in the previous year. Factors, such as age and diabetes duration were associated with falls. Notably, hypoglycemia (aPR: 1.90, p = 0.017), polypharmacy (aPR: 2.39, p = 0.004), osteoarthritis (aPR: 2.48, p = 0.017), (aPR: 1.70, p = 0.025), and malnutrition (aPR: 1.90, p = 0.007) were independently associated with fall risk.

CONCLUSIONS

Fall risk in elderly outpatients with T2DM was linked to various factors, including hospitalization, malnutrition, osteoarthritis, polypharmacy, neuropathy, and hypoglycemia. To mitigate this risk, patient-specific care plans are recommended.

Hyperglycaemia-induced fibrotic and inflammatory gene expression alterations in lung epithelial cells: Implications for pulmonary fibrosis development

Hyperglycaemia has a significant long-term impact on multiple organ systems, including renal, cardiovascular, central nervous, hepatic and ocular systems, leading to the gradual loss of their functional abilities. Numerous studies have elucidated the pathophysiology, etiology, and consequences of hyperglycaemia on these organs. The pulmonary system is also considered as a target of hyperglycaemia, several factors cause lung injury which leads to the development of pulmonary fibrosis, a chronic fibrotic disease with usual interstitial pneumonia patterns. Nevertheless, the effects of hyperglycaemia on the development of pulmonary fibrosis remain poorly understood. We intend to understand the cellular and morphological changes, and the progression of fibrosis in lung epithelial cells subjected to hyperglycaemia. Our experimental data indicate that hyperglycaemia induces fibrotic and inflammatory alterations in cultured lung epithelial cells. These alterations are facilitated by the upregulation of genes related to fibrosis and inflammation, promoting cell proliferation and migration. Further research is required to comprehensively elucidate the impact of hyperglycaemia during lung injury progression of fibrosis, these findings may reveal novel mechanisms that may help in the assessment and treatment of lung ailments in people with hyperglycaemia.

Interconnections between diabetic corneal neuropathy and diabetic retinopathy: diagnostic and therapeutic implications

Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus. Diabetic corneal neuropathy refers to the progressive damage of corneal nerves. Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature. However, growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit, which includes both the retinal vascular structures and neural tissues. Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening. However, diabetic corneal neuropathy is commonly overlooked and underdiagnosed, leading to severe ocular surface impairment. Several studies have found that these two conditions tend to occur together, and they share similarities in their pathogenesis pathways, being triggered by a status of chronic hyperglycemia. This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy, whether diabetic corneal neuropathy precedes diabetic retinopathy, as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy. We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.

Yi-qi-yang-yin decoction ameliorates diabetic retinopathy: New and comprehensive evidence from network pharmacology, machine learning, molecular docking and molecular biology experiment

Yi-Qi-Yang-Yin Decoction (YQYY), a traditional Chinese medicine (TCM) formula, has been used to treat diabetic retinopathy (DR), yet its precise mechanisms of action remain poorly understood. In this study, two distinct diabetic models, namely spontaneous type 2 diabetic db/db mice and streptozotocin (STZ)-induced type 1 diabetic rats, were employed to assess the efficacy of YQYY in ameliorating DR. Ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) was employed to identify the chemical composition of YQYY in mouse serum. Next, the possible targets and key pathways of YQYY for the management of DR were predicted by integrating network pharmacology and weighted gene co-expression network analysis (WGCNA). Network-based indicators were then employed to evaluate the efficacy of the formulae on DR, and molecular docking, along with compound similarity analysis, was used to identify candidate drugs of YQYY for DR. Finally, molecular biology techniques were utilized to experimentally validate the identified targets. Experimental results from animal models showed that YQYY effectively improved hemoglobin A1C (HbA1C), reduced vessel branch points, and mitigated retinal tissue injury in both DR models. 17 herbal components were identified in the YQYY-containing serum by UPLC-QTOF-MS. Network pharmacology predicted 44 common targets of YQYY involved in the regulation of DR. These targets were found to mainly participate in inflammation-related signaling pathways, including the NF-κB signaling pathway, toll-like receptor signaling pathway, IL-17 signaling pathway, and TNF signaling pathway. By integrating the most relevant disease templates for DR with network pharmacology, we preliminarily identified two key functions of YQYY and their associated regulatory targets, which showed strong connections and correlations with the targets identified in the screened DR disease models. These results demonstrate the pivotal role of core targets, such as BAX, BCL2, MMP9, SIRT1, PPARγ, VCAM1, PTGS2, TNF-α, and RELA, in mediating the therapeutic effects of YQYY in managing DR. Network analysis of YQYY efficacy in DR revealed a significant correlation between the YQYY targets and DR-related genes. Furthermore, molecular docking and drug similarity comparisons suggested that kaempferol, formononetin, and caffeic acid show potential as therapeutic candidates for DR. Our investigation demonstrated the therapeutic efficacy of YQYY against DR, shedding light on novel perspectives regarding the active constituents and molecular pathways through which YQYY exerts its effects in managing DR.

Innovative approaches to managing chronic multimorbidity: A multidisciplinary perspective

The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems, necessitating the development of innovative management strategies to optimize patient care and system efficiency. The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit (HCU) specifically designed to improve the management of patients with chronic complex conditions. By adopting a multidisciplinary approach, the HCU aims to provide comprehensive, patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services. Utilizing a longitudinal analysis of data from the Basic Minimum Data Set, this study compares hospitalization metrics among the HCU, Internal Medicine, and other departments within a regional hospital throughout 2022. The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices. The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity, emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care. This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.

Methylglyoxal-induced neuronal dysfunction: Linking diabetes to Alzheimer's disease through cytoskeletal disruption

This study investigates how methylglyoxal affects Alzheimer's disease, which is common in patients with diabetes mellitus. Using SH-SY5Y cells as a model of AD, we investigated the effects of MGO on cell viability, morphology, inflammation, and stress responses. Exposure to MGO induces cytotoxicity, inflammation and oxidative stress that contribute to AD in diabetic patients. We analyzed how MGO (150-900 μM) affects SH-SY5Y cells and its effects on cell survival, gene expression, cytoskeletal integrity, stress indicators, and Aβ42 accumulation (dose- and time-dependent). MGO dramatically affected cell viability depending on the dose and exposure time. Cell death occurred via intrinsic (BAX, CASP9) and extrinsic (FAS, FASLG) apoptotic pathways. Markers related to insulin signaling such as INSR, IRS1, IRS2, SLC2A4, etc. were downregulated, whereas markers of inflammation such as TNF-α, IL-6 and oxidative markers such as HMOX1, G6PD, etc. were upregulated with MGO (P < 0.001). Changes in MAP2 and TUBB3 expression were associated with cytoskeletal damage (P < 0.01). High levels of Aβ42 and low SOD activity confirmed that oxidative stress was induced. LPS treatment exacerbated these effects (P < 0.01). The results highlight the possible role of MGO in cognitive decline associated with diabetes and suggest the need for novel treatment against MGO-related neurotoxicity.

Update in non-alcoholic fatty liver disease management: role of sodium-glucose cotransporter 2 inhibitors

Non-alcoholic fatty liver disease (NAFLD) is characterized by excessive lipid accumulation in hepatocytes without significant alcohol consumption. It is closely associated with sedentarism, hypercaloric diets, obesity, dyslipidemia, insulin resistance, type 2 diabetes mellitus, and genetic predisposition. NAFLD comprises a spectrum of liver disorders, from simple steatosis to non-alcoholic (NASH) and liver cirrhosis. The complex etiological mechanisms include oxidative stress, inflammation, apoptosis, and fibrosis; therefore, its management is challenging. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i), a class of antidiabetic drugs, have emerged as promising therapeutic agents due to their ability to improve key metabolic parameters, including obesity, dyslipidemia, insulin resistance, and hyperglycemia. This review explores the cellular mechanisms by which SGLT2i, either as monotherapy or combined with other treatments, modulate signaling pathways involved in lipid and carbohydrate metabolism. Additionally, we examine their effects on oxidative stress, inflammation, fibrosis, and apoptosis, which are critical drivers of NAFLD progression. This review is intended to summarize the multiple benefits of SGLT2 inhibitors and to educate healthcare providers on the therapeutic potential of these drugs in order to foster their incorporation into effective NAFLD management plans.

Benefits of inulin and fructo-oligosaccharides on high fat diet-induced type 2 diabetes mellitus by regulating the gut microbiota in mice

Type 2 diabetes mellitus (T2DM) is pathologically associated with gut microbiota imbalance, which is implicated in disease progression through metabolic and inflammatory pathways. The therapeutic potential of inulin, a well-characterized prebiotic, has been explored to mitigate T2DM via microbiota modulation. However, the efficacy of this intervention, with its performance dependent on the degree of polymerization (DP), requires further investigation. This study assessed the therapeutic roles of inulin (DP3-60) and fructo-oligosaccharides (FOS, DP3-10) in T2DM management. Dietary administration of these prebiotic compounds demonstrated a significant capacity to alleviate multiple metabolic pathologies, including obesity, insulin resistance, systemic inflammation, oxidative stress, dyslipidemia and hepatic steatosis in high-fat diet (HFD)-fed induced T2DM mice. Significant superior efficacy was observed in FOS for ameliorating glucose metabolic dysregulation, adipocyte hypertrophy, liver weight, and histopathological alterations in colonic tissue, while inulin exhibited greater potency in alleviating oxidative stress. Both inulin and FOS enhanced gut microbiota diversity and richness in T2DM mice, accompanied by a significant reduction in Firmicutes/Bacteroidetes ratio. Notably, the S24-7 family emerged as a crucial microbial taxon modulated by both inulin and FOS. Furthermore, FOS demonstrated superior capacity to restore HFD-induced gut microbiota. Taxonomically significant amplicon sequence variants (ASVs), which were altered by HFD and modulated by inulin and FOS, exhibited distinct taxonomic profiles between the two compounds. This study provides preliminary evidence that the biological effects and beneficial properties of inulin-type fructans exhibit DP-dependent variations, which may enhance their efficient utilization in metabolic disorders.

Distinct temporal profiles of AMPs and cytokines in pleural fluids from open and closed thoracic surgeries and exploration of synergy with antibiotics and wound healing effects

Antimicrobial peptides (AMPs) play a crucial role in immune defense and wound healing. Their expression and function in pleural fluids following different thoracic surgeries remain underexplored. This study aims to compare AMP and cytokine profiles in pleural fluids from patients undergoing open and closed thoracic surgeries and assess their antimicrobial efficacy and wound healing potential. Pleural fluid and blood samples were collected from 24 patients at multiple time points post-surgery. Levels of four AMPs (DEF-1β, Angiogenin, RNase7, LL-37) and five cytokines (IL-1β, IL-2, IL-6, IL-8, TNF-α) were measured. Antimicrobial activity against E. coli and S. aureus was tested, including combinations with cefazolin. Wound healing was assessed using an in vitro scratch assay. DEF-1β was significantly higher in open surgeries, while Angiogenin was elevated in closed surgeries. Pleural fluids exhibited strong antimicrobial activity, enhanced when combined with cefazolin. Wound healing was rapid but transient with open surgery fluids and more sustained with closed surgery fluids. The distinct AMP profiles and synergistic effects with antibiotics suggest that pleural fluid-derived AMPs could enhance postoperative care. Further studies are needed to explore their therapeutic potential.

A red lentils-based synbiotic cookie exerts neuroprotective effects in a mouse model of Alzheimer's disease

Gut microbiota preservation or rational manipulation is a key condition for healthy longevity and a promising strategy to prevent neurodegenerations exploiting the gut-brain axis, with a key role of prebiotics and probiotics. Whether their combination in a functional food can provide a synergistic effect to the host remains controversial. To fill this gap, we supplemented the diet of 3xTg-AD Alzheimer's disease mice with a red lentils (prebiotic)-based cookie enriched with neuroprotective probiotics and we performed behavioural, biochemical and molecular tests. Chronic consumption of this synbiotic preparation (functional cookie) preserved cognition, reduced amyloid load, improved glucose and lipid homeostasis and diminished oxidation and inflammation related damages compared to animals receiving a classic cookie (standard recipe). The synergistic effect was indicated by significantly higher glucose insulinotropic polypeptide concentrations in the functional cookie group compared to probiotic group. Moreover, Ruminoclostridium sp KB18 and Ruminicoccus decreased in the gut of mice supplemented with the functional cookie, partially explaining the improved short-term memory upon treatments and substantiating the combined use over individual components. This synbiotic innovative snack represents a prototype of a simple and affordable dietary approach to promote healthy aging and prevent or delay the onset of neurodegenerations.

A comprehensive view of muscle glucose uptake: regulation by insulin, contractile activity, and exercise

Skeletal muscle is the main site of glucose deposition in the body during meals and the major glucose utilizer during physical activity. Although in both instances the supply of glucose from the circulation to the muscle is of paramount importance, in most conditions the rate-limiting step in glucose uptake, storage, and utilization is the transport of glucose across the muscle cell membrane. This step is dependent upon the translocation of the insulin- and contraction-responsive glucose transporter GLUT4 from intracellular storage sites to the sarcolemma and T tubules. Here, we first analyze how glucose can traverse the capillary wall into the muscle interstitial space. We then review the molecular processes that regulate GLUT4 translocation in response to insulin and muscle contractions and the methodologies utilized to unravel them. We further discuss how physical activity and inactivity, respectively, lead to increased and decreased insulin action in muscle and touch upon sex differences in glucose metabolism. Although many key processes regulating glucose uptake in muscle are known, the advent of newer and bioinformatics tools has revealed further molecular signaling processes reaching a staggering level of complexity. Much of this molecular mapping has emerged from cellular and animal studies and more recently from application of a variety of -omics in human tissues. In the future, it will be imperative to validate the translatability of results drawn from experimental systems to human physiology.

Experimental and computational analysis of benzothiophene as a selective inhibitors of diabetes mellitus

Diabetes mellitus results in chronic hyperglycemia, affecting more than one hundred million people over the world. To treat diabetes mellitus, novel benzothiophene-derived thiadiazole analogues (1-17) were synthesized to biological assess their potential as lead inhibitors of both diabetic enzymes (α-amylase and α-glucosidase). These compounds showed quite remarkable potency against both enzymes and emerged as anti-diabetic agents. As a reference for their biological assessment, acarbose (5.90 ± 0.30 μM, 6.50 ± 1.80 μM) were used and in comparison to it analogue 3 having IC50 of 4.20 ± 0.50 μM, 4.90 ± 1.50 μM, 6 with IC50 of 3.10 ± 1.20 μM, 4.10 ± 0.80 μM, 10 with IC50 of 5.20 ± 1.20 μM, 6.10 ± 2.10 μM and 16 having IC50 of 3.90 ± 2.20 μM, 4.10 ± 1.20 μM emerged as most active analogues among the synthesized derivatives. Versatile attached functionalities such as CF3, F, OH and Cl bind with the target proteins in order to inhibit their normal activity or function. Binding potency (interactive properties) of the leading compounds was also revealed under molecular docking. ADME analysis further unveiled that the potent compounds exhibit drug properties. Moreover, reactivity of these analogues with leading potential was also explored via density functional theory (DFT), revealing their molecular electrostatic potential, electrophilic, nucleophilic, HOMO and LUMO sites.

Serum bicarbonate concentration is associated with bone density in adults with type 2 diabetes mellitus: African American-Diabetes Heart Study

BACKGROUND

Osteoporosis is a significant cause of morbidity and mortality in the aging population. Individuals with type 2 diabetes mellitus (T2D) typically have higher bone density yet also a higher rate of fractures. Blacks, meanwhile, have a lower incidence of osteoporosis compared to European Americans. Serum bicarbonate may be a risk factor for bone loss, but studies are conflicting, and little is known about this relationship in T2D or Blacks.

METHODS

We examined the longitudinal relationship between serum bicarbonate and change in bone density in 300 participants with T2D in the African American-Diabetes Heart Study (AA-DHS). Serum bicarbonate was measured at baseline, and bone density was assessed using CT volumetric bone mineral density (vBMD) scans of the thoracic and lumbar vertebrae at baseline and after five years of follow-up. Multivariate linear regression models assessed associations between baseline serum bicarbonate and longitudinal change in vBMD, adjusted for multiple confounders.

RESULTS

The cohort was 50 % female, with mean age and T2D duration 55.1 years and 10.2 years, respectively. The mean baseline serum bicarbonate was 26.6 (SD 3.3) mEq/L; median baseline lumbar spine vBMD 179.3 (IQR 148.2, 208.9) mg/cm3, and median baseline thoracic spine vBMD 204.9 (IQR 171.6, 231.9) mg/cm3. In fully-adjusted analyses, each 1 mEq/L increase in baseline serum bicarbonate was significantly associated with 5-year relative increase in lumbar vBMD (0.94 mg/cm3, p < 0.001) and thoracic vBMD (1.35 mg/cm3, p < 0.001), without a clear threshold effect or differences by sex.

CONCLUSIONS

In this cohort of Blacks with T2D, higher baseline serum bicarbonate levels were associated with improved changes in bone density over time. Further studies are needed to determine if alkali supplementation would ameliorate loss of bone density in this population.

On-demand dual-stimuli-responsive hydrogels for localized and sustained delivery of MP-L [I5R8] to treat bacterial wound infections

This study presents the development of two novel injectable dual-responsive polyanionic hydrogels (DRPHs) based on N-isopropylacrylamide (NIPAM), incorporating carboxylic acid comonomers for temperature- and pH-responsive drug release. These hydrogels were designed for the sustained and localized delivery of the antimicrobial peptide MP-L [I5R8], targeting multidrug-resistant bacteria (MDRB) in wound infections. The physicochemical characterization confirmed polymer formation and comonomer integration through Fourier-transform infrared spectroscopy (FTIR) and nuclear magnetic resonance (NMR). Rheological analysis demonstrated a temperature-dependent sol-gel transition at ∼35°C, making the hydrogels suitable for in situ gelation at physiological conditions. The hydrogels exhibited tunable swelling behavior and a controlled dual-phase release profile of MP-L [I5R8], ensuring both immediate bactericidal activity and prolonged antimicrobial effect. In vitro assays confirmed sustained antimicrobial efficacy against Staphylococcus aureus and Pseudomonas aeruginosa, while biocompatibility tests validated their safety for biomedical applications. An in vivo diabetic wound infection model demonstrated rapid infection clearance, enhanced wound healing, and organized tissue regeneration following treatment with MP-L [I5R8]-loaded DRPHs. These results highlight the potential of dual-stimuli-responsive hydrogels as a next-generation antimicrobial delivery platform for the treatment of chronic infected wounds, such as diabetic foot ulcers.

A signpost to guide the key therapeutic components of Aralia continentalis Kitag roots in treating T2DM-derived heart attack, and diabetic nephropathy via systems biology concept

AIMS

Aralia continentalis Kitag roots (ACKRs) have been regarded as a nutritional natural resource for treating different diseases, including type 2 diabetes mellitus (T2DM), and its complications (heart attack; HA, diabetic nephropathy; DN). Nonetheless, an extensive investigation of T2DM-derived complications has yet to be performed.

MAIN METHODS

Accordingly, we adopted gas chromatography-mass spectrometry (GC-MS) to identify the molecules of ACKRs, followed by the use of cheminformatics (Similarity Ensemble Approach; SEA, SwissTargetPrediction; STP), bioinformatics (STRING, DisGeNET, and OMIM), and computer screening tools to investigate its corresponding targets, in T2DM diseases and its complications.

KEY FINDINGS

The primary targets (PPARG, and IL6) were confirmed via a protein-protein interaction (PPI) network, suggesting that IL6- Andrographolide, PPARA-Germacrene D, PPARD- Kaurenoic acid, PPARG- Kaurenoic acid, NR1H3- 1-Naphthalenepropanol, α-ethenyldecahydro-5-(hydroxymethyl)-α,2,5,5,8a-pentamethyl-, and FABP4- Kaurenoic acid conformers on PPAR signaling pathway might exert agonistic mode.

SIGNIFICANCE

These findings underline that ACKRs' bioactives filtered by the devised platform could prevent T2DM-derived complications through multiple-target.

Novel insights into differences in the whey proteome of porcine and human colostrum and mature milk

Many mothers are unable to exclusively breastfeed for several reasons. Other mammalian milks should be explored as human milk supplements. Pigs and humans are physiologically similar. Therefore, we hypothesized that the whey protein composition and functions of porcine and human milk are similar. This study aimed to compare and analyze the whey proteomes of porcine and human milk during lactation. Totally, 3390, 3275, 3587, and 3463 whey proteins were identified in porcine colostrum, porcine mature milk, human colostrum, and human mature milk, respectively. Complement components and serotransferrin, which are related to the immune system process were highly expressed in porcine milk. Porcine and human whey proteins were enriched in similar Gene Ontology annotations and Kyoto Encyclopedia of Genes and Genomes pathways. These results revealed that the biological functions of porcine and human whey proteins were similar, which contributes to the development of porcine whey proteins.

The protective effect of amylin in type 2 diabetes: Yes or no

Amylin, which is also called a human islet amyloid polypeptide, is a peptide hormone made up of 37 amino acids that is released from pancreatic β cells. It helps keep blood sugar levels stable by controlling the release of insulin and glucagon. Various studies have indicated its involvement in the pathogenesis of type 2 diabetes (T2D) through the induction of apoptosis in pancreatic cells. Conversely, other studies found that amylin plays a critical role in the pathogenesis of T2D by affecting the release of insulin and glucagon. Therefore, amylin has protective and detrimental effects on the pathogenesis of T2D. Consequently, this review aims to discuss the beneficial and detrimental roles of amylin in T2D.

Cross-sectional study of lipoprotein(a) and the severity of coronary artery disease, cerebrovascular disease, and peripheral vascular disease in a group of South Asian patients

Background

Atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), remain the leading cause of death globally. South Asians exhibit a higher incidence of cardiovascular diseases than other ethnicities, attributed to a range of genetic, environmental, and lifestyle factors. Lipoprotein(a) [Lp(a)] with a unique apolipoprotein(a) component, has emerged as a marker of atherosclerosis and ASCVD risk, with evidence to promote arterial plaque formation and thrombogenesis.

Objective

The aim of this study was to explore the associations between Lp(a) levels and the severity of CAD, CVD, and PVD in a group of South Asian patients.

Methods

Following ethical approval, 60 consecutive patients who underwent coronary angiography for any indication were reviewed. There were 51 eligible participants who were evaluated for Lp(a) level, Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, and severity of CVD and PVD. The SYNTAX-I score was calculated using two-observer consensus on coronary angiograms. Assessment of CVD was by ultrasound/Doppler, and PVD by estimating ankle-brachial index using Doppler. The multisite arterial disease score 2 (MADS2) and SYNTAX score tertiles were used to group the patients. Statistical analysis was performed using the SPSS software.

Results and discussion

In this group, we identified a statistically significant difference with higher Lp(a) levels being associated with more severe coronary disease (SYNTAX tertile 2,3). Despite a numerical trend, statistical significance was not confirmed for Lp(a) levels in relation to MADS2-CVD or MADS2-PVD scores. A larger study may be required to assess these aspects.

Risk factors for diabetic foot ulcer in diabetic patients at the Tehran diabetes clinic: a case-control study

Background and objective

: Diabetic foot ulcer (DFU) is one of the main health challenges of diabetes complications worldwide. A wide range of factors may increase the risk of DFU. This study aimed to investigate the risk factors of DFU among diabetic patients.

Methods

This case-control study was conducted on 800 diabetic patients at the Tehran diabetes clinic of the Endocrinology and Metabolism Research Institute in Iran. The case group included 400 diabetic patients diagnosed with DFU, while the control group included 400 diabetic patients without DFU. Data were collected through medical records, validated questionnaires, and clinical examinations. The association between factors and the risk of DFU was analyzed using both crude and adjusted logistic regression models, adjusting for confounders based on a directed acyclic graphs.

Results

The final adjusted model demonstrated significant direct associations between the risk of DFU with a longer duration of diabetes, a history of previous DFU, peripheral neuropathy, retinopathy, high blood pressure, severe kidney function loss, and good foot self-care. However, there were significant inverse associations between DFU risk with female gender, higher education levels, being married, use of oral diabetes drugs, higher hemoglobin levels, and high physical activity.

Conclusions

The risk of DFU was significantly associated with the following factors: diabetes duration, previous DFU history, peripheral neuropathy, retinopathy, blood pressure, kidney function, foot self-care, gender, education levels, marital status, diabetes drugs, hemoglobin levels, and physical activity. Further studies, especially ones in multicenter cohorts with a special focus on novel risk factors, are warranted to expand on our findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01582-z.

Clinical Features and Implications of Albuminuria Trajectories in Type 2 Diabetes: The Fremantle Diabetes Study Phase 2

Context

The urinary albumin:creatinine ratio (uACR) can exhibit significant temporal changes but few studies have characterized transition patterns between uACR categories in type 2 diabetes.

Objective

The study aim was to use group-based trajectory modeling (GBTM) to identify clusters of people with type 2 diabetes and distinct uACR trajectories.

Methods

Of 1482 participants in the observational Fremantle Diabetes Study Phase 2, a total of 1145 (77.3%; mean age 65.4 years, 53.3% males) with 2 or more biennial uACR measurements over 6 years were included in GBTM. Independent baseline associates of uACR trajectory group membership were assessed using multinomial regression. Associations between group membership and changes in estimated glomerular filtration rate over 4 years were explored.

Results

The optimum GBTM model comprised 6 categories: normoalbuminuria (n = 429, 37.5%), regression (n = 82, 7.2%), progression (n = 71, 6.2%), progression/regression (n = 104, 9.1%), persistent microalbuminuria (n = 401, 35.0%), and persistent macroalbuminuria (n = 58, 5.1%). The latter 5 groups had worse glycemic control than the normoalbuminuria group. The 3 groups starting from/returning to normoalbuminuria had heterogeneous baseline characteristics but a decline in renal function that was similar to the normoalbuminuric group. The persistent microalbuminuria group had adverse baseline cardiometabolic features and longitudinal renal outcomes relative to the normoalbuminuria/other microalbuminuria groups. The persistent macroalbuminuria group had, consistent with its baseline characteristics, the highest mortality (31.0% vs ≤18.5% in the other groups) and most rapid progression of renal dysfunction.

Conclusion

GBTM identified distinct uACR trajectory groups with clinical and prognostic implications, and could be used to stratify participants in clinical trials of new therapies for diabetic kidney disease.

Infections, genetics, and Alzheimer's disease: Exploring the pathogenic factors for innovative therapies

Alzheimer's disease (AD) is a progressive neurodegenerative condition that creates a significant global health challenge and profoundly affects patients and their families. Recent research has highlighted the critical role of microorganisms, particularly viral infections, in the pathogenesis of AD. The involvement of viral infections in AD pathogenesis is predominantly attributed to their ability to induce neuroinflammation and amyloid beta (Aβ) deposition in the brain. The extant research exploring the relationship between viruses and AD has focused largely on Herpesviridae family. Traces of Herpesviruses, such as Herpes Simplex Virus-1 and Epstein Barr Virus, have been found in the brains of patients with AD. These viruses are thought to contribute to the disease progression by triggering chronic inflammatory responses in the brain. They can remain dormant in the brain, and become reactivated due to stress, a secondary viral infection, or immune-senescence in older adults. This review focuses on the association between Herpesviridae and bacterial infections with AD. We explore the genetic factors that might regulate viral illness and discuss clinical trials investigating antiviral and anti-inflammatory agents as possible therapeutic strategies to mitigate cognitive decline in patients with AD. In summary, understanding the interplay between infections, genetic factors, and AD pathogenesis may pave the way for novel therapeutic approaches, facilitating better management and possibly even prevent this debilitating disease.

Current opinions invited review: testosterone and transgender medicine

PURPOSE OF REVIEW

Transgender individuals have a gender identity incongruent with their sex assigned at birth. Social, medical and surgical methods are often affirming. This review focuses on updates from the last 18 months mainly in testosterone use in masculinising gender-affirming hormone therapy (GAHT) in postpubertal adults, and also antiandrogens for suppression or blockade of endogenous testosterone in feminising GAHT. Mental and sexual healthcare are vital for many transgender patients, but are not the focus of this review.

RECENT FINDINGS

There has been a considerable increase in publications regarding testosterone GAHT in recent years, though narrative reviews, opinion pieces and case series continue to dominate. There has also been a notable increase in prospective studies and valuable data particularly from large longitudinal cohorts and studies aiming to refine GAHT prescribing and better understand long-term effects on aspects such as fertility, cardiometabolic and bone health as well as adverse effects.

SUMMARY

Testosterone GAHT is life changing. Increased research will help GAHT optimisation, and improve understanding of tissue-specific impacts and long-term safety. Longer-term data, prospective studies and utilisation of novel research tools and approaches are needed to enrich our understanding and prescribing of testosterone and its blockers in GAHT.

Parental Determinants in Childhood Diabetes Prevention and Management: A Scoping Review Examining Impacts and Strategies

Family-focused diabetes management research has typically followed a linear model, viewing parental cognition about diabetes as the main factor shaping a child's adjustment and metabolic control. This scoping review synthesized the research examining the influence of parental cognition factors on preventive behaviors toward diabetic children. A comprehensive search of PubMed, ProQuest, and EBSCOhost databases between 2013 and 2023 yielded 1225 articles on parental factors covering knowledge, attitudes, perceptions, beliefs, and understanding. After de-duplication and independent screening of titles and abstracts per predefined eligibility criteria, seven studies (six quantitative, one qualitative) were included in the analysis. Narrative synthesis showed that facilitating factors for prevention included knowledgeable parents with positive risk perceptions, self-efficacy, and self-regulation. Hindering barriers were deficiencies in parental diabetes understanding, socioeconomic disadvantages, and lack of targeted family interventions. In-depth literature analysis identified parental education level, and comprehension of diabetes risk, alongside financial constraints, as significant predictors of suboptimal management practices. Hence, this scoping review suggests developing evidence-based, multi-stakeholder initiatives optimizing identified cognitive barriers while empowering families through culturally sensitive education and sources of support for curtailing escalating children's diabetes trends.

Bariatric surgery significantly reduces progression from prediabetes to diabetes compared with the general population: 15-year single-institution data

BACKGROUND

There is a paucity of literature on the impact for bariatric surgery on the progression from prediabetes (PDM) to type II diabetes mellitus (T2DM).

OBJECTIVES

To evaluate the progression from PDM to T2DM in bariatric surgery compared with a nonsurgical cohort.

SETTING

Single academic institution, Center of Bariatric Excellence.

METHODS

This retrospective study of patients with morbid obesity with patients with PDM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2001 and 2022. Nonsurgical controls from a primary care cohort were directly matched by hemoglobin A1c, age, sex, and body mass index. DM was defined as a clinical diagnosis of type II diabetes or hemoglobin A1c ≥6.5%. Kaplan-Meier analysis was used to estimate time until T2DM. Cox regression was used to compare time until T2DM in RYGB versus sleeve gastrectomy and in bariatric surgery versus nonsurgical controls.

RESULTS

A total of 1326 bariatric cases with PDM (n = 1154 RYGB, n = 172 SG) were identified. The cohort was 83% female, mean age = 45.3 years, mean body mass index 46.9 kg/m2, and follow-up was 65% over 15 years. In bariatric cases, PDM progression to T2DM at 5, 10, and 15 years after surgery was 1.8%, 3.3%, and 6.7%, respectively. PDM progression to T2DM was almost 20 times greater in matched nonsurgical controls at 5, 10, and 15 years 31.1%, 51.4%, and 68.7%, respectively (hazard ratio 19.8, 95% confidence interval 13.9-28.4, P < .0001). When stratifying by bariatric surgery type, those with SG were 4 times more likely to progress to T2DM versus RYGB (hazard ratio 4.01, 95% confidence interval 1.71-9.39, P = .0014).

CONCLUSIONS

Bariatric surgery significantly decreases the conversion from PDM to T2DM. The impact was significantly greater for RYGB compared with SG.

Association Between Monounsaturated Fatty Acid Intake and Risk of Total Stroke and Its Subtypes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

There are contradictory results regarding the relationship between dietary intakes of monounsaturated fatty acids (MUFAs) and risk of stroke.

OBJECTIVE

The purpose of this study was to review the existing body of research on the relationship between MUFA consumption and stroke risk through a systematic review and meta-analysis.

DATA SOURCE

PubMed, Scopus, and ISI Web of Science were all systematically searched up to January 2023.

DATA EXTRACTION

A total of 11 prospective cohort studies that investigated MUFA consumption in relation to stroke risk were included.

DATA ANALYSIS

Relative risk (RR) and 95% CIs for the highest vs lowest category of dietary MUFA intake were combined using a random-effects model. Linear and nonlinear dose-response relations were assessed through 1-stage weighted mixed-effects meta-analysis. These studies included 475 207 participants and 8438 cases. In highest vs lowest consumption analysis, MUFA intake was inversely associated with total stroke (RR: 0.80; 95% CI: 0.67, 0.96; I2 =65.2%, Q-test P = .001; n = 11) and hemorrhagic stroke (RR: 0.80; 95% CI: 0.68, 0.95; I2 = 0.0%, Q-test P = .77; n = 5) risk. Conversely, this association was not significant for ischemic stroke (RR: 0.86; 95% CI: 0.69, 1.07; I2 =62.3%, Q-test P = .01; n = 8). An inverse association was observed between each 10-g/d MUFA intake and hemorrhagic stroke (RR: 0.79; 95% CI: 0.65, 0.96) but not total and ischemic stroke. We did not find any evidence for a nonlinear association between MUFA intake and total stroke and its subtypes.

CONCLUSION

This meta-analysis shows that higher MUFA intake could lower the risk of total and hemorrhagic, but not ischemic, stroke. This could be important for public health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023458555.

Sudoscan® reclassifies cardiovascular risk in patients with type 2 diabetes mellitus according to the ESC 2023

Objectives

The objective of this study is to determine if the detection of DAN through Sudoscan® can reclassify cardiovascular risk in patients with T2DM according to the European Society of Cardiology guidelines 2023 (ESC 2023) compared to other risk scales.

Methods

A retrospective cross-sectional analytical study was conducted on 161 patients with T2DM who had undergone Sudoscan® in a Northern Mexico Hospital between December 2022 and July 2023. We compared the cardiovascular risk with SCORE-2, SMART, ADVANCE, ASCVD plus, and Globo Risk scales.

Results

Estimated cardiovascular risk according to the ESC 2023 without consideration of DAN was low for 91 (57%), moderate for 53 (33%), high for 11 (7%) and very high for 22 (3%) of patients. While inclusion of DAN resulted in low risk in 81 (51%), moderate in 46 (28%9, high in 9(5%) and very high risk for 25 ((16%), p = 0.004). The majority of patients were classified as low or moderate risk using other scales such as ASCVD plus, SCORE-2, Globo Risk, ADVANCE, and SMART.

Conclusions

Sudoscan® enhances cardiovascular risk assessment in T2DM by accurately diagnosing microvascular complications, ensuring comprehensive patient evaluation.

The Glucagon Receptor Is Expressed in the Frontal Cortex and Impaired Signaling Associates With Cognitive Decline

Individuals with type 2 diabetes (T2D) have an elevated risk of cognitive decline, yet the mechanisms connecting these pathologies remain unclear. Altered glucagon and insulin signaling contribute to T2D, and insulin resistance may also be associated with cognitive decline. The role of glucagon in this context is unknown. Here we aimed to characterize glucagon receptor (GCGR) expression in brain tissue and investigate the potential impact of altered GCGR signaling on dementia prevalence and cognitive function. We investigated GCGR protein expression in various human brain regions and cell types in postmortem brain samples. To explore the potential link between GCGR signaling and cognitive function, individuals with specific GCGR mutations with known or predicted impaired GCGR signaling were examined in connection to the prevalence of dementia defined by International Classification of Diseases, Tenth Revision coding and by cognitive function using population-scale cognitive tests in the UK Biobank. GCGR mRNA and protein were expressed specifically in neurons of the frontal cortex. Varying degrees of expression were observed across brain regions and with higher expression in the parietal cortex and thalamus by antibody-dependent analyses. GCGR variant carriers did not have a significantly higher prevalence of dementia, but 1 cognitive test was significantly impaired in individuals with a GCGR cAMP loss-of-function variant compared to sex- and age-matched nonvariant carrier controls. Our findings indicate GCGR expression in the human brain, particularly in neurons of the frontal cortex, and altered glucagon signaling may be associated with lower cognitive function. Further research is needed to elucidate mechanisms underlying the potential link between altered GCGR signaling and cognitive decline.

BenchXAI: Comprehensive benchmarking of post-hoc explainable AI methods on multi-modal biomedical data

The increasing digitalization of multi-modal data in medicine and novel artificial intelligence (AI) algorithms opens up a large number of opportunities for predictive models. In particular, deep learning models show great performance in the medical field. A major limitation of such powerful but complex models originates from their 'black-box' nature. Recently, a variety of explainable AI (XAI) methods have been introduced to address this lack of transparency and trust in medical AI. However, the majority of such methods have solely been evaluated on single data modalities. Meanwhile, with the increasing number of XAI methods, integrative XAI frameworks and benchmarks are essential to compare their performance on different tasks. For that reason, we developed BenchXAI, a novel XAI benchmarking package supporting comprehensive evaluation of fifteen XAI methods, investigating their robustness, suitability, and limitations in biomedical data. We employed BenchXAI to validate these methods in three common biomedical tasks, namely clinical data, medical image and signal data, and biomolecular data. Our newly designed sample-wise normalization approach for post-hoc XAI methods enables the statistical evaluation and visualization of performance and robustness. We found that the XAI methods Integrated Gradients, DeepLift, DeepLiftShap, and GradientShap performed well over all three tasks, while methods like Deconvolution, Guided Backpropagation, and LRP-α1-β0 struggled for some tasks. With acts such as the EU AI Act the application of XAI in the biomedical domain becomes more and more essential. Our evaluation study represents a first step towards verifying the suitability of different XAI methods for various medical domains.

Expression and clinical significance of IGF-1 and PDGF in aqueous humor and serum of diabetic patients with visually significant cataract

This study aimed to analyze the expression and clinical significance of IGF-1 and PDGF in the aqueous humor and serum of diabetic patients with visually significant cataract. A retrospective study was conducted on 136 diabetic patients with visually significant cataract who underwent phacoemulsification. Patients were divided into non-complication (n = 82) and complication groups (n = 54) based on postoperative outcomes. Clinical baseline data, as well as IGF-1 and PDGF levels in aqueous humor and serum, were compared between groups. ROC curve analysis was utilized to evaluate the predictive value of IGF-1 and PDGF for postoperative complications. Logistic regression was employed to identify risk factors, and Kaplan-Meier analysis was adopted to assess the impact of IGF-1 and PDGF levels on postoperative complications. No significant differences were found between the two groups in terms of gender, age, BMI, intraocular pressure, surgical eye, phacoemulsification time, phacoemulsification energy, axial length, smoking, drinking history, hypertension, hyperlipidemia, FINS, HbA1C, CRP, or FPG. However, significant differences were observed in disease duration, presence of retinopathy, and IL-6 levels. Patients with complications had significantly higher IGF-1 and PDGF levels in both aqueous humor and serum compared to those without complications. Elevated IGF-1 and PDGF levels were independent risk factors for complications and increased the risk of postoperative complications. Elevated IGF-1 and PDGF levels in aqueous humor and serum are significant independent risk factors for postoperative complications in diabetic patients with visually significant cataract. Both markers can assist in predicting adverse outcomes and are associated with an increased risk of complications.

Fecal microbiota transplantation as a potential therapeutic approach to improve impaired glucose tolerance via gut microbiota modulation in rat model

Objectives

To investigate the impact of diet-induced gut microbiota alterations on type 2 diabetes and assess the therapeutic potential of Fecal Microbiota Transplantation (FMT) in restoring a balanced gut microenvironment.

Methods

To induce type 2 diabetes, rats were fed a high-sugar high-fat diet (HSFD) for 90 days. After diabetes induction, animals were divided into an HSFD control group, a metformin group (100 mg/kg), and an FMT group (100 mg/kg), receiving treatment for an additional 90 days. Fasting blood glucose levels, glucose tolerance, serum markers (HbA1C, free fatty acids, lipopolysaccharides, pro-inflammatory and anti-inflammatory cytokines), and gut microbiota profiles via cecal metagenome sequencing were analyzed post-treatment.

Results

FMT effectively restored gut microbiota composition to a profile similar to healthy controls, rebalancing the Firmicutes/Bacteroidetes ratio and increasing beneficial taxa, including Prevotella ruminicola, Akkermansia muciniphila, Roseburia, and Faecalibacterium prausnitzii. These microbial shifts corresponded with significant metabolic improvements: FMT reduced inflammatory markers (LPS and FFA), lowered HbA1c, and improved glucose tolerance. Enhanced gut barrier integrity observed in FMT-treated animals likely contributed to reduced endotoxemia and systemic inflammation, distinguishing FMT's metabolic effects from those of metformin. Notably, FMT addressed the dysbiosis associated with HSFD, promoting microbial resilience and mitigating the metabolic disruptions linked to type 2 diabetes.

Conclusion

These findings underscore the potential of FMT as a targeted therapeutic approach to modulate gut microbiota composition and mitigate metabolic dysregulation induced by high sugar high fat diet.

Prolonged exposure to simvastatin affects coenzyme Q9/10 status leading to impaired mitochondrial respiratory capacity and reduced viability of cultured cardiac cells

This study investigates the effects of prolonged simvastatin exposure on coenzyme Q9/10 (CoQ9/10) levels, an essential component of antioxidant defense, in cultured cardiac cells. Statins, commonly used to manage dyslipidemia and reduce cardiovascular risk, may impair mitochondrial function, but their impact on CoQ10 depletion and oxidative stress is not well understood. We examined the influence of simvastatin on mitochondrial oxidative capacity, reactive oxygen species (ROS) production, and CoQ9/10 status at concentrations of 0.3, 0.6, 1.25, 2.5, 5, 10, and 20 μM, over durations of 24, 48, and 72 h. Using an in vitro model of cultured H9c2 cardiomyoblasts, our results showed that short-term exposure (24 h) at lower concentrations (<5 μM) enhanced cytosolic and mitochondrial ROS levels without affecting mitochondrial function or CoQ9/10 status. However, prolonged exposure to higher concentrations (≥10 μM for >48 h) resulted in impaired mitochondrial oxidative capacity, indicated by increased proton leak and elevated ROS levels, which were followed by significantly reduced cell viability. These findings suggest that prolonged, high-dose simvastatin exposure may disrupt the oxidative balance of CoQ9/10, leading to myocardial injury. This research addresses a gap in understanding the long-term effects of statins on mitochondrial health and underscores the need for further studies to optimize statin therapy and minimize adverse effects on myocardial function.

Sex Hormones, Sex Hormone-Binding Globulin and Sleep Problems in Females With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVE

Sleep problems like obstructive sleep apnea (OSA) are common in polycystic ovary syndrome (PCOS), although the underlying mechanisms are not well understood. We aimed to determine the prevalence of sleep problems, synthesise and appraise studies analysing the associations between serum sex hormones, sex hormone-binding globulin (SHBG) and sleep problems in females with PCOS.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search using MEDLINE, Embase, PsycInfo, CINAHL, Scopus, and Google Scholar was performed till 3 August 2024. Studies that examined serum sex hormones, SHBG or hyperandrogenism with sleep disorders and/or sleep disturbances in PCOS were eligible. Random effects meta-analyses of sex hormones and SHBG among females with PCOS with compared to without OSA were conducted.

RESULTS

From 4487 screened studies, 24 were included, with nine suitable for meta-analyses. Among females with PCOS, 46.0% had OSA and 56.0% had other sleep disturbances. SHBG levels were significantly lower in women with PCOS and OSA compared to those without OSA (standardised mean difference = -0.62; 95% CI = -0.82 to -0.42; I2 = 0%; 179 participants; p < 0.00001), but no differences were seen in total and free testosterone, dehydroepiandrosterone sulfate, androstenedione, and oestradiol. No significant associations between serum sex hormones, SHBG or hyperandrogenism with sleep disturbances in PCOS were observed.

CONCLUSION

SHBG, rather than hyperandrogenism, may play a more important mechanistic role for OSA in PCOS, while other sleep disturbances exhibit a less severe SHBG profile. These findings enhance comprehension of underlying pathophysiology of sleep problems in PCOS. Further validation across PCOS populations is warranted.

Transient Blindness in Metformin-associated Lactic Acidosis: Resolution With Supportive Care

Metformin remains the first-line pharmacologic treatment for type 2 diabetes mellitus due to its well-established efficacy and safety profile. However, a rare but serious complication is metformin-associated lactic acidosis (MALA), which carries a mortality rate of up to 36.2% in hospitalized patients. Those with chronic kidney disease and cardiovascular comorbidities are particularly vulnerable to severe outcomes. Among the rare manifestations of MALA is complete bilateral blindness, which typically requires urgent hemodialysis for reversal. Here, we present a case of MALA-induced blindness that was unexpectedly reversed through supportive medical management alone, prior to hemodialysis. This case underscores the critical role of early recognition and intervention by intensive care physicians in optimizing MALA outcomes. Further studies are warranted to elucidate the effects of MALA on the visual pathways, particularly the susceptibility of retinal cells and photoreceptors to metformin toxicities.

Exploring the relationship between the gut microbiota and cognitive function in schizophrenia patients with distinct weights

BACKGROUND

The gut microbiota is disrupted in schizophrenia (SZ) patients and is associated with cognitive function. This study aimed to investigate the gut microbiota composition in SZ patients with different body mass index (BMI) levels and their associations with cognitive function.

METHODS

We analyzed 16S rRNA sequencing data from 156 SZ patients, including 88 with overweight/obesity (OW) and 68 with normal weight (NW), and 156 normal control (NC), including 48 with OW and 108 with NW. We analyzed differences in microbial diversity and gut microbiota composition between SZ patients and NC at different BMI levels. Additionally, we explored the correlations between microbial communities, and symptom severity, as well as cognitive function. Furthermore, we examined between-group differences in metabolic pathways.

RESULTS

The abundance of Turicibacter was higher in the SZ_OW group but lower in the SZ_NW group compared to the NC groups at the same BMI level, respectively. In the SZ_OW group, increased Collinsella was significantly negatively associated with cognitive function, whereas decreased Clostridium and Butyricicoccus were significantly positively associated with cognitive function. Additionally, the functional analysis revealed enrichment of "metabolism of other amino acids" and "neurodegenerative disease" pathways, associated with non-standard amino acid metabolism and oxidative stress in the SZ_OW group compared to the NC_OW group.

CONCLUSIONS

Our findings revealed significant differences in the gut microbiota between SZ patients and NC with different BMI levels and identified microbial associations with clinical characteristics, providing new insights into the mechanism of how the gut microbiota could impact cognitive deficits in SZ patients with obesity.

Barriers to and enablers of modifying diet after metabolic bariatric surgery: A systematic review of published literature

This is a qualitative systematic review in which we investigated barriers and enablers influencing dietary behavior change after metabolic bariatric surgery (MBS). Database searches retrieved publications reporting perceived factors influencing dietary behavior change post-MBS. Data (quotes, survey results, interpretative summaries) were extracted and analyzed using combined deductive and inductive thematic analyses. The generated barrier/enabler themes mapped to the Theoretical Domains Framework and then behavior change techniques to identify potential strategies to improve post-operative dietary behavior. Thirty-four publications were included. Key barriers fell within the domains of 'Environmental Context and Resources' (e.g., insufficient and unreliable healthcare services), 'Behavioral Regulation' (e.g., lack of self-discipline), 'Emotions' (e.g., eating as a strategy to overcome negative emotions), 'Beliefs about Consequences' (e.g., the extent of realistic expectations from MBS), and 'Social Influences' (e.g., challenge of eating at social events). Key enablers were also identified within 'Environmental Context and Resources' (e.g. self-access internet-based resources), 'Behavioral Regulation' (e.g. learning how to develop new dietary strategies), 'Beliefs about Consequences' (e.g., positive impacts of surgery-induced food intolerances), and 'Social Influences' (e.g., support from social/group sessions). Potential strategies to change postoperative dietary behavior include social support, problem-solving, goal setting, and self-monitoring of behavior. This provides insight into the targets for future post-operative nutrition-focused interventions.

Exploring the mechanism of Epimedium in treating diabetic nephropathy based on network pharmacology and experimental validation study

Diabetic nephropathy (DN) is a severe complication of diabetes, characterized by chronic inflammation, metabolic disturbances, and progressive renal damage. Natural perennial herb, such as Epimedium, has shown potential therapeutic effects on DN, but its underlying mechanisms remain unclear. This study aimed to explore the pharmacological mechanisms of Epimedium in the treatment of DN through network pharmacology, molecular docking, and experimental validation. Active components of Epimedium were identified using TCMSP and SwissTargetPrediction databases, while DN-related targets were retrieved from GeneCards, DisGeNET, OMIM, and TTD databases. Overlapping targets were analyzed via PPI network and Cytoscape's cytoHubba plugin to identify hub genes. GO and KEGG enrichment analyses were conducted to explore functional pathways. Molecular docking validated the binding affinity between key targets and active components. Finally, high-glucose-induced HK-2 cell injury models were used to verify the protective effects of Epimedium through RT-qPCR, western blotting, and mitochondrial function assays. A total of 224 overlapping targets were identified, with AKT1, TNF, HSP90AA1, and SRC serving as key hub genes. GO and KEGG analyses revealed significant enrichment in pathways such as the PI3K-Akt signaling pathway and lipid metabolism. Molecular docking demonstrated strong interactions between Epimedium components and hub targets. Experimental validation showed that Epimedium restored nephrin and WT1 protein levels, mitigated mitochondrial dysfunction, and reversed high-glucose-induced overexpression of key targets. Epimedium exerts therapeutic effects on DN through multi-target interactions, primarily via the PI3K-Akt pathway, highlighting its potential as a novel treatment for DN.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-025-00748-0.

Excessive exposure to nitrate and nitrite boosts progression of isolated impaired fasting glucose to type 2 diabetes: a cohort study

Objectives

This cohort study investigated the possible association of dietary nitrate (NO3)/nitrite (NO2) intake and risk of progression to type 2 diabetes (T2D) across different phenotypes of prediabetes (Pre-DM).

Methods

A total of 1586 adults diagnosed with Pre-DM [i.e., 60.2% isolated impaired fasting glucose (iIFG), 21% isolated impaired glucose tolerance (iIGT), and 18.8% combined IFG-IGT] in the third (2006-2008) and fourth (2009-2011) examinations of the Tehran Lipid and Glucose Study, were assessed for dietary intake of NO3 and NO2 and were followed up to 2015-2017. Cox proportional hazard models, stratified by Pre-DM phenotypes, were used to plot cumulative hazard curve and calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for developing T2D across tertile categories and per every 100 mg/d NO3 and 2 mg/d NO2 intake exceeded the acceptable daily intake (ADI).

Results

The mean age of the participants was 47.2 ± 12.9 years at baseline, and 52.2% were men. Highest intake of NO3 (≥ 645 vs. < 451 mg/d) and NO2 (≥ 11.5 vs. <9.0 mg/d) increased risk of T2D among subjects with iIFG (HR = 1.69, 95% CI = 1.04-2.74 and HR = 2.07, 95% CI = 1.29-3.32). The cumulative hazards were higher in the highest compared to the lowest NO3 and NO2 intake in subjects with iIFG phenotype. Every 100 mg/d of NO3 and 2 mg/d NO2 intake exceeded ADI was associated with an increased risk of progression from iIFG to T2D by 13 and 25%, respectively.

Conclusion

High exposure to dietary NO3 and NO2 may be a risk factor for developing T2D in subjects with iIFG.

Two-pronged approach: Therapeutic effect of biological scaffold combined with immune intervention and β-cell replacement on type 1 diabetic mice

AIMS

Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by β-cell damage and absolute insulin deficiency. We consider combining immune intervention and β-cell replacement by biological scaffold to treat T1DM. Zinc transporter 8 (ZnT8) is known to be a pancreatic islet-specific autoantigen. Studies have shown that ZnT8(107-115)/HLA-A2 dimers can be used as antigen-specific immunosuppressants for T1DM. Mesenchymal stem cells (MSCs) can be induced to differentiate into insulin-producing cells (IPCs) under certain conditions in vitro. In recent years, the development of biomaterials has provided a more suitable three-dimensional microenvironment for cell transplantation. Our research group previously prepared gelatin/polylactic acid (PLLA/G) nanofiber scaffold by electrospinning technology, fixed GLP-1 analogues on the scaffold by surface modification with polydopamine (pDA) and confirmed the scaffold can promote bone mesenchymal stem cells (BMSCs) proliferation and improve cell survival rate. In addition, the scaffold can promote the differentiation of BMSCs into IPCs. Subsequently, ZnT8(107-115)/HLA-A2 dimer was constructed and loaded on the scaffold and confirmed the scaffold loaded with immunosuppressants can inhibit the proliferation and cytotoxicity of specific CD8+ T cells in vitro. This study used the above scaffold to co-load ZnT8(107-115)/HLA-A2 dimer and IPCs and implanted the scaffold into T1DM mice to study the blood glucose control and immunomodulatory effects on T1DM.

MATERIALS AND METHODS

First, the PLLA/G scaffold was modified with pDA and fixed with Liraglutide (LIR) to obtain the PLLA/G-pDA-LIR scaffold. Rat BMSCs were loaded on the scaffold and the 'three-step induction method' was used to induce differentiation in vitro. The insulin expression of IPCs was detected by Dithizone (DTZ) staining, glucose stimulate insulin secretion (GSIS) in vitro and intraperitoneal glucose tolerance test (IPGTT) in vivo. Then, non obese diabetes mice were modelled with T1DM and randomly divided into 5 groups. Blank control group was not treated; negative control group underwent sham surgery; positive control group was injected with IPCs through tail vein; single load scaffold group was subcutaneously transplanted with PLLA/G-pDA-LIR scaffold loaded with IPCs; double load scaffold group was subcutaneously transplanted with PLLA/G-pDA-LIR scaffold loaded with IPCs and ZnT8(107-115)/HLA-A2 dimer. Blood glucose and body weight were measured weekly before and after transplantation. At 2, 4 and 6 W after transplantation, some mice were taken from each group to detect serum insulin and C-peptide, spleen lymphocyte subsets and Tregs and pancreatic Th1/Th2 cell inflammatory factors.

RESULTS

The results of insulin expression in induced differentiated IPCs show that cells with insulin expression can be obtained through the "three-step induction method", and transplanting IPCs can effectively reduce blood glucose and improve glucose tolerance. Compared with non-scaffold induced IPCs, fixing Liraglutide scaffolds can improve the insulin expression level of IPCs and promote the induction of differentiation. The results after scaffold transplantation showed that compared with the positive control group and the single load scaffold group, the blood glucose was significantly reduced, and the serum insulin and C-peptide were significantly increased and lasted longer. In addition, the pathogenic T cells and inflammatory factors in the double load scaffold group were significantly reduced, and Tregs and anti-inflammatory factors were significantly increased.

CONCLUSIONS

The results show that the biological scaffold with IPCs and ZnT8(107-115)/HLA-A2 dimers has the dual functions of controlling blood glucose and regulating immunity, and may effectively treat T1DM.

Content and quality of smartphone applications for bariatric surgery: A review and content analysis

Objective

Our aim was to provide a descriptive analysis of the content and quality of bariatric apps available in Germany.

Methods

From November 2022 to February 2023, apps available in German used in pre- or postoperative care were searched in the Google Play, the Apple App Store, and the Register for Digital Health Applications (DHA). One author reviewed titles and summary pages. Relevant apps were downloaded and two authors assessed their eligibility. Additionally, the authors independently screened records indexed in Medline/Embase. Besides a summary of the app content, a quality assessment was performed using two checklists (the Action Alliance for Patient Safety Checklist (APS); the Mobile App Rating Scale (MARS).

Results

38 potentially relevant apps were identified, n = 3 were included. Functionality was good (MARS score 13-18/20). Content quality was variable (MARS score 7-19/35). Moreover, the apps' content lacked references and varied in scope.

Conclusion

There are few apps in the field of BS available and the quality of their content is moderate to low. The evidence base remains unclear due to a lack of sources.

Innovation

This is the first structured assessment of bariatric apps in Germany using validated checklists. The results provide a foundation for evidence-based, patient-centered app development in bariatric care and thus represent an important digital innovation in this field.

From root to Recovery: The role of herbs in polycystic ovary syndrome management

Polycystic ovarian syndrome (PCOS) is a prevalent complicated endocrine condition affecting women, caused by both hereditary and environmental factors. It often emerges during the reproductive years (15-35 years) and now affects 1 out of 10 women worldwide. PCOS is distinguished by high androgen levels, particularly testosterone, as well as the appearance of many ovarian cysts (more than 10), which result in anovulation, infertility, and irregular menstrual periods. Furthermore, PCOS is associated with a variety of endocrine and metabolic abnormalities, including obesity, hirsutism, acne, diabetes, insulin resistance, and poor glucose tolerance. PCOS treatment includes allopathic, Ayurvedic, and natural therapies, as well as lifestyle changes. In comparison to allopathic treatments, herbal medicines are recognized for their cost-effectiveness, efficacy, and favourable role in PCOS management/treatment. This literature review briefly examines PCOS diagnosis, symptoms, hormonal imbalance, causes, related risk factors, and management, with a particular emphasis on the role of herbal remedies in PCOS treatment. This review highlights several medicinal plants with potential therapeutic benefits for various health conditions. These herbs have demonstrated efficacy in managing ailments such as hypothyroidism, hyperplasia, obesity, diabetes, menorrhagia, sleep disturbances, cardiovascular disorders, hyperlipidemia, hirsutism, infertility, and irregular menstrual cycles. The information was sourced from PubMed and multiple review articles. Various herbs, whether used individually, in combination, or as extracts, may help reduce risk factors associated with polycystic ovary syndrome (PCOS).

Polyphenols reverse hyperglycemia-induced adipocyte dysfunction: A Metabolomic and Lipidomic study of efficacy

Hyperglycemia leads to metabolic dysfunction in human adipocytes, characterized by decreased AKT phosphorylation, downregulation of glycolysis, TCA cycle, and amino acid metabolism, as well as altered lipid profiles. This study aimed to elucidate these metabolic alterations and evaluate the potential therapeutic effects of selected polyphenols. Comprehensive metabolic profiling revealed profound disruptions, including impaired carbon metabolism, amino acids, and lipids associated with obesity. Importantly, treatment with polyphenols, particularly verbascoside and ferulic acid, effectively mitigated these metabolic disturbances, restoring adipocyte homeostasis. The polyphenols increased metabolites from carbon metabolism and amino acids, improving glycolysis, the TCA cycle, and related pathways. They also modulated lipid profiles that are negatively associated with obesity and related diseases. These findings provide valuable insights into the metabolic pathways underlying adipocyte dysfunction in hyperglycemia and highlight the therapeutic potential of polyphenols in ameliorating metabolic disorders.