Effectiveness of Frequently Used TNF Inhibitors vs. Conventional Immunosuppressive Therapies for Noninfectious Uveitis

PURPOSE

To compare the corticosteroid sparing efficacy of frequently used antimetabolites to tumor necrosis factor (TNF) inhibitors in the management of noninfectious ocular inflammation.

METHODS

Retrospective analysis of patients with noninfectious uveitis on conventional antimetabolite (methotrexate, mycophenolate mofetil, azathioprine,or leflunomide, "CONV") or a TNF inhibitor (adalimumab or infliximab, "TNFi") with active inflammation or more than 7.5 mg daily prednisone. Eyes were assessed in three groups: CONV only, TNFi only and combination of both (COMB). Cox regression models compared treatment success, adjusted for age, race, smoking, anatomic location of uveitis, duration of uveitis and visual acuity. Corticosteroid sparing success was defined as: inactive or slightly active uveitis on <=7.5 mg daily oral prednisone and <=2 drops of prednisolone acetate 1%.

RESULTS

There were 1475 eligible patients in the analysis. By 6 and 12 months, respectively, the Cox model-predicted, percentage success was 27.6% and 44.9% for the CONV group; 34.2% and 53.9% in the TNFi group and 39.9% and 61.1% for the COMB group. COMB was more likely than CONV to achieve success (adjusted HR 1.58 (95% confidence interval (CI), 1.28, 1.95, p < 0.0001). Factors associated with lower success were age under 18 years, smoking, visual acuity worse than 20/50 at cohort entry, over 4-year duration of uveitis and daily baseline prednisone 7.5 mg or higher (all p < 0.05).

CONCLUSION

Our results suggest COMB is more effective than CONV at achieving disease quiescence and corticosteroid sparing success among patients with active noninfectious uveitis. More research is needed to determine if TNFi alone is superior to CONV for uveitic corticosteroid-sparing.

Maternal Immune-Mediated Conditions and ADHD Risk in Offspring

BACKGROUND

Maternal immune-mediated conditions during pregnancy have been linked with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. However, we do not know the extent to which these associations are influenced by shared genetic predispositions, as opposed to maternal inflammatory/immune responses during pregnancy. This study contributes by using paternal immune-mediated conditions as a negative control to explore these underlying factors, as we investigate associations between maternal immune-mediated conditions during pregnancy and offspring ADHD.

METHODS

Prospective data from the Norwegian Mother, Father, and Child Cohort Study (MoBa) was linked with the Medical Birth Registry of Norway (MBRN) and the Norwegian Patient Registry (NPR) to assess associations between prenatal exposure to maternal immune-mediated conditions and offspring ADHD risk up to age 18. Nationwide recruitment from 1999 to 2008 resulted in 104,270 eligible mother-child pairs. Among these, 21,340 children were exposed to maternal allergic conditions (asthma, allergies, atopic conditions) and 7,478 to other immune conditions (autoimmune, inflammatory). Paternal self-reported immune conditions served as negative controls for genetic confounding. Data was mostly collected through MoBa, with additional maternal condition cases sourced from MBRN, and children's ADHD diagnoses obtained from NPR. Cox proportional hazard models estimated Hazard ratios for ADHD diagnoses.

RESULTS

Both overall categories were associated with increased offspring ADHD risk (allergic conditions HR 1.23 95% CI, 1.14-1.34; other immune conditions HR 1.36 95% CI, 1.21-1.53). Specifically, we found associations for maternal asthma (HR 1.47 95% CI, 1.30-1.67); allergies (HR 1.20 95% CI, 1.10-1.31); rheumatologic/musculoskeletal conditions (HR 1.64 95% CI, 1.28-2.10), Crohn's disease/ulcerative colitis (adjusted HR 1.95 95% CI, 1.23-3.09), and endocrine conditions (HR 1.42 95% CI, 1.15-1.77), specifically, type 1 diabetes (adjusted HR 2.50 95% CI, 1.66-3.75). Although some paternal immune-mediated conditions (psoriasis, ulcerative colitis, Crohn's disease) showed similar trends of increased ADHD risk in offspring, only paternal asthma was significantly associated (adjusted HR 1.26 95% CI, 1.10-1.45).

CONCLUSIONS

Several maternal immune-mediated conditions were associated with increased ADHD risk in offspring. Observations of higher, more consistent estimates of ADHD risk in offspring for most maternal immune-mediated conditions versus paternal ones indicate that unmeasured genetic confounding does not fully explain these associations. These results suggest direct effects on fetal development through events at the maternal-fetal interface which may alter fetal immune responses and potentially lead to greater risk of ADHD in the offspring. Asthma may be a possible exception to this mechanism, as paternal asthma was also linked with risk of offspring ADHD.

Association Between Pentraxins and Obesity in Prediabetes and Newly Diagnosed Type 2 Diabetes Mellitus Patients

Systemic inflammation has an important role in the prognosis and progression of many chronic diseases, including diabetes (T2DM). This retrospective study aimed to evaluate inflammatory status by determining the serum inflammatory biomarkers (PTX3, hs-CRP, TNF-α, and IL-6) and new indices, like the mean corpuscular volume (MCV) to lymphocyte ratio (MCVL) and cumulative inflammatory index (IIC), in a cohort of patients with prediabetes (PreDM) and newly diagnosed T2DM. We also wanted to assess the association with clinical parameters and different obesity-related indices, to identify possible correlations and to evaluate the diagnostic accuracy of the biomarkers using ROC curve analysis. In this study, we included 60 patients diagnosed with T2DM and 30 patients with PreDM. The ELISA method was applied. Elevated PTX3, hs-CRP, TNF-α, and IL-6 levels were found in T2DM patients compared to preDM patients. An independent relationship was found between PTX3, hs-CRP, and different obesity-related indices in patients with preDM and T2DM. The MCVL index exhibited an inverse trend proportional to the rising levels of HbA1c in the T2DM group. Spearman's analysis revealed in the T2DM group that the PTX3 values correlated much better with IIC (rho = 0.445, p-value = 0.014) and MCVL (rho = 0.338, p-value = 0.048). Hs-CRP values expressed moderate-to-weak correlations with IIC and MCVL in both groups. Additionally, ROC analysis showed that the PTX3 (AUC was 0.720; p = 0.003; cut-off value 1888.00 pg/mL, with 67.60% sensitivity and 73.30% specificity) and MCVL index (AUC was 0.677; p = 0.047; cut-off value 39.60, with 63.30% sensitivity and 66.70% specificity) have a good, accurate diagnosis compared with IL-6 (AUC was 0.866; p < 0.0001; cut-off value 40.30 pg/mL, with 100.00% sensitivity and 60.00% specificity). IIC showed 61.70% sensitivity and 60.00% specificity, with an AUC of 0.572, p = 0.027 and a cut-off value of 2.35. PTX3 and MCVL can serve as independent predictor factors in the inflammatory status in preDM and T2DM patients, supporting their potential as biomarkers for T2DM management and future research.

Anti-SARS-CoV-2 B and T-Cell Immune Responses Persist 12 Months After mRNA Vaccination with BNT162b2 in Systemic Lupus Erythematosus Patients Independently of Immunosuppressive Therapies

Background: In response to the SARS-CoV-2 pandemic, a massive vaccination campaign was launched. Nonetheless, concerns arose regarding some peculiar groups of patients, including those affected by Systemic Lupus Erythematosus (SLE), because of the immune-suppressive drugs routinely administered to patients and the risk of possible disease flares. Since the effects of the third booster vaccination in SLE have been poorly assessed, this study aims to evaluate the immunogenicity and safety of the third BNT162b2 vaccine dose, together with the effects of immunosuppressive drugs. Methods: A monocentric SLE cohort and a cohort of age- and sex-matched healthy controls (HCs) (all vaccinated with three homologous doses) were consecutively enrolled 6 months (T1) after their third vaccine shot. Vaccine immunogenicity was evaluated by analyzing humoral and cellular immune responses at T1 and 12 months (T2). Vaccine safety was evaluated by assessing adverse events related to vaccination (T0) and comparing disease activity among T0, T1, and T2. Effects of immunosuppressive drugs were assessed by stratifying patients according to therapy at vaccination: (1) receiving (IS) or (2) not receiving immunosuppressive drugs (Non-IS). Results: At T1, the humoral responses were comparable between SLE and HC subjects, while the cellular response was significantly higher in HC (p = 0.01). No differences were found at T2 between cohorts. Similarly, both at T1 and T2, the immune responses of IS and Non-IS groups were comparable. Moreover, lupus disease flares were limited and mostly mild, and no life-threatening adverse events were reported. Conclusions: The booster BNT162b2 vaccine is safe and induces an immune response, which is persistent and not affected by ongoing immunosuppressive drugs.

Optimizing Cancer Treatment Through Gut Microbiome Modulation

The gut microbiome plays a pivotal role in modulating cancer therapies, including immunotherapy and chemotherapy. Emerging evidence demonstrates its influence on treatment efficacy, immune response, and resistance mechanisms. Specific microbial taxa enhance immune checkpoint inhibitor efficacy, while dysbiosis can contribute to adverse outcomes. Chemotherapy effectiveness is also influenced by microbiome composition, with engineered probiotics and prebiotics offering promising strategies to enhance drug delivery and reduce toxicity. Moreover, microbial metabolites, such as short-chain fatty acids, and engineered microbial systems have shown potential to improve therapeutic responses. These findings underscore the importance of personalized microbiome-based approaches in optimizing cancer treatments.

Novel Usefulness of M2BPGi for Predicting Severity and Clinical Outcomes in Hospitalized COVID-19 Patients

Background/Objectives: Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel biomarker for liver fibrosis, and its prognostic role has never been explored in coronavirus disease 2019 (COVID-19). We compared the M2BPGi level simultaneously with age, severe/critical disease, the sequential organ failure assessment (SOFA) score, and the National Early Warning Score 2 (NEWS2) in a total of 53 hospitalized patients with COVID-19 (mild/moderate [n = 15] and severe/critical [n = 38]). Methods: M2BPGi levels were measured using the HISCL M2BPGi assay (Sysmex, Kobe, Japan) in an HISCL-5000 analyzer (Sysmex), and clinical outcomes were analyzed according to M2BPGi and the clinical variables, using the receiver operating characteristic (ROC) curve, Kaplan-Meier survival, and Cox proportional hazards regression analyses. Results: M2BPGi levels differed significantly according to disease severity, 30-day mortality, and 60-day mortality (p = 0.045, 0.011, and 0.002, respectively). In the ROC curve analysis, the M2BPGi, age, SOFA score, and NEWS2, except for severe/critical disease, significantly predicted clinical outcomes (all p < 0.01). In the survival analysis, the hazard ratios of M2BPGi added to each clinical variable were higher than that of each clinical variable alone, and M2BPGi was the only independent prognostic factor for the mortality. Conclusions: This study demonstrated that M2BPGi may be a useful biomarker for assessing disease severity and clinical outcomes in hospitalized COVID-19 patients. Combined with conventional clinical assessment, M2BPGi would provide objective and valuable information for prognosis prediction in these critically ill patients. Further studies are warranted to extend its utility in other clinical settings.

Therapeutic potential of microbiome modulation in reproductive cancers

The human microbiome, a complex ecosystem of microbial communities, plays a crucial role in physiological processes, and emerging research indicates a potential link between it and reproductive cancers. This connection highlights the significance of understanding the microbiome's influence on cancer development and treatment. A comprehensive review of current literature was conducted, focusing on studies that investigate the relationship between microbiome composition, reproductive cancer progression, and potential therapeutic approaches to modulate the microbiome. Evidence suggests that imbalances in the microbiome, known as dysbiosis, may contribute to the development and progression of reproductive cancers. Specific microbial populations have been associated with inflammatory responses, immune modulation, and even resistance to conventional therapies. Interventions such as probiotics, dietary modifications, and fecal microbiota transplantation have shown promise in restoring healthy microbiome function and improving cancer outcomes in pre-clinical models, with pilot studies in humans indicating potential benefits. This review explores the therapeutic potential of microbiome modulation in the management of reproductive cancers, discussing the mechanisms involved and the evidence supporting microbiome-targeted therapies. Future research is warranted to unravel the complex interactions between the microbiome and reproductive cancer pathophysiology, paving the way for innovative approaches.

Protocol for renal subcapsular islet transplantation in diabetic mice to induce long-term immune tolerance

Murine renal subcapsular islet transplantation presents a promising technique for diabetes treatment by addressing challenges such as immune rejection and reliance on immunosuppressive drugs. Here, we present a protocol for the isolation, purification, and transplantation of mouse pancreatic islets that overcomes these challenges. Specifically, we describe steps for inducing diabetes with streptozotocin, pancreatic perfusion and isolation, and islet cell purification. We then detail procedures for renal subcapsular islet transplantation, dual antibody therapy, and immune cell and graft monitoring. For complete details on the use and execution of this protocol, please refer to Liu et al.1.

Embracing the changes and challenges with modern early drug discovery

INTRODUCTION

The landscape of early drug discovery is rapidly evolving, fueled by significant advancements in artificial intelligence (AI) and machine learning (ML), which are transforming the way drugs are discovered. As traditional drug discovery faces growing challenges in terms of time, cost, and efficacy, there is a pressing need to integrate these emerging technologies to enhance the discovery process.

AREAS COVERED

In this perspective, the authors explore the role of AI and ML in modern early drug discovery and discuss their application in drug target identification, compound screening, and biomarker discovery. This article is based on a thorough literature search using the PubMed database to identify relevant studies that highlight the use of AI/ML models in computational chemistry, systems biology, and data-driven approaches to drug development. Emphasis is placed on how these technologies address key challenges such as data integration, predictive performance, and cost-efficiency in the drug discovery pipeline.

EXPERT OPINION

AI and ML have the potential to revolutionize early drug discovery by improving the accuracy and speed of identifying viable drug candidates. However, successful integration of these technologies requires overcoming challenges related to data quality, model interpretability, and the need for interdisciplinary collaboration.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Humoral Immune Response to SARS-CoV-2 Vaccines in Patients with Autoimmune Rheumatic Diseases

BACKGROUND

Patients with autoimmune rheumatic diseases (ARD) are at increased risk of infection due to their impaired immune response, which also reduces vaccination efficacy. Although several studies have evaluated the serological response to SARS-CoV-2 mRNA-based vaccines in patients with ARD, limited information on immune responses to other vaccination platforms is available.

AIMS

This observational prospective study aims to investigate the humoral immune response to different SARS-CoV-2 vaccines in patients with ARD.

METHODS

Total 66 patients with ARD who were scheduled to receive any SARS-CoV-2 vaccine (Gam-COVID-Vac; AZD1222; BBIBP-CorV; mRNA-1273; BNT162b2 and Ad5-nCoV) were enrolled in the study. We analyzed the humoral immune response elicited against the spike receptor-binding-domain (RBD) of SARS-CoV-2 at 0 and 14 ± 2 d after the first vaccine dose and at 0 ± 1, 21-45, and 180 d after the second one. Titers were also measured in patients who received an additional dose of vaccine.

RESULTS

After the second dose of the vaccine, 70.5% experienced seroconversion. The type of vaccine affected serological responses. BBIBP-CorV resulted in lower seroconversion rates, while mixed vaccinations increased anti-RBD titers. Other factors impacting seroconversion were higher prednisone doses, biological therapy, and hypertension. Patients treated with Rituximab had the lowest seroconversion rate. Regression analysis revealed an 89.0% lower probability of seroconversion for BBIBP-CorV recipients and an 88.0% lower probability for those with hypertension. An additional dose increased seroconversion to 85.7%.

CONCLUSIONS

Two-dose vaccination schemes exhibited a 70.5% seroconversion rate to the SARS-CoV-2 vaccine. An additional dose increased this rate to 85.0%. Reduced humoral immune responses were associated with BBIBP-CorV, prednisone higher doses, and biological therapy.

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

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

TLR/NLRP3 inflammasome signaling pathways as a main target in frailty, cachexia and sarcopenia

Mobility disability is a common condition affecting older adults, making walking and the performance of activities of daily living difficult. Frailty, cachexia and sarcopenia are related conditions that occur with advancing age and are characterized by a decline in muscle mass, strength, and functionality that negatively impacts health. Chronic low-grade inflammation is a significant factor in the onset and progression of these conditions. The toll-like receptors (TLRs) and the NLRP3 inflammasome are the pathways of signaling that regulate inflammation. These pathways can potentially be targeted therapeutically for frailty, cachexia and sarcopenia as research has shown that dysregulation of the TLR/NLRP3 inflammasome signaling pathways is linked to these conditions. Activation of TLRs with pathogen-associated molecular patterns (PAMPs or DAMPs) results in chronic inflammation and tissue damage by releasing pro-inflammatory cytokines. Additionally, NLRP3 inflammasome activation enhances the inflammatory response by promoting the production and release of interleukins (ILs), thus exacerbating the underlying inflammatory mechanisms. These pathways are activated in the advancement of disease in frail and sarcopenic individuals. Targeting these pathways may offer therapeutic options to reduce frailty, improve musculoskeletal resilience and prevent or reverse cachexia-associated muscle wasting. Modulating TLR/NLRP3 inflammasome pathways may also hold promise in slowing down the progression of sarcopenia, preserving muscle mass and enhancing overall functional ability in elderly people. The aim of this review is to investigate the signaling pathways of the TLR/NLRP3 inflammasome as a main target in frailty, cachexia and sarcopenia.

Safety of and Adverse Reactions to the COVID-19 Vaccine Among Pregnant and Breastfeeding Women

OBJECTIVES

This study aimed to evaluate the incidence of adverse reactions to the COVID-19 vaccine among pregnant and breastfeeding women and identify associated demographic and clinical factors.

METHODS

A cross-sectional study was conducted at a hospital in Hanoi, Vietnam, from November 2021 to March 2022. A total of 1204 participants, including 991 pregnant women beyond 13 weeks of gestation and 213 breastfeeding women, were recruited through convenience sampling. Data were collected using a self-administered questionnaire designed to capture demographic information and adverse reactions occurring within seven to 28 days post-vaccination. Statistical analyses, including chi-square tests, Fisher's exact tests, and logistic regression, were performed using Stata 16.0, with the significance set at p < 0.05.

RESULTS

The most common adverse reactions were localized pain at the injection site (26.2%), dizziness and fatigue (19.2%), and fever below 39 °C (29.1%). Severe adverse reactions, such as a tight throat, coma, and premature birth, were rare. A multivariate analysis identified the significant factors associated with the adverse reactions, including age (aOR = 2.04 for participants aged 36-40 years), occupation (lower odds for farmers and business professionals), urban residency (aOR = 0.64), and a history of allergies (aOR = 1.59). Education level, number of children, and gestational age were not significantly associated with adverse events.

CONCLUSIONS

The findings support the safety of the COVID-19 vaccine in pregnant and breastfeeding women, with most of the adverse reactions being mild and self-limiting.

The impact of multimorbidity on Quality of Life in inflammatory myopathies: A cluster analysis from the COVAD dataset

OBJECTIVE

The presence of comorbidities can substantially affect patients' quality of life, but data regarding their impact on idiopathic inflammatory myopathies (IIMs) are limited.

METHODS

We examined the prevalence of comorbidities in IIM patients, other autoimmune rheumatic diseases (oAIRDs) and healthy controls (HCs), using data from the self-reported COVAD-2 survey. We defined basic multimorbidity (BM) as the presence of ≥2 non-rheumatic chronic conditions and complex multimorbidity (CM) as the presence of ≥3 non-rheumatic chronic conditions affecting ≥3 organ systems. Hierarchical clustering on principal components was performed for grouping.

RESULTS

Among the COVAD respondents, 1558 IIMs, 4591 oAIRDs and 3652 HCs were analysed. IIMs exhibited a high burden of comorbidities (odds ratio [OR]: 1.62 vs oAIRDs and 2.95 vs HCs, P < 0.01), BM (OR: 1.66 vs oAIRDs and 3.52 vs HCs, P < 0.01), CM (OR: 1.69 vs AIRDs and 6.23 vs HCs, P < 0.01) and mental health disorders (MHDs) (OR: 1.33 vs oAIRDs and 2.63 vs HCs, P < 0.01). Among the IIM patients, those with comorbidities or MHDs had lower PROMIS Global Physical (PGP), PROMIS Global Mental (PGM), and PROMIS Physical Function (SF10) scores, and higher fatigue (F4a) scores (all P < 0.001). PGP, PGM, SF10a and F4a were influenced by age, active disease, BM and MHDs. Four distinct clusters were identified among the IIMs according to comorbidities and PROMIS scores.

CONCLUSION

Patients with IIMs have a higher burden of comorbidities that influence physical and mental health, identifiable as clinical clusters for optimized and holistic management approaches.

Disease characteristics and medications use in idiopathic inflammatory myopathy: a multi-centre prospective observational study of decentralized remote vs. traditional clinic enrolment

OBJECTIVES

Idiopathic inflammatory myopathies (IIM) are rare and characterized by heterogeneous manifestations and clinical trajectories. Utilizing tele-research methods has the potential to improve participant recruitment and advance the understanding of the disease. We aimed to evaluate disease characteristics in IIM patients throughout the USA and compare these parameters between patients recruited remotely through mobile application or website vs those recruited locally in myositis clinics.

METHODS

'Myositis Patient Centered Tele-Research' (My PACER) is a multicentre prospective observational study of US IIM subjects, competitively recruited through traditional in-person clinic visits [centre-based cohort (CBC)] and remotely using mobile application or website and social media [tele-research cohort (TRC)]. Data collection comprised baseline demographic and clinical variables, encompassing symptoms, organ involvement, diagnostic tests results and medication use.

RESULTS

The study included 120 IIM patients, 82 in the TRC and 38 in the CBC. The average age was 55 ± 13.4, 75% females and 81% Caucasians. Both cohorts exhibited similar demographic characteristics. Overall, 41% dermatomyositis, 27% polymyositis, 23% anti-synthetase syndrome, and 9% necrotizing myositis patients were enrolled, with comparable subtypes prevalence among cohorts (P = 0.85). The groups demonstrated similarities in multiple clinical factors, including muscle enzymes, diagnostic delay, employment status, various patient and physician-reported outcomes, functional tests, and the frequency of abnormal findings in chest CT, pulmonary function tests and electromyography. TRC patients received biologics and csDMARDs more frequently (P < 0.001 and P = 0.013, respectively).

CONCLUSION

Tele-research recruitment yielded a patient cohort resembling traditionally recruited patients demographically and clinically, indicating its effectiveness for robust and diverse patient recruitment in clinical studies.

Decoding Autoimmunity: Insights Into Neuromyelitis Optica and Its Relationship With Other Autoimmune Neurological Disorders

Neuromyelitis optica (NMO) is a rare but debilitating autoimmune condition characterized by severe attacks of optic neuritis and transverse myelitis, often resulting in significant neurological disability. Autoantibodies targeting aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) play critical roles in disease pathogenesis, and therapeutic strategies encompassing immunosuppressive therapies and emerging biologics are employed to manage disease activity and prevent relapse. While studies suggest a potential overlap between NMO and other autoimmune neurological conditions, research in this area remains limited. This review explores the commonalities and distinctions between NMO and related autoimmune neurological disorders, hypothesizing that shared autoantibody mechanisms and clinical features may refine diagnostic criteria and therapeutic interventions. Additionally, it addresses tailored management approaches for specific clinical features of NMO and its overlaps. The paper also explores current research on biomarkers and novel treatment modalities, highlighting persistent knowledge gaps, such as understanding the immune mechanisms behind NMO and predicting individual responses to therapies. The review underscores the necessity for collaborative research efforts to improve diagnostic accuracy and therapeutic efficacy. Ultimately, these efforts will enhance personalized care strategies and optimize outcomes and quality of life for patients with NMO and related autoimmune neurological disorders.

The Impact of Vaccination Frequency on COVID-19 Public Health Outcomes: A Model-Based Analysis

Background: While the rapid deployment of SARS-CoV-2 vaccines had a significant impact on the ongoing COVID-19 pandemic, rapid viral immune evasion and waning neutralizing antibody titers have degraded vaccine efficacy. Nevertheless, vaccine manufacturers and public health authorities have a number of options at their disposal to maximize the benefits of vaccination. In particular, the effect of booster schedules on vaccine performance bears further study. Methods: To better understand the effect of booster schedules on vaccine performance, we used an agent-based modeling framework and a population pharmacokinetic model to simulate the impact of boosting frequency on the durability of vaccine protection against infection and severe acute disease. Results: Our work suggests that repeated dosing at frequent intervals (three or more times a year) may offset the degradation of vaccine efficacy, preserving the utility of vaccines in managing the ongoing pandemic. Conclusions: Given the practical significance of potential improvements in vaccine utility, clinical research to better understand the effects of repeated vaccination would be highly impactful. These findings are particularly relevant as public health authorities worldwide have reduced the frequency of boosters to once a year or less.

Enterocutaneous Fistula in a Patient with Crohn's Disease After Internalization of a Foreign Body into the Gastrointestinal Tract

Background/Objectives: Crohn's disease is a chronic inflammatory condition with periods of exacerbation and remission that can involve any part of the gastrointestinal tract. The basic intestinal manifestation is frequently accompanied by extraintestinal involvement and may lead to complications such as perforations, fistulas and abscesses. Despite Crohn's disease being the most common reason of intestinal perforation, the other causes should be considered as well. Internalization of a foreign body, although rare, may still occur, especially in the pediatric population. Methods: The following case report presents the medical history of an 11-year-old patient who developed an enterocutaneous fistula two years after the diagnosis of Crohn's disease. Data analysis was carried out on the basis of patient medical records. Results: The fistula formed in the course of biological treatment during a period free of other symptoms indicating disease exacerbation. The imaging tests revealed the presence of a foreign body in the gastrointestinal tract, which could have been a potential cause of the observed inflammation that resulted in the development of the fistula. Conclusions: The presented case report as well as the literature indicate a correlation between the formation of intestinal fistulas and an active disease process. However, in the absence of symptoms of Crohn's disease exacerbation, other causes should be considered.

Association of spontaneous abortion and lifestyle with diabetes mellitus in women: a cross-sectional study in UK Biobank

BACKGROUND

Spontaneous abortion has been associated with higher risk of type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM), while the evidence remains equivocal. This study aimed to examine the association between spontaneous abortion and the risk of T2DM and GDM, and assesses whether lifestyle factors modified this association.

METHODS

This cross-sectional study used data from the UK Biobank, recruiting 170 599 ever-pregnant women from 22 assessment centers in England, Scotland, and Wales between 2006 and 2010. History of spontaneous abortion was self-reported and was confirmed by using medical records, categorized as none, 1, 2, or ≥3 spontaneous abortions. The primary outcomes, T2DM and GDM, were ascertained from medical records using ICD-10 codes. Multivariable logistic regression was performed to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic and health factors (e.g., age, ethnicity, cancer, chronic hypertension), reproductive factors (e.g., use of oral contraceptives, use of hormone treatment, hypertensive disorders of pregnancy), and lifestyle score. The lifestyle score was constructed based on smoking status, alcohol intake, physical activity, television viewing time, sleep duration, and diet quality. Effect modification by lifestyle score was assessed using multiplicative interaction terms in the regression models.

RESULTS

Among 170 599 ever-pregnant women (mean [SD] age, 56.4 [8.0] years), a history of spontaneous abortion was associated with higher odds of T2DM (OR 1.17, 95% CI 1.10-1.24) and GDM (OR 1.38, 95% CI 1.20-1.60). The odds were higher for recurrent spontaneous abortions (for T2DM: ORs were 1.33 [95% CI 1.14-1.56] for three or more spontaneous abortions, 1.07 [95% CI 0.93-1.23] for two, and 1.09 [95% CI 1.01-1.17] for one compared with none; for GDM: the corresponding ORs were 2.01 [95% CI 1.48-2.71], 1.21 [95% CI 0.90-1.64], and 1.20 [95% CI 1.01-1.42], respectively). The odds of T2DM and GDM higher with less healthy lifestyle behaviors in both categories of spontaneous abortion, although no significant interactions between spontaneous abortion and lifestyle score were observed (P-interaction>0.05).

CONCLUSIONS

Spontaneous abortion was associated with higher odds of T2DM and GDM, with a stronger association observed in women who experienced recurrent spontaneous abortions. It is imperative to integrate reproductive history into routine diabetes risk assessment, particularly for women with a history of multiple spontaneous abortions.

Measurement of Anti-TNF Biologics in Serum Samples of Pediatric Patients: Comparison of Enzyme-Linked Immunosorbent Assay (ELISA) with a Rapid and Automated Fluorescence-Based Lateral Flow Immunoassay

Background: Therapeutic drug monitoring (TDM) of infliximab (IFX) and adalimumab (ADL) mainly relies on the use of enzyme-linked immunosorbent assays (ELISA). More recently, rapid assays have been developed and validated to reduce turnaround time (TAT). Here, we compared IFX and ADL concentrations measured with both ELISA and a new fluorescence-based lateral flow immunoassay (AFIAS). Methods: In serum samples from pediatric patients, IFX and ADL drug levels, and total anti-IFX antibodies were measured using clinically validated ELISA kits (Immundiagnostik AG). Samples were further analyzed using a new rapid assay (AFIAS, Boditech Med Inc.) to measure drug levels and total anti-IFX antibodies. Results: Spearman's correlation coefficients (rho) were 0.98 [95% confidence interval (CI) 0.97 to 0.99] for IFX (p < 0.001) and 0.83 (95% CI 0.72 to 0.90) for ADL (p < 0.001). Calculated % bias was -14.09 (95% Limits of agreement, LoA, -52.83 to 24.66) for IFX and 15.79 (LoA -37.14 to 68.73) for ADL. For the evaluation of total anti-IFX antibodies, we did not collect sufficient data to establish a statistically significant correlation between AFIAS and ELISA. The inter-rater agreement showed a "substantial" and a "moderate" agreement for IFX and ADL, respectively. Conclusions: Our results show that the AFIAS assay has an accuracy and analytical performance comparable to that of the ELISA method used for TDM of IFX and ADL. Therefore, the introduction of this device into routine clinical practice could provide results more quickly and with similar accuracy as ELISA, allowing clinicians to rapidly formulate clinical decisions.

Impact of QazVac vaccination on clinical manifestations and immune responses in post-COVID syndrome: a cross-sectional study

Introduction

Post-COVID syndrome, also known as long COVID, has emerged as a major public health concern, affecting a substantial proportion of individuals recovering from SARS-CoV-2 infection. This condition is characterized by persistent symptoms lasting at least 2 months after acute infection, significantly impacting quality of life and increasing healthcare burdens. In Kazakhstan, the recognition of post- COVID syndrome in national clinical protocols highlights the need for effective prevention and management strategies. Vaccination has been suggested as a key intervention to reduce the severity and prevalence of long COVID symptoms, yet data on its effectiveness, particularly for the domestic QazVac vaccine, remain limited. The aim of this study is to investigate the impact of vaccination with the domestic QazVac vaccine on the features of humoral and cellular immunity in patients with post-COVID conditions and to identify the leading clinical variants of the course.

Methods

We analyzed data from 90 vaccinated and 217 non-vaccinated patients, examining sex, age, smoking status, BMI, comorbidities, and clinical manifestations.

Results

There were no significant differences between the groups with regard to sex, age, and smoking status. However, the characteristics of the subjects indicated that vaccination was correlated with a lower prevalence of diabetes mellitus (2.2% vs. 11.1%, p = 0.011) and cardiovascular diseases (0.0% vs. 10.1%, p = 0.047), and a higher prevalence of hypertension among non-vaccinated subjects. With regard to clinical symptoms, vaccinated individuals presented a significantly decreased frequency of neurological (51.1% vs. 74.2%, p = 0.001), gastrointestinal (4.4% vs. 15.2%, p = 0.008), respiratory (21.1% vs. 36.4%, p = 0.009), rheumatological symptoms (26.7% vs. 38.7%, p = 0.044), and kidney symptoms (2.2% vs. 9.7%, p = 0.024). In contrast, unvaccinated participants had more memory loss (49.8% vs. 22.2%, p < 0.001), depression (31.3% vs. 6.7%, p < 0.001), joint pain (33.2% vs. 14.4%, p = 0.001), and other psychopathological symptoms.

Discussion

A sharp decrease in the frequency of neurological, gastrointestinal, respiratory, and rheumatological symptoms was recorded in vaccinated patients, advocating for the protective role of vaccination against long COVID-19 sequelae. These findings highlight the potential for vaccination to mitigate the burden of post-COVID complications across various organ systems.

Mesenchymal stromal cells in bone marrow niche of patients with multiple myeloma: a double-edged sword

Multiple myeloma (MM) is a hematological malignancy defined by the abnormal proliferation and accumulation of plasma cells (PC) within the bone marrow (BM). While multiple myeloma impacts the bone, it is not classified as a primary bone cancer. The bone marrow microenvironment significantly influences the progression of myeloma and its treatment response. Mesenchymal stromal cells (MSCs) in this environment engage with myeloma cells and other bone marrow components via direct contact and the secretion of soluble factors. This review examines the established roles of MSCs in multiple facets of MM pathology, encompassing their pro-inflammatory functions, contributions to tumor epigenetics, effects on immune checkpoint inhibitors (ICIs), influence on reprogramming, chemotherapy resistance, and senescence. This review investigates the role of MSCs in the development and progression of MM.

The adjunctive role of metformin in patients with mild to moderate ulcerative colitis: a randomized controlled study

Background

Metformin, hypoglycemic medication, is recognized for its diverse properties and its capacity to influence the inflammatory pathways. Medications with anti-inflammatory and anti-oxidative characteristics have been demonstrated to be able to elicit and sustain remission in ulcerative colitis (UC), chronic inflammatory disorder of the bowel. Studies in both preclinical and clinical settings have looked into the several metabolic pathways via which metformin protects against UC.

Aim

To assess efficacy of metformin as adjunctive therapy in patients with mild to moderate UC.

Methods

This clinical research was double-blinded, randomized, controlled, and involved 60 patients with mild to moderate UC. The participants were randomly assigned to one of two groups (n = 30). The control group was given 1 g of mesalamine three times a day (t.i.d.) for a period of 6 months (mesalamine group). The metformin group was given 500 mg of metformin twice daily and 1 g of mesalamine t. i.d. For a period of 6 months. Patients with UC were assessed by a gastroenterologist using the disease activity index (DAI) both at the beginning of treatment and 6 months thereafter. To evaluate the drug's biological efficacy, measurements of fecal calprotectin, serum C-reactive protein (CRP), interleukin 10 (IL-10), and nitric oxide (NO) were taken both before and after treatment.

Study outcomes

Decrease in DAI and change in the level of measured serum and fecal markers.

Results

The metformin group displayed a statistical reduction in DAI (p = 0.0001), serum CRP (p = 0.019), NO (p = 0.04), and fecal calprotectin (p = 0.027), as well as a significant increase in IL-10 (p = 0.04) when compared to the mesalamine group. There was a significant direct correlation between DAI and calprotectin (p < 0.0001, r = 0.551), and between DAI and CRP (p < 0.0001, r = 0.794). There was a significant negative correlation between DAI and IL-10 (p = 0.0003, r = 0.371).

Conclusion

Metformin may be an effective adjunct drug in management of patients with mild to moderate UC by decreasing DAI and other inflammatory markers that were involved in the pathogenesis of UC.

Clinical Trial Registration

identifier NCT05553704.

Racial, Ethnic, Sex, and Geographical Diversity in Myositis Clinical Trials

OBJECTIVE

The number of randomized clinical trials (RCTs) with patients with idiopathic inflammatory myopathies (IIMs) has grown exponentially over the last decade. Race, ethnicity, and sex reporting and representation of participants as well as the geographic distribution of enrolling sites in IIM RCTs are unknown. This information can provide critical insights into the current state of enrollment practices and generalizability in IIM RCTs.

METHODS

A systematic literature review assessed IIM RCTs published between 2010 to 2023. Sex and gender reporting was analyzed per Sex and Gender Equity in Research guidelines. Appropriate reporting of race and ethnicity was defined as reporting them for all trial participants. Countries were categorized based on the Human Development Index. US enrollment sites were grouped using the National Center for Health Statistics Urban-Rural Classification Scheme and medically underserved areas (MUAs).

RESULTS

Of the 19 RCTs included, race was appropriately reported in 58%. Black, Asian, and Hispanic or Latino participants represented 3%, 7%, and 2% of the enrollees, respectively. Ethnicity was only reported in 26% of RCTs, and 16% conflated race and ethnicity. Temporal trends showed encouraging results for race and ethnicity representation. Most trials (90%) had greater than 45% women participants. Geographic regions of sites included North America, Europe, Asia, and Australasia, with no sites in South America or Africa. The majority of US sites were located in large metropolitan areas, whereas none were in nonmetropolitan areas, and only 31% in MUAs.

CONCLUSION

Racial, ethnic, and geographic representation in IIM RCTs remains a critical issue. Inadequate reporting of race and ethnicity and limited sociodemographic and geographic representation of participants raise concerns about the generalizability of findings of IIM RCTs.

Elevating Research and Careers in the Development of Safer Drugs through Artificial Intelligence

The session "Elevating Research and Careers in the Development of Safer Drugs through Artificial Intelligence," held at the American Chemical Society meeting, showcased innovative methodologies that AI brings to drug development, from predictive modeling to personalized medicine.

Dietary arabinogalactan modulates immunity and improves gut barrier in broilers via regulating metabolome and gut microbiome

The extraction of polysaccharides from wood by-products is recognized as a green re-utilization approach to shape a recycling-oriented society. In this research, we identified the structural properties of arabinogalactan (AG) extracted from Larix sibirica Ledeb wood chips and verified its efficacy as an additive in broiler framing. Results showed that the molecular weight of AG is 19.805 KDa. Methylation analysis and NMR spectra indicate that AG has a 1,6-linked Galp backbone, side residues mainly branched at C-1,3,6 on β-D-Galp. The Ara residues were substituted at C-3 of 1,6-linked Galp consisting of α-L-Araf-(1→3)-α-L-Araf-(1 → 3)-α-L-Araf (1→ and α-L-Araf-(1 → 4) β-D-Galp-(1 → 3)-β-D-Galp-(1→. As a dietary supplement in broiler model, AG treatment improved the body weight of broilers especially breast and leg muscle weight. Furthermore, AG could regulate host immune response, gut microbiota composition, and metabolic activity, especially promoting lipid metabolism. By means of serum non-targeted metabolomics analysis, enrichment of pantothenate and CoA biosynthesis and beta-alanine metabolism pathways could be determined. AG treatment led to a rise in bacteria that produce SCFAs, with elevated concentrations of acetic and butyric acids. In conclusion, AG can be considered as a potential dietary supplement to beneficially affect host's health status.

No Association Between Diet Quality, Nutritional Status, and Quality of Life in Women with Hashimoto's Thyroiditis-A Cross-Sectional Study

OBJECTIVES

Dietary habits are identified as a potential factor influencing the quality of life of individuals diagnosed with Hashimoto's disease (HAT). The objective of this study was to analyze the relationship between quality of diet and selected parameters of nutritional status, and quality of life in female patients with HAT.

METHODS

A descriptive cross-sectional study was conducted among 147 women aged 39.9 ± 10.39 years. Diet quality was determined with the Pro-Healthy Diet Index (pHDI-10), quality of life with a thyroid-specific questionnaire (ThyPROpl), and gastrointestinal symptoms with the Gastrointestinal Symptom Rating Scale (GSRS).

RESULTS

The mean pHDI-10 score was 25.5 ± 9.59; 80% of women had a low pro-healthy diet quality (LQD group, 21.9 ± 6,89 pts.) and 20% had a medium pro-healthy diet quality (MQD group, 39.7 ± 4.69 pts.). Nutritional status and anthropometric and health risk parameters did not differ between the groups. The ThyPROpl score was 49.15 ± 31.16 (LQD: 49.58 ± 31.01, MQD: 47.41 ± 32.28, p = 0.73).

CONCLUSIONS

Quality of diet was not associated with the quality of life or nutritional status of HAT patients. However, the majority of participants showed poor healthy eating habits, elevated body mass index and unsatisfactory quality of life in areas, such as tiredness, hypothyroid symptoms, depression, emotional vulnerability, and anxiety.

Research progress of mosquito-borne virus mRNA vaccines

In recent years, mRNA vaccines have emerged as a leading technology for preventing infectious diseases due to their rapid development and high immunogenicity. These vaccines encode viral antigens, which are translated into antigenic proteins within host cells, inducing both humoral and cellular immune responses. This review systematically examines the progress in mRNA vaccine research for major mosquito-borne viruses, including dengue virus, Zika virus, Japanese encephalitis virus, Chikungunya virus, yellow fever virus, Rift Valley fever virus, and Venezuelan equine encephalitis virus. Enhancements in mRNA vaccine design, such as improvements to the 5' cap structure, 5'UTR, open reading frame, 3'UTR, and polyadenylation tail, have significantly increased mRNA stability and translation efficiency. Additionally, the use of lipid nanoparticles and polymer nanoparticles has greatly improved the delivery efficiency of mRNA vaccines. Currently, mRNA vaccines against mosquito-borne viruses are under development and clinical trials, showing promising protective effects. Future research should continue to optimize vaccine design and delivery systems to achieve broad-spectrum and long-lasting protection against various mosquito-borne virus infections.

Efficacy of thunder-fire moxibustion for cancer-related fatigue in breast cancer survivors: study protocol for a randomized controlled trial

Background

Cancer-related fatigue (CRF) is one of the most prevalent and debilitating symptoms experienced by breast cancer survivors, often associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. In China, moxibustion is widely used as a therapeutic approach for managing fatigue. Thunder-fire moxibustion (TFM), a novel technique with high thermal radiation and strong penetrative properties, may provide benefits for CRF. This study aims to assess the efficacy, safety, and underlying mechanisms of TFM in the treatment of CRF among breast cancer survivors.

Methods

This prospective, single-center, open-label, randomized controlled trial will recruit 70 breast cancer survivors diagnosed with CRF. Participants will be randomly assigned in a 1:1 ratio to either a waitlist control group or a TFM intervention group. All participants will receive standard care during the 30-day treatment period. Those in the TFM group will additionally undergo TFM treatment every other day, totaling 15 sessions. The primary outcome measure is the change in total fatigue score, assessed using the Piper Fatigue Scale, from baseline to the end of treatment. Additionally, this study will investigate the underlying mechanisms of TFM by evaluating changes in HPA axis-related hormone levels, inflammatory markers, gut microbiota composition, and conducting metabolomic analyses of fecal and blood samples.

Discussion

This study takes a multidisciplinary approach to comprehensively explore how TFM modulates biological systems involved in CRF, aiming to generate robust evidence. If successful, this study will provide high-quality, evidence-based reference points for the treatment of CRF in breast cancer survivors and inform future research in integrative medicine.

Trial registration

The study has been registered with the International Traditional Medicine Clinical Trial Registry (http://itmctr.ccebtcm.org.cn, ITMCTR2024000406).

A new therapeutic pathway in autoimmune diseases: chimeric antigen receptor T cells (CAR-T) targeting specific cell subtypes or antigen-specific B lymphocytes—a brief review

In hematological malignancies, autologous immunotherapy with T lymphocytes expressing a chimeric antigen receptor (CAR-T) has been successfully applied. CAR enhances the immuno-cellular effector system directly against cells expressing target antigens. The objective here was to discuss the prospects of applying CAR-T and its variants in autoimmune diseases (AIDs) to deplete pathogenic autoantibodies by eliminating B lymphocytes and plasma cells. B cells play a crucial role in the pathogenesis of AID through the production of autoantibodies, cytokine dysregulation, antigen presentation, and regulatory dysfunction. In AID with numerous autoreactive clones against various autoantigens, such as systemic lupus erythematosus, rheumatoid arthritis, vasculitis, myositis, and systemic sclerosis, CAR-T targeting CD19/CD20 and B-cell maturation antigen (BCMA) have shown success in preclinical and clinical studies, representing an innovative option for refractory patients when standard treatments fail. The suppression of B lymphocytes reactive against specific antigens using cytolytic T cells carrying a chimeric autoantibody receptor (CAAR-T) offers a promising approach for managing various AIDs, especially those with characterized pathogenic autoantibodies, such as pemphigus vulgaris, myasthenia gravis, and anti-NMDAR autoimmune encephalitis. CAAR-T allows the elimination of autoreactive B lymphocytes without compromising the general functionality of the immune system, minimizing common side effects in general immunosuppressive therapies, including immunobiologicals and CAR-T. In vitro, preclinical, and clinical (phase 1) studies have demonstrated the efficacy and specificity of CAR-T and CAAR-T in several AIDs; however, extensive clinical trials (phase 3) are required to assess their safety and clinical applicability. These advances promise to enhance precision medicine in the management of AIDs, offering personalized treatments for individual patients.

Systematic literature review of intravenous immunoglobulin use in non-renal and non-hematologic systemic lupus erytehmatosus

Objective: Intravenous immunoglobulins (IVIG) are an established treatment in several immune-mediated diseases such as dermatomyositis or Kawasaki disease and they have been used in distinct clinical scenarios in systemic lupus erythematosus (SLE). However, in this latter disease no clear evidence besides hematological or renal involvement supports its use. The aim of the present study is to establish evidence for the treatment of non-renal non-hematological lupus with IVIG.Methods: We have carried out a systematic literature review following PRYSMA principles on the use of this treatment in SLE patients with no renal no hematologic manifestations.Results: We found 35 articles which were split into two subtypes, those with individualized data (29) and those with grouped data. Overall, 198 lupus patients treated with IVIGs [178 (90%) women and 20 (10%) men] were included. In 167 (84.3%) a clinical response was obtained [62 (31.3%) complete and 105 (53%) a partial one]. Adverse events were reported in 40 patients (20.2%), most of them mild with only 2 (1%) severe. According to individualized data, all cases with respiratory problems (5), 82.4% of those with cardiac involvement (18) and 53.8% of those with neuropsychiatric manifestations (18) achieved a complete response as more outstanding results.Conclusions: After reviewing the experience of the use of IVIGs in extra-renal and extra-hematologic SLE patients, this treatment is demonstrated to be useful in refractory cases, especially in pulmonary, cardiac or neuropsychiatric complications with a good safety profile.

A practical approach to positioning therapies in ulcerative colitis

The therapeutic landscape of ulcerative colitis (UC) has undergone significant change over the last 2 decades. While there are multiple new therapies for the management of UC, long-term remission rates remain low, and this may be in part due to the difficulty of navigating a successful treatment strategy. In this review, we propose a rational framework for treatment selection, sequencing, and optimization in patients with UC. We outline treatment goals and targets for UC, followed by a discussion of the challenges in treatment selection and considerations to help guide a sequencing strategy. These include an assessment of a therapy's efficacy and safety, the convenience in the delivery of the therapy, ease of access, and patient-related factors. We then provide an overview of the currently approved therapies for UC, with an in-depth analysis of their advantages and disadvantages. Finally, we conclude with future directions in the management of UC, which include the use of naturopathic therapies, faecal microbiota therapy, the use of precision medicine, and other strategies such as combination therapy.

Epidemiology of myositis

PURPOSE OF REVIEW

This review aims to synthesize recent developments in the epidemiology of idiopathic inflammatory myopathies (IIMs), focusing on incidence, prevalence, disease classification, and clinical outcomes.

RECENT FINDINGS

IIM is a rare group of autoimmune diseases characterized by muscle weakness and systemic involvement, with incidence rates ranging from 0.2 to 2 cases per 100 000 person-years. The role of myositis-specific autoantibodies (MSAs) in stratifying disease risk and prognosis is increasingly recognized, such as in anti-MDA5 positive DM, which is associated with a high risk of rapidly progressive interstitial lung disease. Furthermore, patients with IIM exhibit elevated risks of comorbidities, including cardiovascular disease and malignancy.

SUMMARY

IIM diseases are complex disorders with significant health impacts, necessitating enhanced awareness and research. Improved classification and understanding of MSAs are crucial for earlier diagnosis and tailored therapeutic strategies. Continued epidemiological research is essential to elucidate underlying mechanisms and inform future interventions, ultimately aiming to enhance the quality of life and clinical outcomes for affected patients.

Notch1 hyperactivity drives ubiquitination of NOX2 and dysfunction of CD8+ regulatory T cells in patients with systemic lupus erythematosus

OBJECTIVES

Patients with SLE display heightened immune activation and elevated IgG autoantibody levels, indicating compromised regulatory T cell (Tregs) function. Our recent findings pinpoint CD8+ Tregs as crucial regulators within secondary lymphoid organs, operating in a NOX2-dependent mechanism. However, the specific involvement of CD8+ Tregs in SLE pathogenesis and the mechanisms underlying their role remain uncertain.

METHODS

SLE and healthy individuals were enlisted to assess the quantity and efficacy of Tregs. CD8+CD45RA+CCR7+ Tregs were generated ex vivo, and their suppressive capability was gauged by measuring pZAP70 levels in targeted T cells. Notch1 activity was evaluated by examining activated Notch1 and HES1, with manipulation of Notch1 accomplished with Notch inhibitor DAPT, Notch1 shRNA, and Notch1-ICD. To create humanized SLE chimaeras, immune-deficient NSG mice were engrafted with PBMCs from SLE patients.

RESULTS

We observed a reduced frequency and impaired functionality of CD8+ Tregs in SLE patients. There was a downregulation of NOX2 in CD8+ Tregs from SLE patients, leading to a dysfunction. Mechanistically, the reduction of NOX2 in SLE CD8+ Tregs occurred at a post-translational level rather than at the transcriptional level. SLE CD8+ Tregs exhibited heightened Notch1 activity, resulting in increased expression of STUB1, an E3 ubiquitin ligase that binds to NOX2 and facilitates its ubiquitination. Consequently, restoring NOX2 levels and inhibiting Notch1 activity could alleviate the severity of the disease in humanized SLE chimaeras.

CONCLUSION

Notch1 is the cell-intrinsic mechanism underlying NOX2 deficiency and CD8+ Treg dysfunction, serving as a therapeutic target for the clinical management of SLE.

Achieving sub-millisievert CT colonography for accurate colorectal tumor detection using smart examination protocols: a prospective self-controlled study

PURPOSE

To assess the feasibility of combining Auto-kVp selection technique, higher preset ASIR-V and noise index (NI) to realize individualized sub-mSv CT colonography (CTC) for accurate colorectal tumor detection and localization.

METHODS

Ninety patients with suspected colorectal cancer (CRC) were prospectively enrolled to undergo standard dose CTC (SDCTC) in the prone and ultra-low dose CTC (ULDCTC) in the supine position. SDCTC used 120 kVp, preset ASIR-V of 30%, SmartmA for a NI of 13; ULDCTC used Auto-kVp selection technique with 80 or 100 kVp, preset ASIR-V of 60%, SmartmA for a NI of 13 for 80 kVp, and NI of 15 for 100 kVp. The effective dose (ED), image quality [signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of colorectal neoplasms] between the two protocols were compared and the accuracies of tumor locations were evaluated for CTC in comparison with the surgery results.

RESULTS

The mean ED of the ULDCTC-80 kVp subgroup was 0.70 mSv, 71.43% lower than the 2.45 mSv for the 120 kVp group, while that of the ULDCTC-100 kVp subgroup was 0.98 mSv, 73.00% lower than the 3.63 mSv for the 120 kVp group (P < 0.001). The tumor SNR and CNR of the ULDCTC were higher than those of SDCTC (P < 0.05), while there was no difference in the subjective image quality between them with good inter-observer agreement (Kappa: 0.805-0.923). Both SDCTC and ULDCTC groups had high detection rate of colorectal tumors, along with good consistency in determining tumor location compared with surgery reports (Kappa: 0.718-0.989).

CONCLUSION

The combination of Auto-kVp selection, higher preset ASIR-V and NI achieves individualized sub-mSv CTC with good performance in detecting and locating CRC with surgery and consistent results between SDCTC and ULDCTC.

Double Diabetes: A Converging Metabolic and Autoimmune Disorder Redefining the Classification and Management of Diabetes

This review explores the pathophysiology, clinical implications, and management of double diabetes. The increasing prevalence of obesity, sedentary lifestyles, and genetic predisposition has blurred the difference between type 1 and type 2 diabetes, leading to diagnostic and therapeutic challenges. Double diabetes presents with overlapping symptoms from both diabetes types, making accurate diagnosis crucial. Biomarkers, such as C-peptide levels, autoantibody testing, and insulin resistance markers, help differentiate double diabetes from classic diabetes subtypes. Early intervention is necessary because of the condition's elevated risk of microvascular and macrovascular consequences, such as retinopathy, nephropathy, and cardiovascular disease. Effective management integrates pharmacological and lifestyle approaches. Metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and insulin therapy adjustments all boost glycemic control and metabolic results. Additionally, structured exercise, dietary modifications, and weight management are essential for reducing insulin resistance and preserving beta-cell activity. The potential of precision medicine, artificial intelligence (AI)-driven healthcare, and continuous glucose monitoring (CGM) offers promising advancements for personalized treatment strategies. Future research should focus on targeted immunotherapies, genetic profiling, and refined clinical guidelines to improve early detection and individualized treatment, with long-term outcomes. The review emphasizes the need for a multidisciplinary approach in managing double diabetes, ensuring early diagnosis, optimized treatment, and improved metabolic health to mitigate long-term complications.

Biological mechanism and functional verification of key genes related to major depressive disorder and type 2 diabetes mellitus

Major depressive disorder (MDD) and type 2 diabetes (T2D) have been shown to be linked, but a comprehensive understanding of the underlying molecular mechanisms remains elusive. The purpose of this study was to explore the biological relationship between MDD and T2D and verify the functional roles of key genes. We used the Gene Expression Omnibus database to investigate the targets associated with MDD and T2D. Using linear models for microarray data, differentially expressed genes associated with MDD and T2D were identified in GSE76826 and GSE95849, respectively, and 126 shared genes were significantly upregulated. Weighted gene coexpression network analysis identified modules associated with MDD and T2D in the GSE38206 and GSE20966 datasets and identified 8 common genes. Functional enrichment analysis revealed that these genes were enriched in cell signaling, enzyme activity, cell structure and amino acid biosynthesis and involved in cell death pathways. Finally, combined with the CTD and GeneCards databases, lysophosphatidylglycerol acyltransferase 1 (LPGAT1) was identified as a key gene. LPGAT1 was validated in GSE201332 and GSE182117, and the subject operating characteristic curve showed good diagnostic potential for MDD and T2D. Additionally, we used an in vitro model of MDD related to T2D to verify the expression of LPGAT1. A subsequent gene knockdown assay revealed that the downregulation of LPGAT1 improved mitochondrial function and reduced apoptosis in damaged neurons. Taken together, our results highlight the role of LPGAT1 in the connection between MDD and T2D, and these findings provide new insights into potential therapeutic targets for depression associated with diabetes.

Shared molecular, cellular, and environmental hallmarks in cardiovascular disease and cancer: Any place for drug repurposing?

Cancer and cardiovascular disease (CVD) are the 2 biggest killers worldwide. Specific treatments have been developed for the 2 diseases. However, mutual therapeutic targets should be considered because of the overlap of cellular and molecular mechanisms. Cancer research has grown at a fast pace, leading to an increasing number of new mechanistic treatments. Some of these drugs could prove useful for treating CVD, which realizes the concept of cancer drug repurposing. This review provides a comprehensive outline of the shared hallmarks of cancer and CVD, primarily ischemic heart disease and heart failure. We focus on chronic inflammation, altered immune response, stromal and vascular cell activation, and underlying signaling pathways causing pathological tissue remodeling. There is an obvious scope for targeting those shared mechanisms, thereby achieving reciprocal preventive and therapeutic benefits. Major attention is devoted to illustrating the logic, advantages, challenges, and viable examples of drug repurposing and discussing the potential influence of sex, gender, age, and ethnicity in realizing this approach. Artificial intelligence will help to refine the personalized application of drug repurposing for patients with CVD. SIGNIFICANCE STATEMENT: Cancer and cardiovascular disease (CVD), the 2 biggest killers worldwide, share several underlying cellular and molecular mechanisms. So far, specific therapies have been developed to tackle the 2 diseases. However, the development of new cardiovascular drugs has been slow compared with cancer drugs. Understanding the intersection between pathological mechanisms of the 2 diseases provides the basis for repurposing cancer therapeutics for CVD treatment. This approach could allow the rapid development of new drugs for patients with CVDs.

Novel antimicrobial strategies for diabetic foot infections: addressing challenges and resistance

AIMS

This review examines the challenges posed by Diabetic Foot Infections (DFIs), focusing on the impact of neuropathy, peripheral arterial disease, immunopathy, and the polymicrobial nature of these infections. The aim is to explore the factors contributing to antimicrobial resistance and assess the potential of novel antimicrobial treatments and drug delivery systems in improving patient outcomes.

METHOD

A comprehensive analysis of existing literature on DFIs was conducted, highlighting the multifactorial pathogenesis and polymicrobial composition of these infections. The review delves into the rise of antimicrobial resistance due to the overuse of antimicrobials, biofilm formation, and microbial genetic adaptability. Additionally, it considers glycemic control, patient adherence, and recurrence rates as contributing factors to treatment failure. Emerging therapies, including new antimicrobial classes and innovative drug delivery systems, were evaluated for their potential efficacy.

RESULTS

DFIs present unique treatment challenges, with high rates of antimicrobial resistance and poor response to standard therapies. Biofilm formation and the genetic adaptability of pathogens worsen resistance, complicating treatment. Current antimicrobial therapies are further hindered by poor glycemic control and patient adherence, leading to recurrent infections. Novel antimicrobial classes and innovative delivery systems show promise in addressing these challenges by offering more targeted, effective treatments. These new approaches aim to reduce resistance and improve treatment outcomes.

CONCLUSION

DFIs remain a clinical challenge due to their multifactorial nature and antimicrobial resistance. The development of novel antimicrobials and drug delivery systems is crucial to improving patient outcomes and combating resistance. Future research should focus on enhancing treatment efficacy, reducing resistance, and addressing patient adherence to reduce the burden of DFIs.

Linking microRNA to metabolic reprogramming and gut microbiota in the pathogenesis of colorectal cancer (Review)

Colorectal cancer (CRC), an emerging public health concern, is one of the leading causes of cancer morbidity and mortality worldwide. An increasing body of evidence shows that dysfunction in metabolic reprogramming is a crucial characteristic of CRC progression. Specifically, metabolic reprogramming abnormalities in glucose, glutamine and lipid metabolism provide the tumour with energy and nutrients to support its rapid cell proliferation and survival. More recently, microRNAs (miRNAs) appear to be involved in the pathogenesis of CRC, including regulatory roles in energy metabolism. In addition, it has been revealed that dysbiosis in CRC might play a key role in impairing the host metabolic reprogramming processes, and while the exact interactions remain unclear, the link may lie with miRNAs. Hence, the aims of the current review include first, to delineate the metabolic reprogramming abnormalities in CRC; second, to explain how miRNAs mediate the aberrant regulations of CRC metabolic pathways; third, linking miRNAs with metabolic abnormalities and dysbiosis in CRC and finally, to discuss the roles of miRNAs as potential biomarkers.

High Interleukin (IL)-6 is Associated with Lower Lung Function and Increased Likelihood of Metabolic Dysfunction in Asthma

INTRODUCTION

Asthma is a complex condition characterized by airway inflammation. Interleukin-6 (IL-6) plays a significant role in asthma pathogenesis through its effects on T cells and its association with pro-inflammatory responses. Both lung and circulating IL-6 levels are elevated in asthma. IL-6 is positively associated with disease severity, frequent exacerbations, and impaired lung function, all of which can be observed clinically. We developed an IL-6 cut-off model to examine the association between high IL-6, race, high body mass index (BMI), metabolic disease, and asthma severity as assessed by reduced lung function.

METHODS

This study utilized the Coronary Artery Risk Development in Young Adults (CARDIA) database, comprised of 5115 adults, to investigate the relationship between IL-6 levels, asthma, race, and metabolic dysfunction. A "healthy" subset of 427 patients was used to compute the IL-6 cut-off. IL-6 levels within detection limits (0.15-12 pg/mL) were analyzed. The IL-6 cut-off was determined using the 95th percentile of log-transformed IL-6 values for lean (BMI < 25) and healthy individuals. Specific cut-offs were established for racial groups. Statistical analyses involved comparing patient characteristics between high and low IL-6 groups, regression analyses, and assessment of factors influencing lung function changes.

RESULTS

Using an IL-6 cut-off of 4.979 pg/mL, the cohort was divided into high and low IL-6 groups. High IL-6 correlated with Black race, higher BMI, hypertension, and markers of metabolic dysfunction, e.g., elevated HbA1c, C-reactive protein (CRP), and reduced lung function. Multivariable analysis linked high IL-6 with male gender, high BMI, Black race, HbA1c, CRP, and inversely with lung function and total cholesterol. Obesity showed a consistent positive association with elevated IL-6, regardless of the presence or absence of asthma. Patients with asthma and high IL-6 were more likely to be Black and showed increased CRP. Lung function was lowest in non-lean, high IL-6 patients with asthma, with similar trends in non-lean (BMI ≥ 25) patients without asthma.

CONCLUSION

This study underscores the significant association between IL-6, asthma, obesity, and metabolic dysfunction. Elevated IL-6 correlates with asthma severity, particularly in individuals with obesity. Future research should explore anti-IL-6 therapies for specific phenotypes, such as obesity-related asthma. These findings advance our understanding of asthma and the role of IL-6 in its pathogenesis.

Clinical application of biological agents in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder primarily distinguished by synovial inflammation, which, as the disease evolves, can lead to bone erosion and destruction. Consequently, the pivotal strategy in preventing joint damage and fostering functional recovery lies in the effective management of synovial inflammation. Disease-modifying antirheumatic drugs (DMARDs) and prednisone therapy remain the first-line treatments for RA. However, in instances of refractory RA, these medications may fall short in adequately controlling inflammation, and they are often accompanied by several adverse effects, including limited bioavailability, therapeutic resistance, and potentially toxic side effects. Given these challenges, the identification of targeted therapies to manage disease activity and diminish inflammation becomes imperative.Recently, biologic agents for the treatment of RA have garnered significant attention owing to their minimal side effect profile, reduced potential for drug dependence, and their precise therapeutic action directly on target cells. This review provides a comprehensive exploration of advancements in biologics that target and inhibit inflammatory cytokine receptors, specifically TNF-α, IL-6, and IL-1β, as well as B lymphocyte receptors, TLR4, nanodrugs, and Janus kinase (JAK) inhibitors in the context of RA. By providing innovative perspectives and strategies for the treatment of this condition, this review contributes to the ongoing efforts to refine and improve the therapeutic landscape for RA.

The Therapeutic Potential of Myo-Inositol in Managing Patients with Respiratory Diseases

Respiratory diseases are major health concerns worldwide. Chronic respiratory diseases (CRDs) are the third leading cause of death worldwide and some of the most common are chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases, and pulmonary hypertension. Despite having different etiology and characteristics, these diseases share several features, such as a persistent inflammatory state, chronic oxidative stress, impaired mucociliary clearance, and increased alveolar surface tension. CRDs are not curable; however, various forms of treatment, that help restore airway patency and reduce shortness of breath, can improve daily life for people living with these conditions. In this regard myo-inositol may represent a valid therapeutic adjuvant approach due to its properties. Being a redox balancer, an inflammation modulator, and, most importantly, a component of pulmonary surfactant, it may improve lung function and counteract symptoms associated with respiratory diseases, as recently evidenced in patients with COPD, COVID-19, asthma, and bronchiectasis. The aim of this review is to evaluate the potential therapeutic role of myo-inositol supplementation in the management of patients with respiratory diseases.

Gut microbiota is associated with persistence of longer-term BNT162b2 vaccine immunogenicity

Introduction

BNT162b2 immunogenicity wanes with time and we investigated association between gut microbiota and longer-term immunogenicity.

Methods

This cohort study prospectively recruited adult BNT162b2 two-dose recipients from three vaccination centers in Hong Kong. Blood samples were collected at baseline and day 180 after first dose, and tested for neutralizing antibodies (NAb) against receptor-binding domain (RBD) of wild type SARS-CoV-2 virus using chemiluminescence immunoassay. Shotgun DNA metagenomic sequencing was performed to characterize baseline stool microbiome. Baseline metabolites were measured by gas and liquid chromatography-tandem mass spectrometry (GC-MS/MS and LC-MS/MS). Primary outcome was persistent high NAb response (defined as top 25% of NAb level) at day 180. Putative bacterial species and metabolic pathways were identified using linear discriminant analysis [LDA] effect size analysis. Multivariable logistic regression adjusting for clinical factors was used to derive adjusted odds ratio (aOR) of outcome with bacterial species and metabolites.

Results

Of 242 subjects (median age: 50.2 years [IQR:42.5-55.6]; male:85 [35.1%]), 61 (25.2%) were high-responders while 33 (13.6%) were extreme-high responders (defined as NAb≥200AU/mL). None had COVID-19 at end of study. Ruminococcus bicirculans (log10LDA score=3.65), Parasutterella excrementihominis (score=2.82) and Streptococcus salivarius (score=2.31) were enriched in high-responders, while Bacteroides thetaiotaomicron was enriched in low-responders (score=-3.70). On multivariable analysis, bacterial species (R. bicirculans-aOR: 1.87, 95% CI: 1.02-3.51; P. excrementihominis-aOR: 2.2, 95% CI: 1.18-4.18; S. salivarius-aOR: 2.09, 95% CI: 1.13-3.94) but not clinical factors associated with high response. R. bicirculans positively correlated with most metabolic pathways enriched in high-responders, including superpathway of L-cysteine biosynthesis (score=2.25) and L-isoleucine biosynthesis I pathway (score=2.16) known to benefit immune system. Baseline serum butyrate (aOR:10.00, 95% CI:1.81-107.2) and isoleucine (aOR:1.17, 95% CI:1.04-1.35) significantly associated with extreme-high vaccine response.

Conclusion

Certain gut bacterial species, metabolic pathways and metabolites associate with longer-term COVID-19 vaccine immunogenicity.

Risk Factors for Flares and New Lesions of Hidradenitis Suppurativa Following COVID-19 Disease: A Retrospective Cohort Study of 310 Patients in Greece

BACKGROUND

COVID-19 disease has been associated with flares or new onsets of various autoinflammatory diseases such as psoriasis and atopic dermatitis. Our aim is to investigate the occurrence and risk factors of flares or new onsets of Hidradenitis Suppurativa (HS) following COVID-19 disease.

METHODS

A retrospective cohort study was performed including 310 patients with HS following COVID-19 disease. Data on the rate of HS flares, new lesions, time of flare onset, and flare duration were recorded. Demographics, clinical characteristics, and treatment parameters were compared between patients with and without HS flares.

RESULTS

HS flares developed in 69 (22.2%) patients, with 14 experiencing their first episode. The median period between COVID-19 and flare onset was 17 days, with a median flare duration of 14 days. For new HS onset, the median period was 9.5 days, and the median duration was 13 days. Biologic treatment was less common in patients with flares (7.2% vs. 23.2%, p = 0.003), and fewer patients with flares were vaccinated (81.1% vs. 99.1%, p < 0.001). Multivariable analysis showed lower risk for flares in those receiving biologics (aOR = 0.14, p = 0.002) and those who were vaccinated (aOR = 0.02, p < 0.001).

CONCLUSIONS

COVID-19 may trigger HS flares and new onset, with biologic treatment and vaccination offering protection.

Gut microbiota therapy in gastrointestinal diseases

The human gut microbiota, consisting of trillions of microorganisms, plays a crucial role in gastrointestinal (GI) health and disease. Dysbiosis, an imbalance in microbial composition, has been linked to a range of GI disorders, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, and colorectal cancer. These conditions are influenced by the interactions between the gut microbiota, the host immune system, and the gut-brain axis. Recent research has highlighted the potential for microbiome-based therapeutic strategies, such as probiotics, prebiotics, fecal microbiota transplantation (FMT), and dietary modifications, to restore microbial balance and alleviate disease symptoms. This review examines the role of gut microbiota in the pathogenesis of common gastrointestinal diseases and explores emerging therapeutic approaches aimed at modulating the microbiome. We discuss the scientific foundations of these interventions, their clinical effectiveness, and the challenges in their implementation. The review underscores the therapeutic potential of microbiome-targeted treatments as a novel approach to managing GI disorders, offering personalized and alternative options to conventional therapies. As research in this field continues to evolve, microbiome-based interventions hold promise for improving the treatment and prevention of gastrointestinal diseases.

Pediatric rheumatology on social media: experts ensure accuracy, public drives engagement - a comparative analysis

We aimed to investigate the quality and characteristics of content related to pediatric rheumatology on social media, comparing posts by health professionals (HPs) and non-HP (NHPs). Content creators, engagement metrics, sentiment, and misinformation were evaluated in the 150 most popular posts from 18 hashtags related to pediatric rheumatology on Facebook, Instagram, and TikTok. The Journal of American Medical Association Benchmark Scale (JAMA) and the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) were used to assess quality, understandability and actionability in educational videos, respectively. Overall, 6723 posts were included (3130 photos, 3593 videos). The content accounted for 37.6 million interactions and 520.8 million views. NHPs represented the majority of creators (5160, 76.8%). Among educational posts (2074, 30.8%), HPs provided longer (59 [IQR 85] sec vs. 50 [IQR 77] sec; p < 0.001) more understandable (PEMAT-A/V 85.7 [IQR 18.9] vs. 75 [IQR 25]; p < 0.001), more actionable (PEMAT-A/V 66.7 [IQR 33.3] vs. 50 [IQR 41.7]; p < 0.001), and higher-quality (JAMA 3 [IQR 0] vs. 3 [IQR 1]; p < 0.001) videos than NHPs. In contrast, NHPs shared more commented educational photos (3 [IQR 11] vs. 1 [IQR 8]; p < 0.001) and videos (8 [IQR 50] vs. 4 [IQR 27]; p < 0.001) and more viewed videos (6181 [IQR 23417] vs. 2967.5 [IQR 20943]; p = 0.034) than HPs. Despite high interest in content related to pediatric rheumatology on social media, HPs are a minority of creators but provide better educational content than NHPs. There is a significant opportunity to provide high-quality educational content through these popular digital platforms.

Blocking peptidyl arginine deiminase 4 confers neuroprotective effect in the post-ischemic brain through both NETosis-dependent and -independent mechanisms

Peptidylarginine deiminase 4 (PAD4) is an enzyme that modifies proteins by converting positively charged arginine residues to neutral citrulline residues. This process, termed citrullination, has been known to trigger NETosis, a neutrophil cell death pathway involving the release of neutrophil extracellular traps (NETs). Abnormal PAD4 activity and protein citrullination have been linked to various diseases, including those affecting the central nervous system. Herein we investigated the profile of PAD4 expression in an animal model of stroke induced by middle cerebral artery occlusion (MCAO). PAD4 levels were significantly elevated in the ischemic core and penumbra of the affected hemisphere at 3-6 and 6-48 h post-MCAO, respectively. Notably, NETosis induction, indicated by the upregulation of CitH3 (citrullinated histone H3, a NETosis marker), was observed between 48 and 96 h post-MCAO, peaking at 96 h. While PAD4 was present in most brain cell types of sham controls, strong PAD4 induction was primarily observed in neurons during the peak PAD4 induction period (12-24 h post-MCAO). Importantly, intranasal administration of the PAD4 inhibitor BB-Cl-amidine (BBCA) significantly reduced infarct volume and improved neurological and functional outcomes at 24 h post-MCAO, demonstrating a strong protective effect of PAD4 inhibition in ischemic stroke. Staining with an antibody that recognizing citrullinated proteins (F95) revealed an accumulation of these proteins, especially degenerating neurons, however, BBCA treatment significantly suppressed this accumulation in dying neurons. These findings indicate that PAD4-mediated protein citrullination in neurons plays a critical role in promoting ischemic brain damage. Furthermore, delayed administration of BBCA (at 48/72 h post-MCAO) suppresses the NETosis induction observed at 96 h post-MCAO, potentially ameliorating repair processes such as blood vessel regeneration. Collectively, these findings suggest a complex role of PAD4 in cerebral ischemia, with neuroprotective effects (NETosis-independent function) during the acute to subacute period and NETosis-suppressive effects at later time points.