The first two human infections with Helicobacter zhangjianzhongii, a new Helicobacter closely related to Helicobacter canis

PURPOSE

In 2023, Helicobacter zhangjianzhongii was proposed as a new species in the Helicobacter genus. We here describe two human cases of H. zhangjianzhongii bacteremia.

METHODS

Four clinical strains from the Helicobacter genus isolated from blood culture between 2017 and 2023 were studied. They were initially identified as H. canis by MALDI-TOF and 16S rDNA sequencing. The strains were biochemically characterized and tested at different temperatures and atmospheres. Two databases were used to characterize the isolates: the Bruker® MBT compass Version 4.1.1 database and a in-house spectrum-enriched database. After bacterial DNA extraction the genomes were sequenced on NovaSeq 6000 (Illumina) and analyzed using an in-house pipeline.

RESULTS

Case 1 involved a 58-year-old woman who was hospitalized in a thoracic oncology unit because her general condition deteriorated in a setting of small-cell carcinoma. She presented with abdominal pain associated with significant hepatomegaly. Case 2 involved a 78-year-old woman on rituximab who was hospitalized to treat chest pain, anemia, and inflammatory syndrome. Both strains exhibited very similar microbiological and genomic characteristics, thus growth in a microaerobic atmosphere at 37°C and 42°C, oxidase-positivity, and urease- and catalase-negativity. Both were formally identified by whole-genome sequencing as H. zhangjianzhongii (ANI > 99% and DDH > 94%).

CONCLUSION

This proposed species is associated with bacteremia in humans. It is thus likely to be a novel human pathogen. Dogs may have been the source of infection.

Gut Microbiota and Autism Spectrum Disorder: A Neuroinflammatory Mediated Mechanism of Pathogenesis?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and behavior, frequently accompanied by restricted and repetitive patterns of interests or activities. The gut microbiota has been implicated in the etiology of ASD due to its impact on the bidirectional communication pathway known as the gut-brain axis. However, the precise involvement of the gut microbiota in the causation of ASD is unclear. This study critically examines recent evidence to rationalize a probable mechanism in which gut microbiota symbiosis can induce neuroinflammation through intermediator cytokines and metabolites. To develop ASD, loss of the integrity of the intestinal barrier, activation of microglia, and dysregulation of neurotransmitters are caused by neural inflammatory factors. It has emphasized the potential role of neuroinflammatory intermediates linked to gut microbiota alterations in individuals with ASD. Specifically, cytokines like brain-derived neurotrophic factor, calprotectin, eotaxin, and some metabolites and microRNAs have been considered etiological biomarkers. We have also overviewed how probiotic trials may be used as a therapeutic strategy in ASD to reestablish a healthy balance in the gut microbiota. Evidence indicates neuroinflammation induced by dysregulated gut microbiota in ASD, yet there is little clarity based on analysis of the circulating immune profile. It deems the repair of microbiota load would lower inflammatory chaos in the GI tract, correct neuroinflammatory mediators, and modulate the neurotransmitters to attenuate autism. The interaction between the gut and the brain, along with alterations in microbiota and neuroinflammatory biomarkers, serves as a foundational background for understanding the etiology, diagnosis, prognosis, and treatment of autism spectrum disorder.

Proposal and exploration of a novel score to quantify patient-perceived burden of inflammatory bowel disease under routine care

BACKGROUND

The burden of inflammatory bowel disease (IBD) is often reported on from a system or cost viewpoint. We created and explored a novel patient-perceived burden of disease (PPBoD) score in a large Australasian cohort.

AIM

To create and explore a novel patient-perceived burden of disease (PPBoD) score in a large Australasian cohort, and correlate PPBoD scores with demographics, disease and treatment factors.

METHODS

The Crohn Colitis Care Registry was interrogated in October 2023. Data from adults with IBD with an outpatient care encounter in the last 14 months among 17 centres were included. A novel PPBoD score was designed for ulcerative colitis (UC), Crohn disease (CD) and IBD-unclassified (IBDU). Correlations between PPBoD scores and demographics, disease and treatment factors were examined.

RESULTS

Of those with adequate data, 46.7% (2653/5685) had no PPBoD, 34.6% (1969/5685) had mild, 11.3% (641/5685) had moderate and 7.4% (422/5685) had significant PPBoD. New Zealanders were more likely to have higher PPBoD compared to Australians (P = 0.047). Greater PPBoD was seen in patients with CD and IBDU compared to patients with UC (P < 0.001) and females were more likely to have significant PPBoD (8.7%) than males (6.1%) (P < 0.001). People with no or mild PPBoD were more likely to be on advanced therapies (55.7% and 59.5% respectively) than those with significant PPBoD (46.3%) (P < 0.001). The proportion of people on advanced therapies in Australia was higher than in New Zealand (61.2% vs 38.5% respectively, P < 0.001). Steroid usage was significantly higher in people with greater PPBoD (significant BoD 7.1% vs no BoD 1.1%; P < 0.001).

CONCLUSION

Most of this real-world care cohort had no or mild PPBoD. Data suggest that higher PPBoD levels may be resolved by appropriate therapeutic escalations.

Integrated Analysis of Intersecting Neutrophil Signatures in Behçet's Disease and Inflammatory Bowel Disease

INTRODUCTION

Behçet's disease (BD) and inflammatory bowel disease (IBD) are chronic inflammatory diseases characterized by immune system dysregulation. The critical role of neutrophils in these conditions is increasingly recognized. This study aimed to identify a shared set of neutrophils differentially expressed genes (NDEGs) to aid in the differential diagnosis of the two diseases.

METHODS

Bioinformatics analysis of GEO data combined with WGCNA identified 65 key NDEGs. Functional enrichment and immune infiltration analyses were conducted. RT-qPCR validated six hub NDEGs in neutrophils from IBD and BD patients. Serum CD226 levels were measured by ELISA, and a ROC curve assessed its diagnostic value. Additionally, neutrophils were stimulated with patient serum, followed by Western blot analysis.

RESULTS

Immune infiltration analysis showed higher blood neutrophil levels in BD than in IBD. Neutrophil sequencing identified NDEGs upregulated in BD but downregulated in IBD, linked to T-cell receptor pathways. RT-PCR confirmed elevated FYN, CD99, SKAP1, and CD226 in BD neutrophils, while KLRG1 and MATK were higher in IBD. ELISA showed increased serum CD226 in BD. Western blot revealed higher Elastase and PAD4 in BD-stimulated neutrophils, while CXCL11 was elevated in IBD-stimulated neutrophils.

CONCLUSIONS

Our findings suggest that BD and IBD neutrophils may have distinct functional states, potentially linked to differential T-cell interactions. These insights highlight neutrophils' diverse roles in immune dysregulation and their potential as diagnostic markers and therapeutic targets.

Low FODMAP diet in children with functional abdominal pain disorders. Is it always worth trying?: Low FODMAP diet in children with functional abdominal pain disorders

OBJECTIVE

Our aim was to assess the use of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet in children with different types of functional abdominal pain disorders (FAPD) and to identify predictive factors of response to this diet.

METHODS

This was a multicenter, experimental, uncontrolled, prospective trial. Patients with irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain followed a low FODMAP diet for 2 weeks. We collected data on abdominal pain before and after the diet. Patients who showed a ≥ 50 % reduction in abdominal pain frequency were considered responders.

RESULTS

A total of 48 patients with FAPD participated in this trial. They all showed a significant decrease in the frequency (p < 0.05) and intensity (p < 0.05) of abdominal pain after the diet. We considered 41.7 % of patients to be responders. Among children with functional dyspepsia, 66.6 % responded to the diet, and so did 71.4 % of those with IBS. On the contrary, 71.8 % of children with functional abdominal pain were non-responders, and this diagnosis was considered a predictive factor of poor response to the diet (OR: 9.87, CI [1.52; 63.97], p = 0.016).

CONCLUSION

In children with FAPD, a diagnosis of functional abdominal pain is a predictive factor of poor response to a low FODMAP diet. Better results were achieved with this diet in children with IBS or functional dyspepsia.

Incidence and Genetic Risk of Juvenile Idiopathic Arthritis in Norway by Latitude

OBJECTIVE

We aimed to investigate the incidence of juvenile idiopathic arthritis (JIA) in the three geographic regions of Norway and whether potential regional incidence differences are explained by environmental or genetic factors across regions.

METHODS

We conducted a register-based cohort study including all Norwegian children born from 2004 to 2019, with follow-up throughout 2020. The JIA diagnosis, defined by at least two International Classification of Diseases, Tenth Revision codes for JIA, was validated against medical records. The incidence rate (IR) and hazard ratio (HR) for JIA were estimated for all Norway and for the North, Mid, and South regions. In a subsample from the Norwegian Mother, Father, and Child Cohort Study (MoBa), the genetic risk for JIA was assessed in the three regions.

RESULTS

After median 9.1 (range 0.3-16.0) years of follow-up, we identified 1,184 patients with JIA and 910,058 controls. The IR for JIA/100,000 person-years was 14.4 in all of Norway, 25.9 in the North region, 17.9 in the Mid region, and 12.5 in the South region. The HR (95% confidence interval [CI]) of JIA in the North region was 2.07 (1.77-2.43) and in the Mid region HR 1.43 (95% CI 1.23-1.67) compared with the South region. Adjustments for perinatal factors, socioeconomic status, and early antibiotic exposure did not change our estimates substantially. In MoBa (238 patients with JIA, 57,392 controls), the association between JIA and region of birth was no longer significant when adjusting for genetic factors.

CONCLUSION

We found a higher incidence of JIA with increasing latitude without evidence for available environmental factors explaining the observed gradient. In contrast, genetic factors modified the association, but further studies are warranted.

Pathological characteristics of inflammatory bowel diseases

Inflammatory bowel disease (IBD) is an inflammatory disorder in which intestinal homeostasis is disrupted for some reason. Among them, ulcerative colitis (UC) and Crohn's disease (CD) are frequently referred to as IBD in the narrow sense, characterized by relapse episodes and remission periods. The differential diagnosis of IBD involves a broad spectrum of inflammatory or infectious diseases that mimic UC and/or CD, as well as others that may complicate existing IBD. Accordingly, these differential diseases and modifying factors should be considered in their pathological diagnosis, and a careful diagnosis should be made in close collaboration with clinicians. Here, we provide a pathological overview of UC, CD, and their differential diseases, as well as IBD-associated cancers, demonstrating their typical gross and histological features. Further, we introduce a pathological scoring system for biopsy specimens to diagnose IBD that may potentially be integrated into clinical practice.

No-Biopsy Diagnosis of Coeliac Disease in Children Without Anti-Endomysial IgA Antibody Testing: Combining Anti-Tissue Transglutaminase IgA and Anti-Deamidated Gliadin IgG Antibodies

AIM

To determine the utility of anti-tissue transglutaminase IgA antibodies (tTG-IgA) and anti-deaminated gliadin peptide IgG antibodies (DGP-IgG) in detecting coeliac disease (CD) and whether DGP-IgG can replace anti-endomysial IgA antibody in the European Society for Paediatric Gastroenterology Hepatology and Nutrition no-biopsy approach in diagnosing CD.

METHODS

Children aged < 19 years who had paired tTG-IgA and DGP-IgG performed and had a gastroscopy with biopsies between 1 March 2016 and 31 October 2020 were retrospectively reviewed.

RESULTS

Of 1206 patients who fulfilled the study criteria, 298 (24.7%) patients were diagnosed with CD. Fifteen patients with IgA deficiency were excluded from any tTG-IgA analysis. tTG-IgA had sensitivity and specificity of 93.5% and 92.0%, respectively, in detecting CD, while DGP-IgG had sensitivity of 97.0% and specificity of 86.7%. tTG-IgA ≥ 10x upper limit of normal (ULN) alone had a specificity of 99.3% and a positive predictive value (PPV) of 96.8%. An optimal DGP-IgG threshold was identified to be 70 U/mL (3.5x ULN) based on > 99% specificity in detecting CD. When tTG-IgA ≥ 10x ULN was combined with DGP-IgG ≥ 3.5 ULN, the PPV in diagnosing CD was 98.5%. DGP-IgG performed well in detecting CD in 126 children aged < 3 years, with all patients with CD having an elevated DGP-IgG (sensitivity 100%).

CONCLUSIONS

Combined tTG-IgA ≥ 10x ULN and DGP-IgG ≥ 3.5x ULN provided a high PPV (98.5%) in diagnosing CD. DGP-IgG testing can potentially replace EMA testing in those children with tTG-IgA ≥ 10x ULN. Future studies should evaluate DGP-IgG testing as a sequential test.

Flourishing in life in patients with Inflammatory Bowel Disease: The role of illness identity and health-related quality of life

Amidst chronic challenges in Inflammatory Bowel Disease (IBD), including physical symptoms, emotional stress, and social constraints, this study aimed to elucidate how patients' perceptions of their illness and its integration into their self-concept are related to their ability to flourish in life. We hypothesized that having a positive and integrative illness identity and social identification will predict higher flourishing, mediated by enhanced health-related quality of life (HRQoL). In an online survey with 244 German-speaking IBD adults (Mage = 36.62, 85% women), we found that lower engulfment (where the disease dominates one's identity) predicted higher levels of flourishing, mediated by higher HRQoL. Enrichment, reflecting personal growth from illness, directly predicted higher flourishing, while stronger social identification predicted higher subjective well-being, but not flourishing. The results highlight the potential of fostering positive illness identities and social connections to enhance flourishing in individuals with IBD or similar chronic conditions.

Incidence of Inflammatory Bowel Disease in Children

Background

Many of the patients with inflammatory bowel disease (IBD) are children and adolescents, and the incidence of pediatric IBD is increasing. However, understanding epidemiological trends is crucial for effective prevention and treatment and reducing the local and global burden of IBD. Little data exist regarding the incidence of IBD in the child population in the Kujawsko-Pomorskie Voivodeship. The aims of this study were to evaluate the incidence of IBD in the period 2011 - 2022 and to compare the data regarding three types of IBD, namely ulcerative colitis (UC), Crohn's disease (CD), and unclassified inflammatory bowel disease (IBD-U), from the first half, i.e. 2011 - 2016, to the second half, i.e. 2017 - 2022.

Methods

This retrospective study analyzed the medical records of 118 IBD patients hospitalized at the Department of Pediatrics, Allergology and Gastroenterology from the central-northern part of Poland.

Results

Of the 118 patients diagnosed with IBD, 48 (40.68%) had CD, 57 (48.31%) had UC, and 13 (11.01%) had IBD-U. Between 2011 and 2016, 48 new IBD patients were diagnosed, with a further 70 new cases added between 2017 and 2022, representing a significant increase over the period (P = 0.033). Also, a significant increase was seen for UC, i.e. rising from 19 new cases between 2011 and 2016, to 38 between 2017 and 2022 (P = 0.015). The increase in CD was not significant.

Conclusion

The incidence of pediatric IBD in the central-northern district of Poland is lower than other countries, it nonetheless appears to be increasing, particularly in children with UC. The number of IBD diagnoses in children has increased by nearly 50% over the last 6 years.

Comparison of taurolidine with 4% ethylenediaminetetraacetic acid on antimicrobial lock effectiveness: An experimental study

BACKGROUND

Antimicrobial lock therapy is recommended for preventing and treating catheter-related bloodstream infections, but different solutions have uncertain efficacy.

METHODS

Two locks, 1.35% taurolidine and 4% ethylenediaminetetraacetic acid (EDTA), were tested on Staphylococcus epidermidis, Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, multidrug-resistant P. aeruginosa, vancomycin-resistant Enterococcus faecium, Klebsiella oxytoca (carbapenemase producing), K. pneumoniae (extended-spectrum β-lactamase producing), Candida albicans, and Candida glabrata. Broviac catheter segments were incubated with these organisms and then exposed to various lock solutions. Colony-forming units (CFUs) were counted after 2, 4, and 24 h of incubation.

RESULTS

Taurolidine showed a significant decrease in CFUs after 2 h in S. aureus, S. epidermidis, methicillin-resistant S. aureus, vancomycin-resistant E. faecium, P. aeruginosa (both sensitive and multidrug-resistant strains), K. oxytoca, C. albicans, and C. glabrata. After 4 h, significant reductions were noted in S. aureus, S. epidermidis, methicillin-resistant S. aureus, P. aeruginosa, multidrug-resistant P. aeruginosa, K. pneumoniae, K. oxytoca, and C. albicans. Taurolidine was also effective after 24 h, especially against methicillin-resistant S. aureus and multidrug-resistant P. aeruginosa. Four percent EDTA acid showed a significant reduction in CFUs after 2 h in S. aureus, vancomycin-resistant E. faecium, P. aeruginosa, K. oxytoca, C. albicans, and C. glabrata. After 4 h, reductions occurred in P. aeruginosa, multidrug-resistant P. aeruginosa, K. oxytoca, and C. albicans and after 24 h in methicillin-resistant S. aureus, P. aeruginosa, and K. oxytoca.

CONCLUSION

Taurolidine is more effective than 4% EDTA acid in eradicating Gram-positive and Gram-negative microorganisms and fungi.

Neutrophil-to-Lymphocyte Ratio at Diagnosis Predicts Colonoscopic Activity in Pediatric Inflammatory Bowel Diseases

INTRODUCTION

Neutrophil-to-lymphocyte ratio (NLR) is a novel biomarker studied in several autoimmune diseases including inflammatory bowel disease (IBD) in adults but poorly characterized in pediatric IBD (pIBD). We aimed to primarily investigate the relationship between NLR and pIBD endoscopic disease severity. We also examined whether NLR predicted hospitalization, surgery, and therapy response by 52 weeks.

METHODS

We used the Canadian Children IBD Network prospective inception cohort including patients < 18 years old with baseline data from 2013 to 2022. We excluded patients with concurrent diseases affecting NLR. Both Mayo endoscopic score (MES) and simple endoscopic scale for Crohn's disease (SES-CD) were dichotomized as low activity (quiescent-mild) and high activity (moderate-severe). For therapy responses, we examined year-1 steroid- and biologic-free remission. We used logistic regression for binary outcomes.

RESULTS

A total of 580 patients with ulcerative colitis and 1,081 patients with CD were included. High NLR was associated with high-activity MES and SES-CD in both univariate and multivariable analyses (odds ratio = 1.45, 95% CI = 1.07-1.97, P value = 0.016; and odds ratio = 1.42, 95% CI = 1.04-1.94, P value = 0.026, respectively). We also calculated the best NLR cutoff point to predict MES (1.90, sensitivity = 68%, specificity = 67%, area under the curve [AUC] = 0.67, AUC 95% CI = 0.59-0.74) and SES-CD (2.50, sensitivity = 63%, specificity = 69%, AUC = 0.66, AUC 95% CI = 0.59-0.75) high activity. NLR did not predict therapy response in either ulcerative colitis or CD.

DISCUSSION

Patients with pIBD with high baseline NLR are more probable to have worse endoscopic disease at diagnosis. This highlights NLR potential as a reliable noninvasive biomarker of disease activity. The predictive power of NLR is based mostly on neutrophils and the balance between neutrophils and lymphocytes.

A multicenter study on enteral autonomy outcome of pediatric intestinal failure patients from a middle-income country

BACKGROUND & AIMS

To identify predictors of enteral autonomy and survival in pediatric intestinal failure patients followed up at three pediatric intestinal rehabilitation centers from a middle-income country.

METHODS

This retrospective multicenter cohort study evaluated patients with intestinal failure from three high-volume intestinal rehabilitation centers on long-term parenteral nutrition between 2014 and 2023. The primary outcome was status at the end of the follow-up: parenteral nutrition dependence, enteral autonomy, transplantation, or death. Secondary outcomes were complications resulting from treatment and current parenteral nutrition dependency index. Competing risk analysis, Cox regression, and a decision tree model were employed.

RESULTS

The cohort comprised 207 patients with a median (interquartile range) age at admission of 6.2 (3.1; 12.9) months and a median follow-up of 29.4 (10.2; 49.6) months. Short bowel (85 %) and motility disorders (10.6 %) were the primary causes of intestinal failure. Cumulative incidence of 5-year for enteral autonomy and survival rates were 37 % and 88 %, respectively. Intestinal failure-associated liver disease was present in 24 % of patients on admission. Enteral autonomy was associated with remnant intestine length >40 cm (hazard ratio: 2.0; 95 % confidence interval: 1.7; 3.6); age at admission <6.2 months (hazard ratio: 1.8; 95 % confidence interval: 1.0; 3.3); and preserved ileocecal valve (hazard ratio: 3.4; 95 % confidence interval: 1.9; 6.0). The overall mortality rate was 7.7 %.

CONCLUSION

The overall survival rate was 92.3 % and the 5-year cumulative incidence of enteral autonomy was 37 %. The probability of achieving enteral autonomy was associated with early arrival at the intestinal rehabilitation center and favorable bowel anatomy.

Specialized and standard nutritional formulas for the dietary management of pediatric patients with Crohn's disease: a systematic literature review

INTRODUCTION

This systematic literature review (SLR) aims to compare the clinical, humanistic, and economic outcomes associated with specialized and standard nutritional formulas for the treatment of mild-to-moderate pediatric Crohn's disease.

METHODS

Search strategies were applied across MEDLINE, Cochrane and Web of Science (January 2000-October 2023) and recent congress proceedings (January 2021-October 2023). PRISMA-P guidelines were followed. Quality assessment evaluated risk of bias.

RESULTS

Twenty-three unique studies met the inclusion criteria. Nineteen studies (754 patients) evaluated specialized formula, 10 assessed standard formula (246 patients). Mucosal healing (7 studies), induction (20 studies) and maintenance of remission (9 studies) were reported over various timeframes. High proportions of patients who received specialized formula achieved mucosal healing (63-89% 8 weeks; 25-74% 10 weeks), and remission (50-100% 8 weeks). Specialized formula sustained remission (34-62.5% 6 months and 24-87.5% 1 year). Results were not directly comparable with standard formula due to significant heterogeneity in study methodology, patient populations, and remission definition.

CONCLUSIONS

The evidence predominantly supports the benefits of specialized formula in inducing mucosal healing, remission, and sustaining positive outcomes across multiple timepoints. Direct comparison of nutritional interventions is required to further support the findings of this SLR.Protocol registration: PROSPERO CRD42023472370.

Machine Learning Identification of Neutrophil Extracellular Trap-Related Genes as Potential Biomarkers and Therapeutic Targets for Bronchopulmonary Dysplasia

Neutrophil extracellular traps (NETs) play a key role in the development of bronchopulmonary dysplasia (BPD), yet their molecular mechanisms in contributing to BPD remain unexplored. Using the GSE32472 dataset, which includes 100 blood samples from postnatal day 28, we conducted comprehensive bioinformatics analyses to identify differentially expressed genes (DEGs) and construct gene modules. We identified 86 DEGs, which were enriched in immune and inflammatory pathways, including NET formation. Weighted gene co-expression network analysis (WGCNA) revealed a key gene module associated with BPD. By intersecting 69 NET-related genes (NRGs), 149 module genes, and 86 DEGs, we identified 12 differentially expressed NET-related genes (DENRGs). Immune infiltration analysis revealed an increase in neutrophils, dendritic cells, and macrophages in BPD patients. Machine learning models (LASSO, SVM-RFE, and RF) identified 5 upregulated biomarkers-MMP9, Siglec-5, DYSF, MGAM, and S100A12-showing potential as diagnostic biomarkers for BPD. Validation using nomogram, ROC curves, and qRT-PCR confirmed the diagnostic accuracy of these biomarkers. Clinical data analysis showed that Siglec-5 was most strongly correlated with BPD severity, while DYSF correlated with the grade of retinopathy of prematurity (ROP) and its laser treatment. Clustering analysis revealed two distinct BPD subtypes with different immune microenvironment profiles. Drug-gene interaction analysis identified potential inhibitors targeting MGAM and MMP9. In conclusion, the study identifies five NET-related biomarkers as reliable diagnostic tools for BPD, with their upregulation and association with disease severity and complications, such as ROP, highlighting their clinical relevance and potential for advancing BPD diagnostics and treatment.

Multifaceted Cardioprotective Potential of Reduced Glutathione Against Doxorubicin-Induced Cardiotoxicity via Modulating Inflammation-Oxidative Stress Axis

Doxorubicin (DOX) is a potent chemotherapeutic agent used to treat many types of cancer. Its use is limited because of the reported accompanied cardiotoxicity, which is driven by oxidative stress and inflammation. Herin, we explored the cardioprotective impact of reduced glutathione (GSH) against DOX-induced cardiac damage in a mice model and highlighted the dynamic interplay between pro-inflammatory and antioxidant mechanisms, with tissue damage markers and oxidative byproducts. Mice were divided into four groups and administered DOX, GSH, or a combination, and the outcomes were compared to untreated controls. DOX administration caused significant mortality, weight loss, elevated serum markers of cardiac injury (CK-MB and LDH), oxidative stress (MDA and iron), pro-inflammatory cytokines (IL-6, IL-17, and IL-23), and upregulated pro-inflammatory gene expression of STAT-3 and NFκB as well as downregulated gene expression of NRF-2 and HO-1. Histological analysis showed myocardial fibrosis, vacuolization, and apoptosis, as confirmed by a TUNEL assay. Meanwhile, treatment with GSH improved survival rate, attenuated weight loss, and restored cardiac function markers. Furthermore, GSH suppressed oxidative stress and inflammation, modulated gene expression, and declined histopathological damage. These findings demonstrated the multifaceted cardioprotection of GSH through the restoration of redox homeostasis and modulation of the pro- and anti-inflammatory responses. GSH supplementation emerges as a promising adjunct therapy to mitigate DOX-induced cardiotoxicity, offering a strategy to improve cardiac health in cancer patients undergoing doxorubicin chemotherapy.

The role of parenting stress and perceived social support in affecting family function among families of patients with cleft lip and/or palate: a path analysis based on the family adjustment and adaptation response model

OBJECTIVES

Family function is important for the normal operation of the family and the development of children. However, existing studies have limited explorations on family function among families of patients with cleft lip and/or palate (CL/P). This study aims to validate a hypothesized model of family function based on the family adjustment and adaptation response model, and identify key variables affecting family function among families of patients with cleft lip and/or palate (CL/P) in China.

MATERIALS AND METHODS

The cross-sectional study enrolled 248 families with CL/P patients from two centers in China. The demographic, clinical, family function, resilience, hope, perceived social support, optimism, parenting stress, and coping data were collected. Path analysis was used to investigate the key variables of the family function.

RESULTS

Family functions among families of CL/P patients were higher than the Chinese norm in conflict, moral-religious-emphasis, and control. Furthermore, they were lower in expressiveness, independence, achievement orientation, intellectual, cultural orientation, active recreational orientation, and organization. The fitness of the modified path model was evaluated using various measures, including CMIN/DF = 1.954, GFI = 0.914, RFI = 0.801; IFI = 0.919;TLI = 0.909; CFI = 0.917; RMSEA = 0.065. The path analysis showed that perceived social support and parenting stress have a direct positive effect (β = 0.186) and negative effect (β = -0.384), respectively. Hope, optimism, perceived social support, coping, and resilience indirectly affect family function. The effects from highest to lowest are hope (β = 0.260), optimism (β = 0.203), perceived social support (β = 0.085), coping (β = 0.055), and resilience (β = 0.009). The overall effects of different variables on the family function are as follows: parenting stress (β = -0.384), perceived social support (β = 0.271), hope (β = 0.260), optimism (β = 0.203), coping (β = 0.055), and resilience (β = 0.009).

CONCLUSIONS

The family functions of families with CL/P patients are worthy of attention in China. This study showed that parenting stress and perceived social support are key factors that directly affect family function. Coping, hope, resilience, and optimism could indirectly affect family function through parenting stress and perceived social support. Therefore, strategies targeting these two key factors should be implemented to facilitate family function among families with CL/P patients.

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.

Modifiable Factors Influencing Disease Flares in Inflammatory Bowel Disease: A Literature Overview of Lifestyle, Psychological, and Environmental Risk Factors

Background: A significant concern for patients with Inflammatory Bowel Disease (IBD) is predicting and managing disease flares. While healthcare providers rely on biomarkers, providing conclusive patient advice remains challenging. This review explores the role of lifestyle, psychological health, and environmental exposures in the prediction and management of IBD flares. Methods: This review followed PRISMA guidelines (2020). A structured search was conducted in PubMed for articles published between 2012 and 2024, using free and Medical Subject Heading (MeSH) terms for predicting factors in IBD. Inclusion criteria included studies reporting primary data on modifiable clinical or environmental predictors of IBD relapse, excluding studies on post-operative investigations, treatment cessation, and pediatric or pregnant populations. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies. Results: Out of 2287 identified citations, 58 articles were included. Several modifiable factors influencing disease flares were identified, including psychological stress, sleep disturbances, smoking, and nutrition. Poor sleep quality and mental health were linked to increased flare risks, while smoking was associated with higher relapse rates in Crohn's disease. Environmental exposures, such as heat waves and high-altitude regions, also contributed. Predictive models integrating clinical, lifestyle, and psychological factors showed promising accuracy but require further refinement. Limitations of this review include the potential for publication bias, variability in flare definitions, and limited sample sizes Conclusions: Key predictors of IBD flares include dietary factors, psychological stress, poor sleep quality, and pharmacological influences. Personalized approaches integrating these predictors can optimize disease control and improve patient outcomes.

Predictive value of serum calcium ion level in patients with colorectal cancer: A retrospective cohort study

BACKGROUND

Serum calcium ion (Ca2+) is an economical and readily available indicator as a routine screening test for hospitalized patients. There are no studies related to serum Ca2+ level and digestive tract malignancy.

AIM

To evaluate the effectiveness of serum Ca2+ level in predicting the prognosis of patients with colorectal cancer (CRC).

METHODS

We retrospectively collected the data of 280 patients diagnosed with CRC who underwent radical surgery at the Affiliated Cancer Hospital of Xinjiang Medical University. By analyzing the clinicopathological features, differences between serum Ca2+ concentrations on the first day after surgery were determined. We used the receiver operating characteristic curve to assess the predictive ability of serum Ca2+ for survival. Survival analyses were performed using the Kaplan-Meier method, and multivariate Cox proportional risk regression was used to determine association between calibration serum Ca2+ levels and CRC survival outcomes.

RESULTS

By receiver operating characteristic curve analysis, the ideal threshold value for Ca2+ the first postoperative day and delta serum calcium (δCa2+) value were 1.975 and 0.245, respectively. Overall survival (OS) and progression-free survival (PFS) were better in both the high Ca2+ group and high δCa2+ group on the first postoperative day. The variables identified through univariate analysis were incorporated into multivariate analysis and showed that tumor differentiation (P = 0.047), T stage (P = 0.019), N stage (P < 0.001), nerve vascular invasion (P = 0.037), carcinoembryonic antigen (P = 0.039), baseline serum Ca2+ level (P = 0.011), and serum Ca2+ level on the first day (P = 0.006) were independent predictors of prognosis for patients undergoing feasible radical CRC surgery. Using the findings from the multifactorial analysis, we developed a nomogram and the calibration showed a good predictive ability.

CONCLUSION

Low serum Ca2+ level on the first postoperative day is an independent risk factor for OS and PFS in CRC.

Interpreting positive celiac serology in children with new-onset type 1 diabetes

OBJECTIVES

The association of celiac disease (CD) in type 1 diabetes mellitus (T1DM) is well-established, yet variation exists in screening practices. This study measures the accuracy of early screening with tissue transglutaminase immunoglobulin A (TTG-IgA) and endomysial antibody (EMA) in newly diagnosed T1DM.

METHODS

This is a retrospective study of children with T1DM between 2013 and 2019 with early CD screening and follow-up. Data elements included anthropometrics, serologies, blood pH, bicarbonate, and Hemoglobin A1c. Celiac serologies were analyzed using chi-square and receiver operating characteristic curves to calculate optimal levels for predicting CD.

RESULTS

A total of 1,292 children met inclusion criteria with 142 having positive celiac serologies; 47 (33.1 %) of whom were subsequently diagnosed with CD - an incidence of 3.6 %. All subjects with positive EMA and TTG-IgA ≥8 times upper limit of normal were diagnosed with CD. Gastrointestinal symptoms, BMI, and thyroid disease were not statistically significant variables in this cohort, although there was a trend toward CD in lower BMI patients and higher TTG IgA in those with markedly elevated HgbA1c.

CONCLUSIONS

Early celiac screening in T1DM is reliable and promotes timely CD diagnosis and treatment. Although transient positive celiac serologies were noted, the degree of TTG-IgA elevation and EMA positivity are strong predictors of coexisting CD. Larger prospective studies using these assays will further define the risk stratification algorithm that is needed for our T1DM community.

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D): a decentralised feasibility randomised controlled trial delivered across the UK and Canada

OBJECTIVES

Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).

DESIGN

Feasibility multicentre, parallel group, randomised controlled trial (RCT).

SETTING

Participants were recruited from England and Canada using a decentralised design.

PARTICIPANTS

Adults (40-75 years) recently diagnosed with T2D (5-24 months).

INTERVENTIONS

Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.

OUTCOMES

The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.

RESULTS

n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: -5% change from baseline, CI -10 to 2: 12 months: -2% change from baseline, CI -8 to -4; systolic BP: 6 months: -1 mm Hg, CI -5 to 3: 12 months: -4 mm Hg, CI -8 to 1).

CONCLUSIONS

Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.

Anti-inflammatory and immunomodulatory effects of Glycyrrhiza uralensis fisch. On ulcerative colitis in rats: Role of nucleotide-binding oligomerization domain 2/receptor-interacting protein 2/nuclear factor-kappa B signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

As a traditional Chinese herb, Glycyrrhiza uralensis Fisch. exhibits a range of pharmacological activities, including anti-inflammatory, immunomodulatory and antifibrotic, which suggests its therapeutic potential for inflammatory bowel disease, and related mechanisms need to be further clarified.

AIM OF THE STUDY

To evaluate in vivo anti-inflammatory effects of Glycyrrhiza uralensis Fisch. aqueous extract (GE) on 2, 4, 6-trinitrobenzene sulfonic acid (TNBS)-induced acute experimental colitis rat model and its potential mechanisms.

MATERIALS AND METHODS

The protective effects of GE on IBD were evaluated in vivo using a TNBS and 75% ethanol-induced ulcerative colitis (UC) model. The evaluated clinical and anatomical indexes included body weight, colon length, disease activity index (DAI) score, Colonic Mucosal Damage Index (CMDI) score. The percentages of T, B lymphocytes, NK cells, and macrophages in the colon, spleen and peripheral blood were investigated by flow cytometry. Colon tissues were stained with Hematoxylin and Eosin (H&E) for histopathological examination. After using transcriptome sequencing to screen targeted genes, the expression of related genes was detected by Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR) and Western blot (WB).

RESULTS

The decrease of food intake, soft feces, and colon histopathological injury were observed in colitis rats, which were alleviated by GE, with the best therapeutic effect in the 100 mg/kg GE group. The average CMDI scores of colon in UC rats were decreased from 4.0 to 1.5. The percentages of CD161a+ NK cells, CD68+ total macrophages, CD68+/CD161a+ M1 type macrophages, CD3+ T lymphocytes, and CD45RA+ B lymphocytes were decreased in the spleen and colon. The transcriptomics analysis of colon showed that the results were mainly related to the TNF signaling pathway and NF-κB signaling pathway. The RT-qPCR and WB results determined that the upregulated expression of nucleotide-binding oligomerization domain 2 (NOD2), receptor-interacting protein 2 (RIP2), nuclear factor-kappa B (NF-κB), tumor necrosis factor-α (TNF-α) in the colon of the colitis rats were downregulated by GE treatment.

CONCLUSION

The research results indicate that GE can exert therapeutic effects on TNBS-induced UC in rats by alleviating cell injury and inflammatory responses, and its mechanisms may be related to the regulation of NOD2/RIP2/NF-κB signaling pathway.

Clinical and Immunological Prognostic Factors With Novel Variants in a Large Cohort of Diacylglycerol Acyltransferase 1 Deficiency

BACKGROUND

Biallelic variants in diacylglycerol acyltransferase 1 (DGAT1) genegene have been implicated congenital diarrhea and protein-losing enteropathy. Insights into the immunopathologic features of this ultrarare disorder remain scarce, with only one cohort published to date.

OBJECTIVE

To delineate the clinical presentations, laboratory and immunologic profiles, and therapeutic responses associated with DGAT1 deficiency and identify prognostic indicators that affect survival rates.

METHODS

In this multicenter retrospective analysis of a comprehensive cohort of nine patients carrying seven novel variants, each displaying distinct phenotypic features, we recorded clinical, immunologic, and laboratory data of patients and evaluated the impact of various factors on prognosis.

RESULTS

A total of 67% of patients (n = 6) exhibited symptoms during the first month of life, whereas one demonstrated symptom onset after 6 months. Moreover, 78% of patients (n = 7) presented with diarrhea, all of whom all had vomiting, failure to thrive, hypoalbuminemia, and hypogammaglobulinemia as the advent of protein-losing enteropathy. Patients with reduced CD4+ T-cell frequency (n = 2) exhibited severe infections with unexpected bacteria during the follow-up. Despite immunoglobulin replacement therapy, 45% of patients (n = 4) died of infective complications. A decreased CD4+/CD8+ T-cell ratio was observed in all deceased patients whose colon biopsy samples showed marked inflammation or apoptosis. Early fat-restricted nutrition extended survival, whereas early symptom onset, recurrent severe infections, and a reduced CD4+/CD8+ T-cell ratio were associated with less favorable outcomes.

CONCLUSIONS

Our findings advocate early fat restriction as a critical therapeutic strategy. Given the heightened risk of severe infections, antibiotic prophylaxis can be recommended in addition to immunoglobulin replacement therapy for DGAT1-deficient patients exhibiting lymphopenia or diminished CD4+ T cells.

Providing care for kidney transplant recipients: An overview for generalists

Kidney transplantation is the preferred treatment for patients with advanced chronic kidney disease and end-stage kidney disease, offering superior quality of life and survival compared to dialysis. This manuscript provides an updated overview of post-transplant care, highlighting recent advancements and current practices to assist generalists in managing these patients. It covers key areas such as immunosuppression strategies, drug interactions, and the management of transplant-specific acute kidney injury. The focus includes the use of sodium-glucose cotransporter-2 inhibitors and cell-free DNA monitoring for evaluating allograft health and immune-mediated injury. The manuscript reviews the fundamentals of immunosuppression, including both induction and maintenance therapies, and underscores the importance of monitoring kidney function, as well as addressing hypertension, diabetes, and infections. It also provides recommendations for vaccinations and cancer screening tailored to kidney transplant recipients and emphasizes lifestyle management strategies, such as exercise and sodium intake, to reduce post-transplant complications.

Research progress on the relationship between Helicobacter pylori infection and iron deficiency anemia

Helicobacter pylori (H. pylori) infection affects around half of the global population and is a globally highly prevalent pathogen that is closely linked not only to gastrointestinal diseases such as chronic atrophic gastritis, functional dyspepsia and peptic ulcer but also to the development and progression of a variety of extra-gastrointestinal diseases. Numerous studies have shown the correlation between H. pylori infection and iron-deficiency anemia (IDA). The prevalence of H. pylori infection is higher in individuals with IDA, and the hemoglobin level of patients with IDA can be increased to different degrees or even returned to normal following active H. pylori eradication. However, this conclusion is still controversial. In this paper, a comprehensive literature search was conducted using the PubMed/MEDLINE/Web of Science database, combining the following terms: "Helicobacter pylori," "Helicobacter pylori infection," "iron deficiency anemia," "iron deficiency," "iron absorption," "iron malabsorption," "serum iron," "hemoglobin," "pathogenesis," "mechanism," and "eradication therapy." Through extensive literature searches, the correlation between H. pylori infection and IDA, its potential mechanism, and the efficacy of H. pylori eradication therapy in IDA patients have been comprehensively discussed. We conclude that the majority of existing studies have confirmed the correlation between H. pylori infection and IDA, indicating that patients with H. pylori infection are more likely to develop IDA and that the prevalence of H. pylori infection is higher in individuals with IDA. Compared with iron supplementation alone, combining H. pylori eradication with iron supplementation is more effective in treating IDA, particularly in unexplained or refractory IDA cases. These findings provide valuable insights for clinicians managing patients with unexplained or refractory IDA.

Sexual Health in Women with Inflammatory Bowel Diseases: A Narrative Review

Background/Objectives: Inflammatory bowel diseases (IBDs), such as Crohn's disease and ulcerative colitis, have a significant impact on overall well-being. Sexual health, a critical component of overall well-being, is often compromised in individuals with IBD, especially in women, owing to physical, psychological, and social factors. This narrative review aims to synthesize the fragmented existing evidence on the impact of IBD on women's sexual health by examining clinical manifestations along with patients' perceptions and lived experiences. Methods: Five databases (CINAHL Complete, Medline, APA PsycInfo, APA PsycArticles, and Psychology and Behavioral Sciences Collection) were searched using keywords related to IBD, sexual health, and women's experiences. Fifteen studies that met the predefined inclusion and exclusion criteria were analyzed. Results: Women with IBD often perceive their bodies as "damaged" or "mutilated," which profoundly affects their self-esteem and sexual satisfaction. Physically, debilitating symptoms such as abdominal pain, diarrhea, and chronic fatigue limit sexual desire and intimacy. Psychological factors, including anxiety, depression, and negative body image, exacerbate these challenges, and compromise emotional well-being and intimate relationships. Social stigma further isolates patients, making it more difficult for them to communicate their sexual needs to both partners and healthcare providers. Strategies such as psychological support, health education, and promoting open communication with partners emerge as promising avenues to improve sexual health and quality of life. Conclusions: IBD profoundly affects women's sexual health by intertwining physical, psychological, and social challenges. A holistic and personalized clinical approach that incorporates sexual well-being into routine care is essential to improve patients' quality of life.

Carbohydrate Quality Is Independently Associated with Cardiometabolic Risk in Chinese Individuals with Impaired Glucose Tolerance

Background/Objectives: Dietary manipulation with carbohydrate restriction has been extensively investigated in diabetes prevention programmes. Carbohydrate (CHO) quality, rather than quantity, is associated with various metabolic outcomes. Few studies examined the fibre/CHO ratio on lipid profiles, liver fat and insulin resistance in individuals with impaired glucose tolerance (IGT). Methods: In this comprehensive cross-sectional study, we evaluated the association of carbohydrate-related nutritional factors with metabolic parameters in a cohort of 177 Hong Kong Chinese with impaired glucose tolerance (IGT). The subjects underwent a 75 g oral glucose tolerance test (OGTT) with measurement of plasma C-peptide and lipid profiles, body composition, transient elastography, and three-day food records. The fibre/CHO ratio is calculated by dividing fibre intake by total carbohydrate intake (in grams). Results: The median (IQR) age of the study cohort was 60 (54-62) with a mean ± SD BMI of 26.7 ± 3.9 kg/m2, and 40.7% were female. A higher carbohydrate quality, measured as fibre/CHO ratio, was inversely correlated with triglycerides (r = -0.305, p < 0.001) and positively correlated with High-density lipoproteins cholesterol (HDL-C) (r = 0.354, p < 0.001). These associations remained significant after adjusting for age, gender, lipid-lowering drugs, total calorie, macronutrient and sugar intake, physical activity and sodium/potassium ratio. Blood pressure, liver fat and insulin resistance were also associated with the fibre/CHO ratio after the adjustment of these confounding factors. Consuming more than 5.5 g of fibre per 100 g carbohydrate was associated with lower serum triglycerides. Conclusions: Our results highlight the potential for using the fibre/CHO ratio as a metric for daily carbohydrate quality and the importance of addressing both carbohydrate quality and quantity in designing dietary interventions to reduce cardiometabolic risk.

Pediatric Inflammatory Bowel Disease in Romania: The First Epidemiological Study of the North-West Region (2000-2020)

Background: Inflammatory bowel disease (IBD) represents a group of disorders with increasing incidence in the pediatric population worldwide. There are limited data on pediatric IBD (pIBD) epidemiology in Eastern Europe and none so far from Romania. The aim of our study was to evaluate incidence rates and time trends for pIBD in the north-west region of Romania and to compare them with results from studies on the same topic published worldwide. Methods: We performed a retrospective study of patients under 18 years of age diagnosed with pIBD in the time frame between 1 January 2000 and 31 December 2020 at the Emergency Clinical Hospital for Children in Cluj-Napoca. Age-adjusted incidence rates, annual percentage change (APC), average annual percentage chance (AAPC) and their corresponding 95% confidence intervals (CIs) were calculated for pIBD, Crohn's disease (CD) and ulcerative colitis (UC). Temporal trends were plotted using Joinpoint regression. Results: Ninety-four patients were identified. For the entire studied period, the incidence rate for pIBD was 0.79/105 (±0.74), 0.4/105 for CD (±0.42) and 0.34/105 for UC (±0.4). Time trends for incidence were positive, but statistical significance was found only for pIBD and CD. The APC observed for pIBD, CD and UC was 12 (95% CI: 6.5-17.7), 13.1 (95% CI: 8-18.5) and 5.67 (95% CI: 1.5-13.4), respectively. Comparison to other similar studies placed Romania among the countries with the lowest incidence of pIBD. Conclusions: Although pIBD incidence in our region appears to be low, there has been an important and significant increase in the incidence of overall pIBD and especially CD.

Bulk and single-cell RNA sequencing reveal the roles of neutrophils in pediatric Crohn's disease

BACKGROUND

Pediatric Crohn's disease (CD) is a chronic inflammatory bowel disorder that poses significant health risks to children. Although the precise etiology of CD remains elusive, further exploration is needed to identify diagnostic biomarkers and therapeutic targets.

METHODS

This study utilized single-cell and bulk RNA sequencing data derived from ileal and colonic biopsy samples to explore the molecular mechanisms and cell types associated with CD, as well as to pinpoint potential biomarkers and therapeutic targets.

RESULTS

The results revealed a more pronounced alteration in both the quantity and functional state of neutrophils in the CD cohort compared to those with ulcerative colitis and healthy controls. Neutrophils were present in higher proportions in the CD group, primarily in an activated state, potentially correlating with the presence of deep ulcerations and inflammatory histopathological features. Additionally, neutrophil interactions with other cell types were markedly enhanced in the CD group, making neutrophils the dominant participants in cell-to-cell communications. Further analysis indicated a shift in neutrophil phenotype from pro-inflammatory and antimicrobial to tissue-repairing, which may contribute to the progression and exacerbation of CD.

CONCLUSION

IL1B, ICAM1, CXCL1, and CXCL9, primarily expressed in neutrophils, were potential biomarkers for CD. Neutrophils might be considered a potential target for pediatric CD.

IMPACT STATEMENT

This study demonstrated that patients with CD exhibited a greater proportion of activated neutrophils, with enhanced interactions between neutrophils and all other cell types, resulting in neutrophils contributing the most cell-cell interactions within the CD gut. Neutrophils in the CD gut transition from a pro-inflammatory and antibacterial phenotype to one that promotes tissue healing, potentially influencing the progression and exacerbation of CD. Neutrophils represent a promising therapeutic target in pediatric CD. Hub genes associated with CD, including IL1B, ICAM1, CXCL1, and CXCL9, are predominantly expressed in neutrophils, positioning them as promising diagnostic biomarkers for CD.

Impact of ESPGHAN no-biopsy strategy on the outcome of celiac disease treatment in children

Aim

The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) allows a no-biopsy diagnostic of celiac disease under certain conditions. We assessed the impact of the diagnostic algorithm on the patient's long-term outcome by comparing the serology-based diagnosed patients to biopsy-proven ones.

Methods

We reviewed the charts of children presenting with antitransglutaminase IgA titers above ten times upper limit of normal and consecutively diagnosed with celiac disease between 2010 and 2014, a time-period overlapping with ESPGHAN diagnostic guideline change in 2012. Outcome measures for no-biopsy vs. biopsy-proven diagnosed patients were clinical and laboratory findings, compliance to gluten-free diet and to regular visits after one, two and 8-10 years of follow-up.

Results

Clinical and laboratory, i.e., serum chemistry and autoantibody outcome measures on gluten-free diet clearly showed worse patient healing in the 33 serology-based diagnosed children compared to the 30 biopsy-proven ones. The attendance of the follow-up visits was also higher in the biopsy group.

Conclusions

Our results indicate that dietary transgressions are common in childhood celiac disease resulting in slow healing. Therefore, there is a need of improvement of the management, with special attention regarding the ESPGHAN no-biopsy criteria diagnosed patients. Our study also indicates that novel treatments adjunctive to diet are warranted in children.

Structural Concepts, Definition, Classification, and Macronutrient and Food Composition of Carbohydrate-Restricted Diets for Individuals with Type 2 Diabetes Mellitus: A Scoping Review

Objective: This study aimed to review the structural concepts, definition, classification, and macronutrient and food composition of carbohydrate-restricted diets (CRDs) for individuals with type 2 diabetes mellitus (T2DM). Methods: A scoping review was conducted following Joanna Briggs Institute guidelines. Searches were performed in Scopus, PubMed, Web of Science, and Embase, including texts published in Portuguese, English, and Spanish. Official documents from governments, regulatory agencies, and international diabetes organizations were also consulted. Results: In total, 79 articles and 17 official documents were analyzed. The following structural concept was identified: restricted carbohydrate intake decreases the need for endogenous and exogenous insulin, contributing to the maintenance of glycemic control, and justifies its consideration among the nutritional therapy options for individuals with T2DM. CRDs varied in definition, classification, and macronutrient composition. Studies failed to provide detailed information on the food composition of diets, precluding an in-depth understanding of metabolic effects. The existence of several approaches with varying recommendations makes it difficult to generalize the results. International CRD guidelines for T2DM adopt divergent definitions, compromising interpretation, recommendation, and even adherence. Conclusions: Although the concept of CRDs justifies their adoption within the nutritional therapy choices for T2DM, the multiple denominations can hinder understanding and comparison between studies. The lack of information on food composition and carbohydrate types compromises the assessment of the effects and adherence to CRD-based nutritional interventions. We emphasize the need for methodologically consistent studies that evaluate CRDs based on fresh and minimally processed foods with a low glycemic index to support official diabetes guidelines and organizations.

The Prevalence of Polyketide Synthase-Positive E. coli in Cystic Fibrosis

Cystic fibrosis (CF) patients experience higher risks of colorectal cancer but the pathogenesis is unclear. In the general population, polyketide synthase-positive (pks+) E. coli is implicated in intestinal carcinogenesis via the production of colibactin; however, the relevance in CF is unknown. In this study, we investigate pks+E. coli prevalence in CF and potential associations between pks+E. coli, gastrointestinal inflammation, and microbiome dynamics with fecal calprotectin and 16SrRNA gene taxonomic data. Cross-sectional analysis demonstrated no difference in pks+E. coli carriage between CF patients and healthy controls, 21/55 (38%) vs. 26/55 (47%), p = 0.32. Pks+E. coli was not associated with significant differences in mean (SD) calprotectin concentration (124 (154) vs. 158 (268) mg/kg; p = 0.60), microbial richness (159 (76.5) vs. 147 (70.4); p = 0.50) or Shannon diversity index (2.78 (0.77) vs. 2.65 (0.74); p = 0.50) in CF. Additionally, there was no association with exocrine pancreatic status (p = 0.2) or overall antibiotic use (p = 0.6). Longitudinally, CF subjects demonstrated intra-individual variation in pks+E. coli presence but no significant difference in overall prevalence. Future investigation into the effects of repeat exposure on risk profile and analysis of older CF cohorts is necessary to identify if associations with colorectal cancer exist.

Chronic Inflammation to Cancer: The Impact of Oxidative Stress on DNA Methylation

The genomic landscape of cancer cells is complex and heterogeneous, with aberrant DNA methylation being a common observation. Growing evidence indicates that oxidants produced from immune cells may interact with epigenetic processes, and this may represent a mechanism for the initiation of altered epigenetic patterns observed in both precancerous and cancerous cells. Around 20% of cancers are linked to chronic inflammatory conditions, yet the precise mechanisms connecting inflammation with cancer progression remain unclear. During chronic inflammation, immune cells release oxidants in response to stimuli, which, in high concentrations, can cause cytotoxic effects. Oxidants are known to damage DNA and proteins and disrupt normal signalling pathways, potentially initiating a sequence of events that drives carcinogenesis. While research on the impact of immune cell-derived oxidants on DNA methylation remains limited, this mechanism may represent a crucial link between chronic inflammation and cancer development. This review examines current evidence on inflammation-associated DNA methylation changes in cancers related to chronic inflammation.

Capsule Endoscopy-Guided Proactive Treat-to-Target Versus Continued Standard Care in Patients With Quiescent Crohn's Disease: A Randomized Controlled Trial

BACKGROUND & AIMS

Optimal treat-to-target strategies for Crohn's disease (CD) are still being sought. The value of video capsule endoscopy (VCE) to guide proactive treat-to-target optimization in CD was examined.

METHODS

A randomized controlled trial of patients with small bowel-involved (L1/L3) CD in corticosteroid-free clinical remission (Crohn's Disease Activity Index < 150). Patients ingested a VCE at baseline and those with a Lewis inflammatory score (LS) ≥ 350 were designated "high risk" and randomized to either treat-to-target treatment optimization or continued standard care. Treat-to-target was optimized by means of repeat VCE results every 6 months. Patients with LS < 350 ("low risk") continued standard care. The primary outcome was the rate of disease exacerbation (Crohn's Disease Activity Index increase > 70 points and score > 150 or hospitalization/surgery) in high-risk standard care vs treat-to-target groups at 24 months.

RESULTS

Of 118 patients screened, 60 were enrolled. Treatment intensification in patients in the high-risk group allocated to proactive strategy comprised biologic dose escalation (n = 11 of 20), starting a biologic (n = 8 of 20), or swapping biologics (n = 1 of 20). The primary outcome, clinical flare by 24 months, occurred in 5 of 20 (25%) of high-risk treat-to-target patients vs 14 of 20 (70%) of the high-risk standard-care group (odds ratio, 0.14; 95% CI, 0.04-0.57; P = .006). Mucosal healing was significantly more common among the treat-to-target group when determined by a cutoff LS < 350 (odds ratio, 4.5; 95% CI, 1.7-17.4; nominal P value = .03), but not by the combined scores of total LS < 450 and highest-segment LS < 350. Among all patients continuing standard care (n = 40), baseline LS was numerically higher among relapsers vs nonrelapsers (450, 225-900 vs 225, 135-600, respectively; P = .07). Of 221 VCEs ingested, there was a single (0.4%) temporarily retained spontaneously resolved event.

CONCLUSIONS

A VCE-guided treat-to-target strategy for patients with CD in remission confers superior clinical outcomes compared with continued standard care.

CLINICALTRIALS

gov, Number: NCT03555058.

Association between vitamin C, D, and K intake and inflammatory bowel disease risk: findings from 2009 to 2010 NHANES

BACKGROUND

Micronutrient deficiency is commonly observed in patients with inflammatory bowel disease (IBD), yet the role of certain dietary trace elements in the risk of IBD development remains unclear.

OBJECTIVES

This study aimed to investigate the relationship between vitamin C, D, and K intake and IBD risk.

METHODS

This study included 3,591 participants from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression were conducted to assess associations between vitamin C, D, and K intake and IBD risk while controlling for multiple confounders. Subgroup analyses were employed to test the robustness of the associations across participants with various characteristics. Additionally, restricted cubic spline (RCS) analysis was conducted to investigate potential nonlinear relationships.

RESULTS

In the fully adjusted model, each 1 mcg increase in vitamin D intake was linked to an approximately 51% decrease in IBD risk (adjusted OR = 0.49, 95% CI: 0.25-0.98, p = 0.045). The benefit appeared stronger in women, individuals without hypertension, and non-smokers. No statistically significant associations were found between vitamin C or vitamin K intake and IBD risk. However, among individuals without diabetes, each 1 mcg increase in vitamin K intake was associated with an approximate 67% reduction in IBD risk (adjusted OR = 0.33, 95% CI: 0.12-0.94, p = 0.039). RCS analysis suggested a linear relationship between dietary micronutrient intake and IBD risk (vitamin D: p for nonlinearity = 0.127, p for overall = 0.015; vitamin C: p for nonlinearity = 0.984, p for overall = 0.937; vitamin K: p for nonlinearity = 0.736, p for overall = 0.434).

CONCLUSION

Increased vitamin D intake may reduce the risk of IBD, with more pronounced benefits in certain subgroups, highlighting the potential of vitamin D supplementation as a novel therapeutic approach for IBD prevention and management. Future well-designed studies should further test the therapeutic effects of vitamin D supplementation and investigate the associations of other dietary trace elements with IBD risk to better inform prevention and treatment approaches.

Myths and Facts Regarding Low-Carbohydrate Diets

As the prevalence of chronic diseases persists at epidemic proportions, health practitioners face ongoing challenges in providing effective lifestyle treatments for their patients. Even for those patients on GLP-1 agonists, nutrition counseling remains a crucial strategy for managing these conditions over the long term. This paper aims to address the concerns of patients and practitioners who are interested in a low-carbohydrate or ketogenic diet, but who have concerns about its efficacy, safety, and long-term viability. The authors of this paper are practitioners who have used this approach and researchers engaged in its study. The paper reflects our opinion and is not meant to review low-carbohydrate diets systematically. In addressing common concerns, we hope to show that this approach has been well researched and can no longer be seen as a "fad diet" with adverse health effects such as impaired renal function or increased risk of heart disease. We also address persistent questions about patient adherence, affordability, and environmental sustainability. This paper reflects our perspective as clinicians and researchers engaged in the study and application of low-carbohydrate dietary interventions. While the paper is not a systematic review, all factual claims are substantiated with citations from the peer-reviewed literature and the most rigorous and recent science. To our knowledge, this paper is the first to address potential misconceptions about low-carbohydrate and ketogenic diets comprehensively.

Intestinal tissue-resident memory T cells: Characteristics, functions under physiological and pathological conditions and spatial specificity

BACKGROUND

Tissue-resident memory T (TRM) cells are a distinct subset of memory T cells that persist in non-lymphoid tissues, providing localized and rapid immune responses to infection and malignancy. Unlike circulating memory T cells, TRM cells have unique homing and functional characteristics that are shaped by the tissue microenvironment. In the gut, TRM cells play a pivotal role in maintaining mucosal immunity, exhibiting phenotypic and functional heterogeneity in different intestinal compartments and in response to aging and pathological conditions.

AIM OF REVIEW

This review aims to systematically examine the definition, spatial heterogeneity and functional roles of intestinal TRM (iTRM) cells. It highlights their contributions to physiological immunity, their involvement in pathological processes such as inflammatory bowel disease (IBD) and colorectal cancer (CRC), and their age-related dynamics. The review also explores emerging therapeutic implications of modulating iTRM cells for intestinal health and disease management. KEY SCIENTIFIC CONCEPTS OF REVIEW: iTRM cells are defined by surface markers like CD69 and CD103, transcriptional regulators such as Hobit, Runx3, Blimp-1, as well as cytokine signals including TGF-β, IFN-β, IL-12. They exhibit spatial and functional heterogeneity across intestinal layers (epithelium versus lamina propria) and regions (small intestine versus colon). In IBD, iTRM cells play a dual role, contributing to both inflammation and tissue repair, whereas in CRC, specific subsets of iTRM cells (e.g., CD8+ CD103+ CD39+) are associated with enhanced antitumor immunity. Aging impacts iTRM functionality, with shifts in the CD4+/CD8+ ratio and reduced cytokine production in elderly individuals. Insights into the metabolic, transcriptional, and environmental regulation of iTRM cells provide avenues for targeted therapies in intestinal diseases, cancer immunotherapy, and interventions to delay intestinal aging.

Polyphenolic and Immunometric Profiling of Wheat Varieties: Impact of Organic and Conventional Farming on Allergenic and Bioactive Compounds

This study investigates the impact of organic and conventional farming on the allergenic and bioactive properties of wheat. The primary aim was to assess the immunometric parameters and polyphenolic composition in four varieties of winter and four varieties of spring wheat cultivated under both farming systems. Immunometric assays focused on gluten content, the allergenic QQQPP peptide, and the panallergenic profilin Tri a 12. While gluten levels (15-20 g/kg) showed no clear dependence on farming type, organic wheat exhibited a mild yet significant increase in QQQPP-dependent immunoreactivity in five samples (>20 µg/g). However, all organic wheat samples demonstrated a notable reduction in profilin content (<0.6 µg/g), suggesting that the type of wheat cultivation could influence allergenic risk for individuals with wheat-related allergies. Polyphenolic profiling revealed that kaempferol, p-coumaric acid, and gallic acid were the predominant compounds, with organic wheat displaying slightly higher polyphenol levels on average. Despite these differences, the variations were insufficient to determine a superior cultivation method. These findings highlight the potential allergenic and nutritional implications of organic versus conventional wheat farming.

Proton Pump Inhibitors for Inducing and Maintaining Remission in Eosinophilic Esophagitis: An Updated Systematic Review and Meta-Analysis

BACKGROUND & AIMS

Proton pump inhibitor (PPI) therapy results in clinical and histological remission in approximately 50% of eosinophilic esophagitis (EoE) patients. We aimed to systematically update this topic due to cumulative data from pediatric/adult populations in wider geographical settings.

METHODS

A search in MEDLINE, Embase, and Scopus databases was performed. Primary outcomes were clinical response and histological remission (<15 eosinophils per high-power field). Subgroup analyses included age group, PPI drug and dosage, study design, data origin, and risk of bias. Data were pooled using random-effects models.

RESULTS

Seventy-three studies comprising 7304 patients were included. PPI therapy led to clinical response in 65% (95% confidence interval [CI], 57.2-72.4; I2 = 0%) and histological remission in 45.4% (95% CI, 41.6%-49.3%) of patients, without differences between children and adults (41.2% vs 48%; P ••• .17). Overall, 34.1% (95% CI, 27.9%-40.5%) achieved <5 eosinophils per high-power field. Pooled effectiveness was significantly superior (P < .001) in Western Pacific areas, principally Japan (67.9%), compared with American and European areas (40.6% and 44.4%, respectively). Histological remission was significantly higher with double PPI doses compared with standard (51.7% vs 28.3%; P •••.005). Response was significantly higher in studies with lower risk of bias. Maintenance half-doses led to sustained histological remission in 68.2% (95% CI, 63.7%-72.6%; I2 = 0%) of patients.

CONCLUSIONS

PPI therapy induces clinic-histological remission in almost half of pediatric and adult EoE patients. Response to PPIs is significantly higher in Japan. Sustained remission is common on tapering PPI doses.

Transcriptomic Alterations Induced by Tetrahydrocannabinol in SIV/HIV Infection: A Systematic Review

Given the high prevalence of cannabis use among people with HIV (PWH) and its potential to modulate immune responses and reduce inflammation, this systematic review examines preclinical evidence on how tetrahydrocannabinol (THC), a key compound in cannabis, affects gene and micro-RNA expression in simian immunodeficiency virus (SIV)-infected macaques and HIV-infected human cells. Through a comprehensive search, 19 studies were identified, primarily involving SIV-infected macaques, with a pooled sample size of 176, though methodological quality varied across the studies. Pathway analysis of differentially expressed genes (DEGs) and miRNAs associated with THC revealed enrichment in pathways related to inflammation, epithelial cell proliferation, and adhesion. Notably, some DEGs were targets of the differentially expressed miRNAs, suggesting that epigenetic regulation may contribute to THC's effects on gene function. These findings indicate that THC may help mitigate chronic immune activation in HIV infection by altering gene and miRNA expression, suggesting its potential immunomodulatory role. However, the evidence is constrained by small sample sizes and inconsistencies across studies. Further research employing advanced methodologies and larger cohorts is essential to confirm THC's potential as a complementary therapy for PWH and fully elucidate the underlying mechanisms, which could inform targeted interventions to harness its immunomodulatory effects.

Patient experiences with and adherence to Crohn's disease exclusion diet in Dutch Crohn's disease patients: a cohort study

Background

Dietary therapy is commonly used as a treatment for Crohn's disease (CD). High dietary adherence is associated with achieving clinical remission. Crohn's disease exclusion diet (CDED) is a relatively new therapy in the management of CD.

Objective

This publication aims to assess the first real-life patient experience with and adherence to Crohn's disease exclusion diet plus partial enteral nutrition (CDED + PEN) in Dutch children and adults with mild-to-moderate CD.

Design

Interviews were performed with patients and/or caregivers prospectively after phases I, II, and III, and once after finishing therapy in a retrospective cohort.

Methods

We obtained data on patient experiences with CDED and the accompanying Modulife patient support platform and assessed effectiveness from patients' and physicians' perspectives based on medical and clinical data obtained from the patient file. The interview contained open questions, 5-point Likert scales, and Net Promotor Scores (NPS).

Results

Sixty-nine patients were included (52 pediatric and 17 adults). Approximately half of the patients in the prospective cohort and the majority (83%) of patients in the retrospective cohort would recommend CDED to others. Two-thirds of the patients would reconsider starting CDED again. A positive NPS (31) was given for recommending the support platform to others with the recipes feature as the most used and esteemed part. Median fecal calprotectin and C-reactive protein gradually decreased from baseline to 18 weeks of therapy in both children and adults. Two-thirds of the physicians assessed the diet as showing good effectiveness and would continue the dietary therapy at each phase of the diet.

Conclusion

Many mild-to-moderate active CD patients may experience positive outcomes and have good experiences with the CDED + PEN dietary therapy and the associated Modulife patient support platform. This study might add valuable patient perspectives to the growing clinical use of CDED in managing CD.

Biologics in the management of pediatric inflammatory bowel disease: When and what to choose

Pediatric inflammatory bowel disease (PIBD) is a chronic inflammatory disorder of the gastrointestinal tract, with rising global incidence and prevalence. Over the past two decades, biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease. The available biologics include monoclonal antibodies which target inflammatory cytokines (anti-tumor necrosis factor alpha, anti-interleukin 12/23) or recruitment of leucocytes to the gastrointestinal tract (anti-alpha4beta7 integrin) and small molecules (Janus kinase inhibitors, sphingosine 1-phosphate-inhibitors) which modify the proinflammatory signaling. Considering their potential disease-modifying ability, recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach. Although real-world studies are available regarding the clinical efficacy of biologics in PIBD, there is paucity of long-term outcome and safety data in children. Also, little information is available about the best approach in the newly industrialized - developing countries where PIBD is rising but at the same time, infections are prevalent and resources are limited. In this review, we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD, especially in the developing world, and future directions.

Extended versus limited mesenteric excision in bowel resection for Crohn's disease: a meta-analysis and systematic review

BACKGROUND

There is ongoing debate regarding the benefits of extended mesenteric excision (EME) versus limited mesenteric excision (LME) in intestinal resection for Crohn's disease (CD). Some studies suggest that EME may reduce surgical recurrence, which is defined as the need for reoperation due to disease complications or insufficient response to therapy, when compared with LME. This systematic review and meta-analysis aims to compare postoperative complications, surgical recurrence, and endoscopic recurrence in patients undergoing EME versus LME for CD.

METHODS

MEDLINE, Cochrane, the Central Register of Clinical Trials, Scopus and Web of Science databases were searched for studies published through April 2024. Odds ratios (OR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with Cochran's Q test and I2 statistics, with p-values < 0.10 and I2 > 25% considered significant. Statistical analyses were performed using R software, version 4.4.1.

RESULTS

One randomized controlled trial (RCT) and five observational studies were included, totaling 4498 patients, of whom 1059 (23.5%) underwent EME and 3439 (76.5%) LME. EME was associated with a lower surgical recurrence rate (5% versus 15%; OR 0.31; 95% CI 0.12-0.84; p = 0.021; I2 = 47%). No significant differences were observed between EME and LME for overall complications, Clavien-Dindo ≥ 3 events, bleeding requiring transfusion, anastomotic leaks, intraabdominal abscesses, surgical site infections (SSIs), reoperations, readmissions, ileus, endoscopic recurrences, operative times, or hospital stays.

CONCLUSIONS

EME was associated with a significant reduction in surgical recurrence compared with LME, without differences in endoscopic recurrence or postoperative complication rates.

A 6-Month mHealth Low-Carbohydrate Dietary Intervention Ameliorates Glycaemic and Cardiometabolic Risk Profile in People with Type 2 Diabetes

Aim: Mobile health (mHealth) applications have been reported to be effective in improving glycaemic control and cardiometabolic health, but mainly as part of shorter-term intervention studies. The aim of this study is to examine the effect of the ongoing Defeat Diabetes mHealth low-carbohydrate diet (LCD) intervention on clinical markers and cardiometabolic risk after 6 months of intervention. Methods: Data were collected via primary care physicians as part of routine T2D monitoring. These included HbA1c (primary outcome), blood pressure, blood lipids, and markers of kidney and liver function. Anthropometrics, as well as changes in the prescription of diabetes, hypertension, and dyslipidaemia medication, were also recorded. Calculated variables, total cholesterol to HDL-c, triglyceride to HDL-c, and waist to height ratios, were analysed to examine changes in cardiometabolic risk profile. Three-day food records were used to assess dietary intake and intervention adherence. Univariate regression models examined changes from baseline to 6 months. Results: Ninety-four participants remained in the study out of the ninety-nine at baseline (mean age 59 ± 11 years, 55 females). After 6 months of intervention, there were significant reductions in HbA1c by -1.0% (95% CI: -1.3 to -0.6), as well as in the liver enzymes ALT (-9.3 U/L 95% CI -16.3 to -2.4) and GGT (-18.8 U/L 95% CI: -31.4 to -6.3) across the cohort. In addition, there was a significant reduction in cardiometabolic risk, as measured by the calculated variables and a decrease in waist circumference (-4.6 cm 95% CI: -8.9 to -0.2). Conclusions: People with T2D receiving LCD education and resources through the Defeat Diabetes mHealth app (version 3.3.8) improved their glycaemic control after 6 months of intervention. Cardiometabolic risk profile and liver function also showed significant improvement. These findings indicate that the use of an LCD digital app is a valuable adjunct in the management of T2D.

Iron content of glioblastoma tumours and role of ferrous iron in the hypoxic response in vitro

Introduction

Glioblastomas are an aggressive primary brain cancer, characterised by hypoxia and poor patient survival. Iron is the most abundant transition metal in the brain, yet data on the iron content of brain cancers is sparse. Ferrous iron is an essential cofactor for a super-family of enzymes, the iron- and 2-oxoglutarate-dependent dioxygenase enzymes (2-OGDD). These enzymes control the response to hypoxia via hydroxylation of the hypoxia-inducible factor-1α (HIF-1α), and DNA demethylation via hydroxylation of 5-methyl cytosines (5hmC).

Methods

This study used clinical glioblastoma samples from 40 patients to determine the relationship between 2-OGDD activity and iron. Elemental iron was measured using inductively coupled plasma mass spectrometry (ICP-MS) and ferrous iron was measured using the colorimetric ferrozine assay. Iron measurements were compared against patient survival and clinicopathological data, and 2-OGDD-dependent activity of HIF-1 activation and 5hmC.

Results and discussion

Elemental and ferrous iron levels were weakly related. Higher ferrous iron content of clinical glioblastoma tissue was associated with longer overall survival compared to lower ferrous iron content, but elemental iron showed no such relationship. Neither form of iron was related to clinicopathological data or markers of 2-OGDD activity. The impact of iron supplementation on the hypoxic response was assessed in three glioblastoma cell lines in vitro, similarly showing only a limited influence of iron on these 2-OGDD enzymes. Our data, together with prior studies in anaemic patients, highlight the importance of healthy iron levels in patients with glioblastoma, but further mechanistic studies are needed to elucidate the molecular pathways involved.