Effect of sodium-glucose co-transporter 2 inhibitor on contrast-induced acute kidney injury and prognosis in type 2 diabetes patients undergoing percutaneous coronary intervention

Introduction

Contrast-induced acute kidney injury (CIAKI) is a common and serious complication following contrast administration in patients undergoing percutaneous coronary intervention (PCI). dapagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i), has demonstrated renal protective effects in various clinical settings. However, the impact of dapagliflozin on the incidence of CIAKI in patients with type 2 diabetes mellitus (T2DM) undergoing PCI is not yet fully understood.

Objective

To evaluate the impact of dapagliflozin on CIAKI and long-term prognosis in T2DM patients undergoing PCI.

Methods

This retrospective cohort study included T2DM patients who underwent PCI at the Department of Cardiology, Tianjin University Chest Hospital, from January 2022 to June 2023. Patients were grouped based on dapagliflozin use (dapagliflozin vs. no dapagliflozin). Renal function was assessed before PCI, 48 h, and 1 week post-PCI, measuring serum creatinine, estimated glomerular filtration rate, cystatin C, and neutrophil gelatinase-associated lipocalin. All patients were followed for at least 1 year. The primary endpoint was CIAKI incidence, with secondary endpoints including renal function changes and major adverse cardiovascular events (MACE).

Results

CIAKI occurred less frequently in the dapagliflozin group compared to the control group (5.8% vs. 11.7%, χ2  = 4.494, p = 0.033). After adjusting for confounders, dapagliflozin was an independent predictor of reduced CIAKI risk (OR = 0.365, 95% CI: 0.176-0.767, p = 0.008). During a median 15-month follow-up, the dapagliflozin group had a lower incidence of MACE compared to the control group (Log-rank χ 2 = 6.719, p = 0.009). Cox regression analysis showed that dapagliflozin reduced the risk of MACE (HR = 0.484, 95% CI: 0.246-0.955, p = 0.036).

Conclusion

Chronic administration of dapagliflozin can reduces the risk of CIAKI and improves long-term cardiovascular outcomes in T2DM patients undergoing PCI. These findings support its potential use as adjunctive therapy to mitigate kidney injury and improve prognosis in this high-risk population.

The Role of Venous Excess Ultrasound Score in Optimizing Acute Heart Failure Diagnosis and Prognosis

Acute heart failure (AHF) is a critical condition with significant morbidity and mortality, necessitating timely and accurate diagnosis for effective management. The Venous Excess Ultrasound (VExUS) score has emerged as a non-invasive diagnostic tool, aimed at evaluating venous congestion through ultrasound. This scoring system integrates assessments of the inferior vena cava, hepatic veins, portal veins, and renal venous flow to quantify congestion severity. By providing a real-time assessment of venous pressure, the VExUS score has shown potential in optimizing early diagnosis of AHF and predicting outcomes and overall prognosis. Recent studies suggest that incorporating the VExUS score into clinical practice can enhance patient stratification and guide tailored therapeutic interventions, reducing the need for invasive procedures like right heart catheterization. However, further large-scale studies are required to fully validate its role in predicting long-term outcomes and establishing its place in standard heart failure protocols. We aimed to review the current evidence on the utility of the VExUS score in improving AHF diagnosis and its potential as a prognostic marker, highlighting its technical aspects, clinical implications and future research directions.

Estimating inflammatory risk in atherosclerotic cardiovascular disease: plaque over plasma?

Inflammation is an important driver of disease in the context of atherosclerosis, and several landmark trials have shown that targeting inflammatory pathways can reduce cardiovascular event rates. However, the high cost and potentially serious adverse effects of anti-inflammatory therapies necessitate more precise patient selection. Traditional biomarkers of inflammation, such as high-sensitivity C-reactive protein, show an association with cardiovascular risk on a population level but do not have specificity for local plaque inflammation. Nowadays, advancements in non-invasive imaging of the vasculature enable direct assessment of vascular inflammation. Positron emission tomography (PET) tracers such as 18F-fluorodeoxyglucose enable detection of metabolic activity of inflammatory cells but are limited by low specificity and myocardial spillover effects. 18F-sodium fluoride is a tracer that identifies active micro-calcification in plaques, indicating vulnerable plaques. Gallium-68 DOTATATE targets pro-inflammatory macrophages by binding to somatostatin receptors, which enhances specificity for plaque inflammation. Coronary computed tomography angiography (CCTA) provides high-resolution images of coronary arteries, identifying high-risk plaque features. Measuring pericoronary adipose tissue attenuation on CCTA represents a novel marker of vascular inflammation. This review examines both established and emerging methods for assessing atherosclerosis-related inflammation, emphasizing the role of advanced imaging in refining risk stratification and guiding personalized therapies. Integrating these imaging modalities with measurements of systemic and molecular biomarkers could shift atherosclerotic cardiovascular disease management towards a more personalized approach.

The Role of SGLT2-Inhibitors Across All Stages of Heart Failure and Mechanisms of Early Clinical Benefit: From Prevention to Advanced Heart Failure

Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents have proven efficacy in both chronic and acute HF presentations. This review explores SGLT2i applications spanning the HF continuum, from early stages (Stage A) in at-risk individuals to the mitigation of progression in advanced HF (Stage D). Evidence from numerous trials has shown that SGLT2i significantly lower rates of HF hospitalization, improve renal function, and decreases cardiovascular mortality, highlighting their multifaced mechanisms of action in HF care. This review also highlights the potential mechanisms by which SGLT2i exert their beneficial effects on the cardiovascular and renal systems, each contributing to early and sustained clinical improvements. However, the integration of SGLT2i into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, and monitoring, which are addressed to support effective treatment adaptation across patient populations. Ultimately, this review provides a comprehensive assessment of SGLT2i as a foundational therapy in HF, emphasizing their role as an intervention across multiple stages aimed at improving outcomes across the entire HF spectrum.

Effect and mechanism of Dichloroacetate in the treatment of stroke and the resolution strategy for side effect

Stroke is a serious disease that leads to high morbidity and mortality, and ischemic stroke accounts for more than 80% of strokes. At present, the only effective drug recombinant tissue plasminogen activator is limited by its indications, and its clinical application rate is not high. Therefore, it is urgent to develop effective new drugs according to the pathological mechanism. In the hypoxic state after ischemic stroke, anaerobic glycolysis has become the main way to provide energy to the brain. This process is essential for the maintenance of important brain functions and has important implications for recovery after stroke. However, acidosis caused by anaerobic glycolysis and lactic acid accumulation is an important pathological process after ischemic stroke. Dichloroacetate (DCA) is an orphan drug that has been used for decades to treat children with genetic mitochondrial diseases. Some studies have confirmed the role of DCA in stroke, but the conclusions are conflicting because some believe that DCA is not effective for ischemic stroke and may aggravate hemorrhagic stroke. This study reviews these studies and finds that DCA has a good effect on ischemic stroke. DCA can protect ischemic stroke by improving oxidative stress, reducing neuroinflammation, inhibiting apoptosis, protecting blood-brain barrier, and regulating metabolism. We also describe the differences in the outcomes of DCA in the treatment of ischemic stroke and the reasons why DCA aggravate hemorrhagic stroke. In addition, DCA, as a water disinfection byproduct, has been concerned about its toxicity. We describe the causes and solutions of peripheral neuropathy caused by DCA. In summary, this study analyzes the neuroprotective mechanism of DCA in ischemic stroke and the contradiction of the different research results, and discusses the causes and solutions of its adverse effects.

Pathophysiology of Maternal Obesity and Hypertension in Pregnancy

Obesity is one of the biggest health problems in the 21st century and the leading health disorder amongst women of fertile age. Maternal obesity is associated with several adverse maternal and fetal outcomes. In this group of women, the risk for the development of hypertensive disorders of pregnancy (HDPs), such as gestational hypertension (GH) and pre-eclampsia (PE), is increased. In fact, there is a linear association between an increase in pre-pregnancy body mass index (BMI) and PE. Excessive weight gain during pregnancy is also related to the development of PE and GH. The role of obesity in the pathophysiology of HDP is complex and is most likely due to an interaction between several factors that cause a state of poor maternal cardiometabolic health. Adipokines seem to have a central role in HDP development, especially for PE. Hypoadiponectinemia, hyperleptinemia, insulin resistance (IR), and a proinflammatory state are metabolic disturbances related to PE pathogenesis, contributing to its development by inducing a state of maternal endothelial dysfunction. Hypertriglyceridemia is suggested to also be a part of the disease mechanisms of HDP. Therefore, this review seeks to explore the scientific literature to assess the complications of maternal obesity and its association with the development of HDP.

Lymphocyte-based inflammatory markers: Novel predictors of significant coronary artery disease✰,✰✰

BACKGROUND

Lymphocyte-based inflammatory indices such as monocyte-to-lymphocyte ratio (MLR) have long been recognized as reliable coronary artery disease (CAD) predictors. More recently, novel indices like the Systemic Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI), and Systemic Immune-Inflammation Index (SIIRI) have emerged. These newer markers offer a more comprehensive assessment of inflammation by integrating multiple immune cell types, potentially enhancing the prediction of cardiovascular outcomes.

OBJECTIVES

We evaluated the predictive value of novel inflammatory markers in estimating the pretest probability of severe CAD in high-risk patients.

METHODS

We enrolled consecutive patients undergoing diagnostic coronary angiography in a single tertiary care hospital. Inflammatory markers were calculated based on pre-procedural complete blood count laboratory measurements. Severe CAD was defined as critical (>70 %) and actionable narrowing of a primary coronary artery. Classification performance was assessed using multivariate logistic regression.

RESULTS

The study sample included 363 patients (age 58.9± 11 years, 44.9 % females, 30 % severe CAD). In univariate analysis, MLR, SIRI, and SIIRI were significant predictors of severe CAD, with age- and sex-adjusted OR of 1.98 [1.25-3.14], 1.79 [1.24-2.59], and 1.63 [1.11-2.38], respectively. In multivariate analysis, SIRI remained an independent predictor of severe CAD (OR = 1.98, 95 % CI 1.13-3.46, p = 0.02).

CONCLUSION

Our results suggest that novel inflammatory markers derived from routine blood tests are predictive of severe CAD in high-risk patients. Such simple, practical, and cost-effective inflammatory markers may enhance cardiac risk stratification and prediction of severe CAD.

Vibro-tactile stimulation of the neck induces head righting in people with cervical dystonia

INTRODUCTION

Cervical dystonia (CD) is characterized by involuntary neck muscle spasms that lead to abnormal head movements or postures. It is associated with somatosensory (tactile and proprioceptive) dysfunction. Here we tested whether vibro-tactile stimulation (VTS) of the cervical muscles constitutes a non-invasive form of neuromodulation of the somatosensory system that can provide temporary symptom relief for people with CD.

MATERIAL AND METHOD

In a multi-centre study, 67 CD patients (44 female) received VTS to sternocleidomastoid and/or trapezius muscles for up to 45 min under 9 different stimulation conditions. Retention was assessed 1, 5 and 20 min past VTS. Head angles and neck muscle EMG were recorded. The primary outcome measure was a head angle index (HAI), a composite measure reflecting the head deviation across the three axes of the head.

RESULTS

After identifying the most effective VTS condition for each participant, analysis showed that 85 % (57/67) of participants experienced an improvement in HAI of at least 10 % during the application of VTS. HAI improved by 50 % or higher in 26/67 of participants. For those responding to VTS, the effects tended to decay within 20 min. For the different CD phenotypes several stimulation sites could induce similarly large relative improvements in head posture.

CONCLUSION

The study provides first systematic evidence that cervical VTS can induce fast-acting improvements in abnormal head posture in patients with CD. It demonstrates that a stimulation of somatosensory afferent networks modulates the innervation of dystonic muscles. It highlights the potential of cervical VTS as an adjuvant, non-invasive neuromodulation treatment in CD.

Computational metabolomics reveals overlooked chemodiversity of alkaloid scaffolds in Piper fimbriulatum

Plant specialized metabolites play key roles in diverse physiological processes and ecological interactions. Identifying structurally novel metabolites, as well as discovering known compounds in new species, is often crucial for answering broader biological questions. The Piper genus (Piperaceae family) is known for its special phytochemistry and has been extensively studied over the past decades. Here, we investigated the alkaloid diversity of Piper fimbriulatum, a myrmecophytic plant native to Central America, using a metabolomics workflow that combines untargeted LC-MS/MS analysis with a range of recently developed computational tools. Specifically, we leverage open MS/MS spectral libraries and metabolomics data repositories for metabolite annotation, guiding isolation efforts toward structurally new compounds (i.e., dereplication). As a result, we identified several alkaloids belonging to five different classes and isolated one novel seco-benzylisoquinoline alkaloid featuring a linear quaternary amine moiety which we named fimbriulatumine. Notably, many of the identified compounds were never reported in Piperaceae plants. Our findings expand the known alkaloid diversity of this family and demonstrate the value of revisiting well-studied plant families using state-of-the-art computational metabolomics workflows to uncover previously overlooked chemodiversity. To contextualize our findings within a broader biological context, we employed a workflow for automated mining of literature reports of the identified alkaloid scaffolds and mapped the results onto the angiosperm tree of life. By doing so, we highlight the remarkable alkaloid diversity within the Piper genus and provide a framework for generating hypotheses on the biosynthetic evolution of these specialized metabolites. Many of the computational tools and data resources used in this study remain underutilized within the plant science community. This manuscript demonstrates their potential through a practical application and aims to promote broader accessibility to untargeted metabolomics approaches.

Targeting PCSK9 beyond the liver: evidence from experimental and clinical studies

INTRODUCTION

PCSK9 has been widely studied as a target for lipid-lowering as its inhibition increases LDLR recycling on the surface of hepatocytes, which promotes the catabolism of LDL particles. PCSK9 can be synthesized in extra-hepatic tissues, including in the brain, the pancreas, and the heart, and in immune cells. It is of interest to understand whether the extra-hepatic effects observed when PCSK9 is genetically inhibited by naturally occurring mutations are also recapitulated by pharmacology.

AREA COVERED

Genetics studies reported an increased risk of developing new-onset diabetes, ectopic adiposity, and reduced immune-inflammatory responses with PCSK9 deficiency. However, these aspects were not observed in clinical trials and data from real-world medicine with monoclonal antibodies (mAbs) and gene silencing approaches targeting PCSK9.

EXPERT OPINION

It is possible that the biological adaptations occurring when PCSK9 is inhibited lifelong, as in the case of genetic studies, could explain the discrepancy with the data obtained by clinical studies testing the pharmacological inhibition of PCSK9. Also, PCSK9 mAbs have been in use for 12 years; thus, probably, in this time window, a pharmacological reduction of circulating PCSK9 up to 80-90% does not lead to changes other than the impressive reduction in LDL-C and in CVD events.

Quantitative imaging outperforms No-reflow in predicting functional outcomes in a translational stroke model

Microvascular dysfunction and no-reflow are considered a major cause of secondary damage despite revascularization in acute ischemic stroke (AIS), ultimately affecting patient outcomes. We used quantitative PET-MRI imaging to characterize early microvascular damages in a preclinical non-human primate model mimicking endovascular mechanical thrombectomy (EVT). During occlusion, PET perfusion and MRI diffusion were used to measure ischemic and lesion core volumes respectively. Following revascularization, multiparametric PET-MRI included perfusion, diffusion, blood-brain barrier (BBB) permeability MRI, and 15O-oxygen metabolism PET. Lesion growth on MRI was evaluated at one week, and the neurological score was assessed daily; a poor outcome was defined as a score>6 (0-normal, 60-death) after one week. Early after recanalization, the gold-standard PET ischemic threshold (<0.2 ​mL/min/g) identified post-EVT hypoperfusion in 67 ​% of the cases (14/21) located in the occlusion acute lesion. Acquired 110 ​min post-EVT, the area of MRI Tmax hypoperfusion was larger and even more frequent (18/20) and was also located within the acute lesion. Eight of the total cases (38 ​%) had a poor outcome, and all of them had no-reflow (7/8 MRI no-reflow and 6/8 ​PET no-reflow). Diffusion ADC alterations and post-EVT oxygen extraction fraction (OEF) values were significantly different in PET no-reflow cases compared to those without no-reflow, exhibiting an inverse correlation. Independently of no-reflow, long perfusion Tmax and post-EVT high BBB Ktrans in the lesion core were the hallmarks of poor outcome and infarct growth. This early quantitative imaging signature may predict infarct growth and poor outcome and help to identify neuroprotection targets.

A critical review on SGLT2 inhibitors for diabetes mellitus, renal health, and cardiovascular conditions

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were originally formulated to reduce blood glucose levels in individuals with diabetes. Recent clinical trials indicate that this compound can be repurposed for other critical conditions. A literature search was performed on PubMed, Scopus, Embase, ProQuest, and Google Scholar, utilizing key terms such as SGLT2i, diabetes, and oxidative stress. SGLT2i has significant beneficial effects not only in cardiovascular disease but also in renal dysfunction. SGLT2i therapy can mitigate critical cardiovascular complications like heart attacks, strokes, mortality rates, and hospitalization duration, as well as delay the necessity for dialysis irrespective of diabetic condition. Evidence supports potential advantages of SGLT2 inhibitors for individuals with renal problems and heart failure, regardless of diabetes status. In addition to diabetic mellitus, this analysis explores the latest updates on SGLT2i and the therapeutic advantages it offers in many renal and cardiovascular diseases (CVDs).

Glutathione S-transferase: A keystone in Parkinson's disease pathogenesis and therapy

Parkinson's disease is a progressive neurodegenerative disorder that predominantly affects motor function due to the loss of dopaminergic neurons in the substantia nigra. It presents significant challenges, impacting millions worldwide with symptoms such as tremors, rigidity, bradykinesia, and postural instability, leading to decreased quality of life and increased morbidity. The pathogenesis of Parkinson's disease is multifaceted, involving complex interactions between genetic susceptibility, environmental factors, and aging, with oxidative stress playing a central role in neuronal degeneration. Glutathione S-Transferase enzymes are critical in the cellular defense mechanism against oxidative stress, catalysing the conjugation of the antioxidant glutathione to various toxic compounds, thereby facilitating their detoxification. Recent research underscores the importance of Glutathione S-Transferase in the pathophysiology of Parkinson's disease, revealing that genetic polymorphisms in Glutathione S-Transferase genes influence the risk and progression of the disease. These genetic variations can affect the enzymatic activity of Glutathione S-Transferase, thereby modulating an individual's capacity to detoxify reactive oxygen species and xenobiotics, which are implicated in Parkinson's disease neuropathological processes. Moreover, biochemical studies have elucidated the role of Glutathione S-Transferase in not only maintaining cellular redox balance but also in modulating various cellular signalling pathways, highlighting its neuroprotective potential. From a therapeutic perspective, targeting Glutathione S-Transferase pathways offers promising avenues for the development of novel treatments aimed at enhancing neuroprotection and mitigating disease progression. This review explores the evident and hypothesized roles of Glutathione S-Transferase in Parkinson's disease, providing a comprehensive overview of its importance and potential as a target for therapeutic intervention.

Exploring Cognitive Dysfunction in Long COVID Patients: Eye Movement Abnormalities and Frontal-Subcortical Circuits Implications via Eye-Tracking and Machine Learning

BACKGROUND

Cognitive dysfunction is regarded as one of the most severe aftereffects following coronavirus disease 2019 (COVID-19). Eye movements, controlled by several brain areas, such as the dorsolateral prefrontal cortex and frontal-thalamic circuits, provide a potential metric for assessing cortical networks and cognitive status. We aimed to examine the utility of eye movement measurements in identifying cognitive impairments in long COVID patients.

METHODS

We recruited 40 long COVID patients experiencing subjective cognitive complaints and 40 healthy controls and used a certified eye-tracking medical device to record saccades and antisaccades. Machine learning was applied to enhance the analysis of eye movement data.

RESULTS

Patients did not differ from the healthy controls regarding age, sex, and years of education. However, the patients' Montreal Cognitive Assessment total score was significantly lower than healthy controls. Most eye movement parameters were significantly worse in patients. These included the latencies, gain (computed as the ratio between stimulus amplitude and gaze amplitude), velocities, and accuracy (evaluated by the presence of hypermetric or hypometria dysmetria) of both visually and memory-guided saccades; the number of correct memory saccades; the latencies and duration of reflexive saccades; and the number of errors in the antisaccade test. Machine learning permitted distinguishing between long COVID patients experiencing subjective cognitive complaints and healthy controls.

CONCLUSION

Our findings suggest impairments in frontal subcortical circuits among long COVID patients who report subjective cognitive complaints. Eye-tracking, combined with machine learning, offers a novel, efficient way to assess and monitor long COVID patients' cognitive dysfunctions, suggesting its utility in clinical settings for early detection and personalized treatment strategies. Further research is needed to determine the long-term implications of these findings and the reversibility of cognitive dysfunctions.

Recompensation in Cirrhosis: Biomarkers and Strategies

The onset of decompensation in advanced chronic liver disease (ACLD) is a hallmark in natural history, with a poor prognosis and a significantly increased liver-related mortality. Etiological treatments for viral hepatitis or abstinence in cirrhosis due to alcohol abuse have demonstrated that some patients experience partial to complete clinical and analytical improvement, a stage termed "recompensation." Although recompensation is primarily defined clinically based on treatable etiologies, it is still evolving for conditions like metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the need for specific biomarkers in hepatic recompensation, no biomarkers have been thoroughly studied in this context. Biomarkers identified in compensated ACLD (cACLD) following etiological treatment might be explored for recompensation. Although the pathophysiology mechanisms underlying the hepatic recompensation remain unclear, understanding the mechanism involved in cirrhosis decompensation could help identify potential targets for recompensation. This review provides an update on the hepatic recompensation concept, examines the existing data on invasive and non-invasive biomarkers, mainly in cACLD after cure, that could be raised in recompensation, and explores future therapeutic targets for the hepatic recompensation process.

Abdominal obesity: A lethal factor in elderly male osteoporosis patients - insights from NHANES

BACKGROUND AND AIM

This study aims to investigate the relationship between A Body Shape Index (ABSI) Z-score and all-cause mortality among osteoporotic patients using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS AND RESULTS

We analyzed NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018, focusing on individuals aged 50 and above with complete bone mineral density (BMD) data. The ABSI Z-score, calculated by adjusting waist circumference (WC) for height and weight, was used to independently assess abdominal fat beyond Body Mass Index (BMI). Mortality status was confirmed by linking NHANES data with the National Death Index (NDI), with follow-up until December 31, 2019. Weighted Cox proportional hazards models were employed for analysis, adjusting for age, gender, race, fracture history, anti-osteoporosis treatment history, diabetes, and cardiovascular disease (CVD). The study included 1596 participants. Higher ABSI Z-scores were significantly associated with increased all-cause mortality risk, especially among elderly male osteoporotic patients. This association remained robust after adjusting for multiple potential confounders.

CONCLUSION

The ABSI Z-score serves as a valuable non-invasive screening tool that effectively identifies osteoporotic patients at higher risk of mortality. These findings emphasize the importance of body management in health, supporting further research to explore the practical utility of ABSI Z-score in osteoporotic patients and how body management can enhance long-term survival rates.

Effects of nanocurcumin supplementation on metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Metabolic syndrome (MetS) encompasses metabolic risk factors like elevated blood glucose, abnormal lipid levels, and hypertension. Nanocurcumin, a nanoscale formulation of curcumin, may offer therapeutic benefits for MetS management. This systematic review and meta-analysis evaluates the impact of nanocurcumin supplementation on key MetS parameters.

METHODS

A systematic literature search identified 20 randomized controlled trials (RCTs) with 1394 participants. Data were pooled using a random-effects model, and standardized mean differences (SMDs) were calculated for key outcomes.

RESULTS

Nanocurcumin supplementation significantly improved waist circumference (WC) (standardized mean difference (SMD): -0.30 cm), fasting blood sugar (FBS) (SMD: -0.34 mg/dL), HbA1c (SMD: -0.33 %), and quantitative insulin sensitivity check index (QUICKI) score (SMD: 0.73). Lipid profile parameters, including total cholesterol (SMD: -0.18 mg/dL), LDL-C (SMD: -0.16 mg/dL), and HDL-C (SMD: 0.32 mg/dL), also reduced significantly. Improvement in diastolic blood pressure (DBP) (SMD: -0.32 mmHg), total antioxidant capacity (TAC) (SMD: 0.44 mmol/L), malondialdehyde (MDA) (SMD: -0.37 mmol/L), tumor necrosis factor-α (TNF-α) (SMD: -2.30 ng/L), interleukin-6 (IL-6) (SMD: -1.07 ng/L), and high-sensitivity C-reactive protein (hs-CRP) (SMD: -0.34 mg/L) were observed.

CONCLUSION

Nanocurcumin supplementation significantly improves multiple MetS-related parameters, including anthropometric measures, glycemic control, lipid profile, blood pressure, oxidative stress markers, and inflammatory biomarkers. These findings highlight nanocurcumin's potential as an effective adjunctive therapy for managing MetS. However, the variability in study participant ages, treatment durations, and sample sizes suggests the need for further well-designed RCTs to establish optimal usage guidelines.

Delayed atorvastatin delivery promotes recovery after experimental spinal cord injury

Spinal cord injury (SCI) significantly alters gene expression, potentially impeding functional recovery. This study investigated the effects of atorvastatin, a widely prescribed cholesterol-lowering drug, on gene expression and functional recovery in a chronic murine SCI model. Female C57BL/6J mice underwent moderate 0.25 ​mm lateral compression SCI and received daily atorvastatin (10 ​mg/kg) or vehicle-only injections from two weeks post-injury for four weeks. Sensorimotor functions were assessed using the Basso Mouse Scale (BMS), its subscore, and the inclined plane test. RNA sequencing of spinal cord tissues identified robust transcriptomic changes from SCI and a smaller subset from atorvastatin treatment. Atorvastatin enhanced sensorimotor recovery within two weeks of treatment initiation, with effects persisting to the experimental endpoint. Pathway analysis showed atorvastatin enriched neural regeneration processes including Fatty Acid Transport, Axon Guidance, and the Endocannabinoid Developing Neuron Pathway; improved mitochondrial function via increased TCA Cycle II and reduced Mitochondrial Dysfunction; and decreased Inhibition of Matrix Metalloproteases. Key gene drivers included Fabp7, Unc5c, Rest, and Klf4. Together, these results indicate atorvastatin's potential in chronic SCI recovery, especially where already indicated for cardiovascular protection.

Serum Neutrophil Biomarkers to Predict Crohn's Disease Progression and Infliximab Treatment Outcomes

BACKGROUND AND AIMS

Predicting the treatment outcomes of biological therapies is an unmet need in Crohn's Disease. In this study, we explored the potential of serum neutrophil-related biomarkers to predict infliximab therapeutic results and disease progression in Crohn's Disease patients, over a 2-year period, in a real-world setting.

METHODS

The study included 100 asymptomatic Crohn's Disease patients in the IFX maintenance phase from the prospective, observational, multicenter DIRECT study. Patients were categorized according to a composite outcome reflecting progression that included surgery, hospitalizations, new fistulae, abscess or stricture, and drug treatment escalation. Serum neutrophil elastase, lipocalin-2, lactoferrin, and resistin (non-neutrophil control) were analyzed via multiplex magnetic bead assays at multiple touchpoints. Fecal calprotectin was assessed by ELISA.

RESULTS

Over up to 2 years of follow-up, serum biomarkers did not differentiate between the composite outcome groups, whereas fecal calprotectin was significantly higher in patients with worse outcomes. During the infliximab maintenance phase, there was a significant, sustained reduction of neutrophil elastase (p < 0.001), lipocalin-2 (p < 0.001), and lactoferrin (p < 0.001), but not of resistin, despite stable neutrophil levels. Correlations between NE and NGAL levels were strong (Pearson correlations 0.75-0.85); all other correlations were of small magnitude.

CONCLUSION

Our real-world data do not support using serum neutrophil elastase, lipocalin-2, or lactoferrin concentrations as predictors of treatment outcomes or disease evolution in infliximab -treated Crohn's Disease patients. On the other hand, the sustained decrease in biomarkers over time suggests that neutrophil stabilization might be an additional infliximab mechanism of action.

Unraveling the Microenvironment and the Pathogenic Axis of HIF-1α-Visfatin-Fibrosis in Autoimmune Pancreatitis Using a Single-Cell Atlas

Autoimmune pancreatitis (AIP) is identified as a severe chronic immune-related disorder in pancreas, including two subtypes. In this study, pancreatic lesions in patients diagnosed as either type 1 AIP or type 2 AIP are examined, and these patients' peripheral blood at single-cell level. Furthermore, flow cytometry, immunofluorescence, and functional assays are performed to verify the identified cell subtypes. In type 1 AIP, there is a notable increase in the amount of B cells and plasma cells, and IgG4+ plasma cells are key pathogenic cells of AIP. The differentiation path of naïve-stage B cells into IgG4+ produced plasma cells is observed, and an increased amount of T helper cells and T follicular helper (Tfh) cells. This study also reveals that HIF-1α, an activated transcriptional factor, can directly bind to promoter site of NAMPT, promoting higher levels of visfatin production in HIF1A+ classical monocytes. Pancreatic stellate cells can be activated by extracellular visfatin and promote the development of fibrotic response in pancreatic lesions across both AIP subtypes. The current findings shed light on the exploration of dynamic alterations in peripheral blood cells and cell subgroups in pancreatic lesions of AIP, while elucidating a pathogenic cell subset and potential fibrosis mechanism of AIP.

Preliminary evaluation of a mindfulness intervention program in women with long COVID dysautonomia symptoms

Background

The symptom burden for patients with Long COVID-associated dysautonomia is high, yet there are currently no effective treatments. Mindfulness programs reduce psychological and physical symptoms as well as inflammatory gene expression in a variety of medical conditions. The study aim was to evaluate the effect of a six-week mindfulness program in women with Long COVID dysautonomia symptoms.

Methods

Using a single arm, pre- and posttest design, women aged 18-54 years with Long COVID and orthostatic intolerance suggestive of dysautonomia were recruited from a single center. Participants attended a standardized, six-week, virtual mindfulness program. An active stand test and 6-min walk test (6MWT) were performed at baseline and post-intervention. Self-reported measures of physical and mental health symptoms collected at baseline, post-intervention and 4 week follow up included the composite autonomic symptom score (COMPASS-31), perceived stress (PSS), anxiety (GAD7), depression (PHQ8), COVID-19 event specific distress (IES-R), fatigue (FSI), sleep (ISI), well-being (MHC-SF), resilience (CD-RISC 10), and quality of life (SF-20). The effects on conserved transcriptional response to adversity (CTRA) were examined by next-generation sequencing of dried whole blood samples.

Results

Twenty participants were enrolled with a mean age of 39.9 years (range 21-52 years). No significant changes were observed for the active stand test or 6MWT. A significant reduction in insomnia severity (ISI: 16.6 vs. 13.6; p = 0.001) was observed post-intervention, but scores reverted toward baseline levels at 4-week follow-up. No significant improvements were seen in autonomic symptoms, anxiety, perceived stress, depression, well-being, or COVID-19 related distress. Pro-inflammatory CTRA gene expression decreased significantly from pre-to post-intervention (p = 0.004). Declines in CTRA gene expression were most significant among those with 3 COVID-19 positive events (p = 0.01), followed by 2 events (p = 0.04) and 1 event (p = 0.05). Declines in CTRA gene expression did not vary significantly as a function of recent illness, COVID-19 hospitalization, demographic characteristics, or general medical history.

Conclusion

A virtual, six-week mindfulness program may improve sleep quality in women with Long COVID dysautonomia. While no objective improvement in dysautonomia symptoms were observed, our findings suggest a favorable effect of the mindfulness intervention on inflammatory and antiviral biology with a decrease in CTRA gene expression. Nonetheless, the symptom burden in this population is very high, and more attention is needed to provide effective multi-modal clinical therapies to this population.

P2 purinergic receptors at the heart of pathological left ventricular remodeling following acute myocardial infarction

Pathological left ventricular remodeling is a complex process following an acute myocardial infarction, leading to architectural disorganization of the cardiac tissue. This phenomenon is characterized by sterile inflammation and the exaggerated development of fibrotic tissue, which is noncontractile and poorly conductive, responsible for organ dysfunction and heart failure. At present, specific therapies are lacking for both prevention and treatment of this condition, and no biomarkers are currently validated to identify at-risk patients. Physiopathological understanding of this process is limited, probably due to the combination of the multicellular responses involved that are initially necessary for tissue healing but may be detrimental in the longer term. Current research focuses on understanding and modulating the inflammatory response, a key aspect of the tissue healing process. Inflammation is triggered by the release of inflammatory mediators from cardiomyocytes undergoing cell death in the context of ischemia-reperfusion injury. Among them, extracellular ATP is a strong mediator of inflammation through the activation of P2 purinergic receptors, regulating the behavior of all the cellular actors of the postmyocardial infarction response and impacting organ function and recovery. Rather than considering each cellular protagonist independently, this review provides an integrated overview of the inflammatory and tissue response to myocardial infarction by members of the P2 receptor family. Finally, it explores the possibility of reducing pathological left ventricular remodeling through the modulation of these receptors and their associated signaling pathways.

Perihematomal oligemia is associated with progression to ischemia and poor outcome in a subset of patients with intracerebral hemorrhage

OBJECTIVES

We aimed to characterize the longitudinal evolution of perihematomal oligemia in acute intracerebral hemorrhage (ICH).

MATERIALS AND METHODS

A single center prospectively collected cohort of 150 patients with primary spontaneous ICH were imaged with computed tomography perfusion within 6 h from onset (T0), at 24 h (T1) and at 7 days (T7). Perihematomal cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area and categorized into ischemic (< 20 mL/100 g/min), oligemic (20-39.9 mL/100 g/min), normal (40-55 mL/100 g/min) and hyperemic (> 55 mL/100 g/min).

RESULTS

pCBF values were ischemic in 20.7%, oligemic 47.3%, normal in 17.3%, and hyperemic in 14.7% of patients at T0. All patients with T0 ischemia remained ischemic at T7, normal and hyperemic patients at T0 maintained good perfusion values at T7, whereas 46.5% of oligemic patients at T0 developed delayed perihematomal ischemia. In patients with T0 perihematomal oligemia, the risk of conversion into delayed ischemia at T7 was higher in those with pCBF < 30 mL/100 g/min (p < 0.001). A total of 42.7% patients had perihematomal ischemia at T7 and this profile correlated with poor outcome, regardless of baseline perfusion status.

CONCLUSION

Our findings suggest that perihematomal oligemia may not represent a benign entity and indicate that delayed perihematomal ischemia is common and associated with unfavorable outcome.

KEY POINTS

Question The natural history and longitudinal evolution of perihematomal oligemia over time in patients with intracerebral hemorrhage (ICH) remains to be established. Findings Conversion of baseline perihematomal oligemia into ischemia occurs in 46.5% of oligemic ICH patients at 7 days, where a total of 42.7% patients were ischemic. Clinical relevance Evolution of perihematomal oligemia into ischemia during the transition from hyperacute to subacute phases is common. ICH patients with perihemorrhagic cerebral blood flow values < 30 mL/100 g/min are at high risk of ischemic progression, which in turn contributes to poor outcome.

Adhesive and Conductive Hydrogels for the Treatment of Myocardial Infarction

Myocardial infarction (MI) is a leading cause of mortality among cardiovascular diseases. Following MI, the damaged myocardium is progressively being replaced by fibrous scar tissue, which exhibits poor electrical conductivity, ultimately resulting in arrhythmias and adverse cardiac remodeling. Due to their extracellular matrix-like structure and excellent biocompatibility, hydrogels are emerging as a focal point in cardiac tissue engineering. However, traditional hydrogels lack the necessary conductivity to restore electrical signal transmission in the infarcted regions. Imparting conductivity to hydrogels while also enhancing their adhesive properties enables them to adhere closely to myocardial tissue, establish stable electrical connections, and facilitate synchronized contraction and myocardial tissue repair within the infarcted area. This paper reviews the strategies for constructing conductive and adhesive hydrogels, focusing on their application in MI repair. Furthermore, the challenges and future directions in developing adhesive and conductive hydrogels for MI repair are discussed.

Dopamine agonist therapy in Parkinson's disease: Spanish expert consensus on its use in different clinical situations

BACKGROUND

Different types of therapies were proven effective for the medical management of motor and non-motor symptoms in Parkinson's disease (PD). We aimed to gain consensus on the dopamine agonist (DA) therapy use in different clinical scenarios of Parkinson's disease (PD) patients.

METHODS

This consensus study was based on the nominal group technique. Initially, a consensus group comprising 12 expert neurologists in the PD field identified the topics to be addressed and elaborated different evidence-based preliminary statements. Next, a panel of 48 Spanish neurologists expressed their opinion on an internet-based systematic voting program. Finally, initial ideas were reviewed and rewritten according to panel contribution and were ranked by the consensus group using a Likert-type scale. The analysis of data was carried out by using a combination of both qualitative and quantitative methods. The consensus was achieved if the statement reached ≥ 3.5 points in the voting process.

RESULTS

The consensus group produced 76 real-world recommendations. The topics addressed included 12 statements related to DA therapy in early PD, 20 statements concerning DA treatment strategy in patients with motor complications, 11 statements associated with DA drugs and their side effects, and 33 statements regarding DA therapy in specific clinical scenarios. The consensus group did not reach a consensus on 15 statements.

CONCLUSION

The findings from this consensus method represent an exploratory step to help clinicians and patients in the appropriate use of DA in different stages and clinical situations of PD.

Sirtuins as therapeutic targets in diabetes

INTRODUCTION

Sirtuins (SIRTs) are NAD+-dependent deacetylases that mediate post-translational modifications of proteins. Seven members of the SIRT family have been identified in mammals. Importantly, SIRTs interact with numerous metabolic and inflammatory pathways. Thus, researchers have investigated their role in metabolic and inflammatory disorders.

AREAS COVERED

In this review, we comprehensively discuss the involvement of SIRTs in the processes of pancreatic β-cell dysfunction, glucose tolerance, insulin secretion, lipid metabolism, and adipocyte functions. In addition, we describe the current evidence regarding modulation of the expression and activity of SIRTs in diabetes, diabetic complications, and obesity.

EXPERT OPINION

The development of specific SIRT activators and inhibitors that exhibit high selectivity toward specific SIRT isoforms remains a major challenge. This involves the need to elucidate the physiological pathways involving SIRTs, as well as their important role in the development of metabolic disorders. Molecular modeling techniques will be helpful to develop new compounds that modulate the activity of SIRTs, which may contribute to the preparation of new drugs that selectively target specific SIRTs. SIRTs hold promise as potential targets in metabolic disease, but there is much to learn about specific modulators and the final answers will await clinical trials.

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.

Neurological long COVID in the outpatient clinic: Is it so long?

BACKGROUND AND PURPOSE

Neurological involvement in long COVID (coronavirus disease 2019) is well known. In a previous study we identified two subtypes of neurological long COVID, one characterized by memory disturbances, psychological impairment, headache, anosmia and ageusia, and the other characterized by peripheral nervous system involvement, each of which present a different risk factor profile. In this study, we aimed to clarify the persistence of neurological long COVID symptoms with a significantly longer term follow-up.

METHODS

We prospectively collected data from patients with prior COVID-19 infection who showed symptoms of neurological long COVID. We conducted a descriptive analysis to investigate the progression of neurological symptoms over time at 3-, 6-, 12-, and 18-month follow-ups. We performed a k-means clustering analysis on the temporal evolution of the symptoms at 6, 12, and 18 months. Finally, we assessed the difference between the recovery course of vaccinated and non-vaccinated patients by computing the cumulative recovery rate of symptoms in the two groups.

RESULTS

The study confirmed the presence of two subtypes of neurological long COVID. Further, 50% of patients presented a complete resolution of symptoms at 18 months of follow-up, regardless of which subtype of neurological long COVID they had. Vaccination against SARS-Cov-2 appeared to imply a higher overall recovery rate for all neurological symptoms, although the statistical reliability of this finding is hampered by the limited sample size of the unvaccinated patients included in this study.

CONCLUSIONS

Neurological long COVID can undergo complete resolution after 18 months of follow-up in 50% of patients and vaccination can accelerate the recovery.

Impact of COVID-19 on functional, cognitive, neuropsychiatric, and health-related outcomes in patients with dementia: A systematic review

Background

This systematic review analyzes the impact of COVID-19 on dementia patients' functional, cognitive, neuropsychiatric, and health related outcomes. It hypothesizes that dementia patients infected with SARS-CoV-2experience more pronounced deterioration compared to those who are uninfected.

Methods

Research from 01/03/2020 to 07/10/2023 was conducted using Medline, Web of Science, and Embase databases, and adhering to PRISMA guidelines and the PICO framework. The study aimed to determine if SARS-CoV-2 infection is associated with worse outcomes in dementia patients. The protocol is registered in PROSPERO (CRD42022352481), and bias was evaluated using the Newcastle-Ottawa Scale.

Results

Among 198 studies reviewed, only three met the criteria. Chen et al. (2023) identified higher mortality in SARS-CoV-2-infected dementia patients, while Merla et al. (2023) observed faster cognitive decline in infected individuals with increased hospital admissions. Additionally, Cascini et al. (2022) reported an increased risk of infection and significantly elevated mortality in dementia patients, highlighting comorbidities and antipsychotic medication use as key risk factors.

Conclusion

These limited data suggest higher mortality and cognitive decline in dementia patients following COVID-19, underscoring the need for extensive research in this area.

Effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin and canagliflozin, on the musculoskeletal system in an experimental model of diabetes induced by high-fat diet and streptozotocin in rats

The effect of SGLT2 inhibitors, a new group of antidiabetic drugs, on the skeletal system is a matter of debate. There are concerns that they may unfavorably affect bones. The aim of the study was to investigate the effects of dapagliflozin and canagliflozin on musculoskeletal system in an experimental rat model of type 2 diabetes induced by a high-fat diet (HFD) and streptozotocin (STZ). The experiments were carried out on mature female rats. To induce diabetes, STZ was administered 2 weeks after the introduction of HFD. Administration of dapagliflozin (1.4 mg/kg p.o.) or canagliflozin (4.2 mg/kg p.o.) started 1 week after the STZ injection, and lasted 4 weeks. Skeletal muscle mass and strength, serum bone turnover marker concentration and other biochemical parameters, and bone mass, density, histomorphometric parameters and mechanical properties were determined. Diabetes induced decreases in skeletal muscle mass and osteoporotic changes, including decreases in bone density, and worsening of the histomorphometric parameters and cancellous bone mechanical properties. The SGLT2 inhibitors decreased glycemia and other diabetes-induced metabolic changes, and counteracted only some unfavorable effects of diabetes on bones. The effects of dapagliflozin and canagliflozin on metabolic parameters were similar, whereas there were some differences in their effects on the skeletal system. The study demonstrated possibility of differential skeletal effects of different SGLT2 inhibitors in diabetic conditions, indicating the need for caution concerning their use in patients at risk of bone fractures.

Serum Uric Acid/Serum Creatinine Ratio and Chronic Vascular Lesions on Renal Biopsy: A Retrospective Observational Study

INTRODUCTION

Increased serum uric acid (SUA) levels are found in cardiovascular and kidney diseases, associated with the development of vascular injury. Uric acid stimulates the inflammatory pathways, promotes vascular smooth muscle cells proliferation, activates renin-angiotensin system leading to the development and progression of vascular damage. Renal function-normalized uric acid [SUA to serum creatinine ratio (SUA/SCr)] has been suggested to be a better indicator of uric acid.

AIM

To investigate the correlation between SUA level and SUA/SCr in the development of chronic and vascular lesions (CVL) in patients with primary glomerulonephritis (GN).

METHODS

A retrospective observational study was conducted in 95 consecutive renal native biopsies performed at Policlinico Umberto I of Rome (Italy). Patient inclusion criteria were age ≥ 18 years, a renal biopsy confirming diagnosis of primary GN, the availability of complete demographic, clinical, pathological, and laboratory data.

RESULTS

Median SCr was 1.06 mg/dl (IQR 0.77;1.70) with a median eGFR of 70.40 ml/min (IQR 40.40;105). Median SUA was 5.90 mg/dl (IQR 4.30;6.90) and median SUA/SCr was 4.70 (IQR 3.20;6.80). CVL were reported in 56 (58.9%) patients. Median SUA/SCr was significantly lower in patients with CVL than patients without CVL [3.95 (IQR 2.65;6) vs 5.90 (IQR 4.30;7.20), p<0.01]. Logistic regression analysis showed that SUA/SCr ≤ 4.05 [OR 5.451 (95% CI 1.222;24.325), p<0.05] was independently associated with CVL.

CONCLUSIONS

CVL play a crucial role in the progression of kidney disease. SUA/SCr ≤ 4.05 is associated with CVL in patients with primitive GN.

Empagliflozin and dapagliflozin decreased atrial monoamine oxidase expression and alleviated oxidative stress in overweight non-diabetic cardiac patients

The sodium-glucose-cotransporter 2 inhibitors (SGLT2i) are the blockbuster antidiabetic drugs that exert cardiovascular protection via pleiotropic effects. We have previously demonstrated that empagliflozin decreased monoamine oxidase (MAO) expression and oxidative stress in human mammary arteries. The present study performed in overweight, non-diabetic cardiac patients was aimed to assess whether the two widely prescribed SGLT2i decrease atrial MAO expression and alleviate oxidative stress elicited by exposure to angiotensin 2 (ANG2) and high glucose (GLUC). Right atrial appendages isolated during cardiac surgery were incubated ex vivo with either empagliflozin or dapagliflozin (1, 10 µm, 12 h) in the presence or absence of ANG2 (100 nm) and GLUC (400 mg/dL) and used for the evaluation of MAO-A and MAO-B expression and ROS production. Stimulation with ANG2 and GLUC increased atrial expression of both MAOs and oxidative stress; the effects were significantly decreased by the SGLT2i. Atrial oxidative stress positively correlated with the echocardiographic size of heart chambers and negatively with the left ventricular ejection fraction. In overweight patients, MAO contributes to cardiac oxidative stress in basal conditions and those that mimicked the renin-angiotensin system activation and hyperglycemia and can be targeted with empagliflozin and dapagliflozin, as novel off-target class effect of the SGLT2i.

Asparagine Endopeptidase Inhibition Attenuates Tissue Plasminogen Activator-Induced Brain Hemorrhagic Transformation After Ischemic Stroke

BACKGROUND

Thrombolytic treatment with tissue plasminogen activator (tPA) is one of the approved pharmacological therapies for acute ischemic stroke. However, the use of tPA is limited due to hemorrhagic transformation (HT) and the narrow therapeutic time window. Previous studies demonstrated that asparagine endopeptidase (AEP), a widely expressed pH-dependent endo-lysosomal cysteine protease, can induce neuronal death during ischemia-reperfusion injury. But whether AEP is engaged in HT during ischemia-reperfusion injury is unclear. In the current study, we expanded the role of AEP on HT after delayed tPA administration.

METHODS

In order to investigate the effects of AEP on HT after delayed tPA administration following ischemic stroke, the middle cerebral artery occlusion/reperfusion (MCAO/R) was performed in wild-type (WT) and AEP knockout (KO) transgenic mice, followed by delayed administration of tPA (10 mg/kg, 3 h after occlusion). Additionally, we explored the potential of R13, a specific TrkB agonist with a strong inhibitory impact on AEP, to mitigate injury induced by tPA. 24 h after tPA administration, the following parameters were assessed: infarct volume, behavioral tests, hemorrhagic levels, Evans blue leakage, tight and adherens junction protein expression, blood-brain barrier (BBB) function, cerebral vascular structure, matrix metalloproteinases (MMPs), and BBB-regulated protein low-density lipoprotein receptor-related protein 1 (LRP-1) expression. To construct an in vitro model to examine the effects of AEP on ischemia-reperfusion injury after tPA treatment, human umbilical vein endothelial cells (HUVECs) were exposed to 4 h of oxygen-glucose deprivation (OGD), followed by treatment with tPA (500 ng/mL). 7,8-dihydroxyflavone (7,8-DHF), a natural TrkB agonist with an inhibitory effect on AEP, was applied before OGD.

RESULTS

Compared with tPA-treated WT mice, AEP KO mice treated with tPA showed improved infarct volume, neurological function, brain edema, brain hemoglobin levels, Evans blue leakage, vascular tight junctions, and basement membrane structure combined with reduced AEP expression and activity within the peri-infarct area. In addition, the mice treated with R13 exhibited protective effects on the BBB. Furthermore, we found that the expression of MMP2, MMP9, and LRP-1 in the brain was inhibited by both AEP knockout and R13 treatment. Moreover, HUVECs treated with 7,8-DHF showed improvements in tight and adherens junction proteins and suppressed levels of MMP2, MMP9, and LRP-1.

CONCLUSION

Our findings demonstrate that AEP exacerbates HT induced by delayed tPA treatment in acute ischemic stroke by activating LRP-1, MMP2, and MMP9, which disrupts BBB integrity. We further confirmed R13 as a preventive therapy to attenuate HT induced by delayed tPA treatment in acute ischemic stroke. The present study suggests AEP inhibition may serve as a promising strategy to enhance the safety of delayed tPA thrombolysis for ischemic stroke.

Recent advances in biomimetic nanodelivery systems for the treatment of myocardial ischemia reperfusion injury

Myocardial ischemia/reperfusion injury (MIRI) is a significant challenge in the treatment of myocardial infarction, a leading cause of global mortality due to irreversible cardiac damage. Biomimetic nanodelivery systems offer promising therapeutic strategies to address MIRI. In this review, we comprehensively investigate the underlying pathophysiological mechanisms of MIRI and discuss recent advances in biomimetic nanodelivery systems including cell membrane-coated nanoparticles, exosomes, and nanoenzymes as innovative approaches for MIRI treatment. We emphasize the advantages and potential of biomimetic strategies in enhancing therapeutic efficacy, assess the preclinical effectiveness of these nanodelivery systems, and discuss the challenges associated with translating these approaches into clinical practice. This paper aims to provide new perspectives on biomimetic strategies for MIRI treatment, contributing to the development of effective drug delivery systems.

A Phase 2b, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of intravenous prasinezumab in early-stage Parkinson's disease (PADOVA): Rationale, design, and baseline data

INTRODUCTION

Prasinezumab was shown to potentially delay motor progression in individuals with early-stage Parkinson's disease (PD) who were either treatment-naïve or on monoamine oxidase type B inhibitor (MAO-Bi) therapy in the PASADENA study. We report the rationale, design, and baseline patient characteristics of the PADOVA study, designed to evaluate prasinezumab in an early-stage PD population receiving standard-of-care (SOC) symptomatic medications.

METHODS

PADOVA (NCT04777331) is a Phase 2b, multicenter, randomized, double-blind, placebo-controlled, parallel-group study, in which individuals with early-stage PD on SOC stable symptomatic monotherapy (levodopa or MAO-Bi) receive intravenous prasinezumab 1500 mg every 4 weeks. The primary endpoint is time to confirmed motor progression, defined as ≥5 points increase from baseline on the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in practically defined OFF-medication state.

RESULTS

586 participants were enrolled between May 5th, 2021 and March 22nd, 2023. At baseline, 74.2 % and 25.8 % of participants were receiving levodopa and MAO-Bi, respectively. Mean age was 64.2 years and 63.5 % were male. Mean time from diagnosis was 18.6 months, 85 % of participants were in Hoehn & Yahr (H&Y) Stage 2, and mean MDS-UPDRS Part III score was 24.5. Compared with the PASADENA population, PADOVA participants were older (∼5 years), with longer disease duration (∼8 months), and slightly more advanced based on H&Y stage (10 % more in Stage 2) and MDS-UPDRS Part III (∼3 points more).

CONCLUSIONS

PADOVA has successfully recruited an early-stage PD population to test the effect of prasinezumab when added to background SOC.

The association of Neutrophil-to-Lymphocyte ratio with metabolic syndrome in U.S. Adults: Findings from the 1999-2018 National Health and Nutrition Examination survey

Background

Identifying and treating metabolic syndrome (MetS) early is of great importance, as MetS portends numerous negative health outcomes. Identifying an inexpensive, readily available inflammatory biomarker that accurately predicts MetS could be of use to clinicians.

Methods

The aim of this study was to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and MetS in U.S. adults. We used data from adult participants of the 1999-2018 National Health and Nutrition Examination Surveys to conduct a cross-sectional study. MetS was determined using National Cholesterol Education Program Adult Treatment Panel III (2005 revision) criteria; NLR was calculated by dividing the absolute neutrophil count by absolute lymphocyte count. Data were weighted and analyzed using survey procedures in SAS v9.4.

Results

Data from 101,316 participants were reviewed, of whom 19,613 were eligible for weighted analysis. MetS was observed in 40.3 % of participants (n = 7,896), who met 3 (n = 3,902; 49.4 %), 4 (n = 2,817; 35.7 %), and 5 (n = 1,177; 14.9 %) criteria of MetS, respectively. Across the survey years, NLR was higher in those with MetS compared to those without (mean 2.24 [95 % CI 2.21, 2.28] vs 2.05 [95 % CI 2.02, 2.08]; p < 0.001). There was a consistent trend of increasing NLR according to MetS severity (p < 0.001). An NLR cutoff of 1.67 had 74.3 % sensitivity and 62.3 % specificity for MetS with Area-under-the-curve of 0.736 [95 % CI 0.73, 0.74].

Conclusions

Among U.S. adults, NLR was associated with MetS and MetS severity, independent of age and race/ethnicity.

Strategies to Maximize the Benefits of Evidence-Based Enteral Nutrition: A Narrative Review

Enteral nutrition (EN) has been reported to have some physiological importance for critically ill patients. However, the advantage of EN over parenteral nutrition remains controversial in recent paradigms. To maximize the benefits and efficiency of EN, implementing measures based on comprehensive evidence is essential. Here, we systematically reviewed EN-related studies and integrated them into the best and most up-to-date EN practices. We extracted studies from 13 systematic reviews during the development of Japanese Critical Care Nutrition Guidelines, summarizing findings on the assessment of enteral feeding intolerance (EFI), the timing of EN, formula composition and nutrients, and method of administration in critically ill adult patients. Multifaceted EFI assessment may be needed in patients for high-risk patients. Early EN may reduce infectious complications, and initiating EN even earlier may offer an additional advantage. High protein intake (≥1.2 g/kg/day) could maintain muscle mass and physical function without increasing gastrointestinal complications. Probiotics, prebiotics, and synbiotics may serve as beneficial options for preventing infection and gastrointestinal complications, although their efficacy depends on the strains, types, and combinations used. For patients with EFI, post-pyloric feeding could be an effective approach, while intermittent feeding may be a safer approach. Both methods should be utilized to achieve nutritional targets. Integrating these nutritional interventions into EN strategies may help maximize their effectiveness and minimize complications. However, careful consideration regarding timing, dosage, nutrient selection, administration methods, and patient selection is required.

Pharmacological approaches to enhance mitochondrial biogenesis: focus on PGC-1Α, AMPK, and SIRT1 in cellular health

BACKGROUND

Mitochondrial biogenesis is essential for cellular energy balance and metabolic stability. Its dysregulation is linked to various metabolic and neurodegenerative diseases, making it a significant therapeutic target. Pharmacological approaches aimed at enhancing mitochondrial function have gained attention for their potential to restore cellular metabolism.

OBJECTIVES

This review examines recent advancements in pharmacological strategies targeting mitochondrial biogenesis, focusing on the roles of PGC-1α, AMPK, and SIRT1, alongside novel therapeutic agents and drug delivery systems.

METHODS

A systematic review of studies published between 2018 and 2023 was conducted using databases such as PubMed, Web of Science, and Elsevier. Keywords related to mitochondrial biogenesis and pharmacological modulation were used to identify relevant literature.

RESULTS

Various pharmacological agents, including resveratrol, curcumin, and metformin, activate mitochondrial biogenesis through different pathways. SIRT1 activators and AMPK agonists have shown promise in improving mitochondrial function. Advances in mitochondria-targeted drug delivery systems enhance therapeutic efficacy, yet challenges remain in clinical translation due to the complexity of mitochondrial regulation.

CONCLUSION

Pharmacological modulation of mitochondrial biogenesis holds therapeutic potential for metabolic and neurodegenerative diseases. While preclinical studies are promising, further research is needed to optimize drug efficacy, delivery methods, and personalized treatment strategies.

Serum Lipids, Inflammation, and the Risk of Atrial Fibrillation: Pathophysiological Links and Clinical Evidence

Dyslipidemia is a metabolic disorder characterized by quantitative and/or qualitative abnormalities in serum lipid levels. Elevated serum cholesterol levels can modify the turnover and recruitment of ionic channels in myocytes and cellular homeostasis, including those of inflammatory cells. Experimental and clinical data indicate that inflammation is implicated in the pathophysiology of atrial remodeling, which is the substrate of atrial fibrillation (AF). Data about the association between increased lipid serum levels and AF are few and contrasting. Lipoprotein (a), adiposity, and inflammation seem to be the main drivers of AF; in contrast, low-density lipoproteins, high-density lipoproteins and triglycerides are not directly involved in AF onset. The present review aimed to describe the pathophysiological link between dyslipidemia and AF, the efficacy of lipid-lowering therapies in atherosclerotic cardiovascular disease (ASCVD) patients with and without AF, and the impact of lipid-lowering therapies on AF incidence.

Roles of Sirtuins in Cardiovascular Diseases: Mechanisms and Therapeutics

Cardiovascular diseases (CVDs) are experiencing a rapid surge and are widely recognized as the leading cause of mortality in the current aging society. Given the multifactorial etiology of CVDs, understanding the intricate molecular and cellular mechanisms is imperative. Over the past 2 decades, many scientists have focused on Sirtuins, a family of nicotinamide adenine dinucleotide-dependent deacylases. Sirtuins are highly conserved across species, from yeasts to primates, and play a crucial role in linking aging and diseases. Sirtuins participate in nearly all key physiological and pathological processes, ranging from embryogenic development to stress response and aging. Abnormal expression and activity of Sirtuins exist in many aging-related diseases, while their activation has shown efficacy in mitigating these diseases (eg, CVDs). In terms of research, this field has maintained fast, sustained growth in recent years, from fundamental studies to clinical trials. In this review, we present a comprehensive, up-to-date discussion on the biological functions of Sirtuins and their roles in regulating cardiovascular biology and CVDs. Furthermore, we highlight the latest advancements in utilizing Sirtuin-activating compounds and nicotinamide adenine dinucleotide boosters as potential pharmacological targets for preventing and treating CVDs. The key unresolved issues in the field-from the chemicobiological regulation of Sirtuins to Sirtuin-targeted CVD investigations-are also discussed. This timely review could be critical in understanding the updated knowledge of Sirtuin biology in CVDs and facilitating the clinical accessibility of Sirtuin-targeting interventions.

Coronavirus anxiety and its relationship to mood and cognition in post-acute sequelae of COVID-19

Background: Subjective and objective cognitive dysfunction may be observed in patients with post-acute sequelae of COVID-19 (PASC), and are associated with depression and general anxiety. Coronavirus anxiety (CA) is associated with subjective cognition, depression, and general anxiety in community samples. We determined the base rate of CA in patients with PASC and its relation to mood, subjective and objective cognition. Design and Methods: Participants were 79 patients with PASC referred for clinical neuropsychological evaluation, who completed the Coronavirus Anxiety Scale (CAS), BDI-II, BAI, BRIEF-A, and cognitive tests. Results: Base rate of clinically elevated CAS was low (5.1%), whereas BDI-II (78.6%), BAI (80%), and BRIEF-A Global Executive Composite (GEC; 60.3%) were high. Objective dysfunction was most common for Color-Word Interference (20.8%) and Trail Making Test (TMT) Part-B (23.1%). Greater CA was associated with worse depression, general anxiety, BRIEF-A GEC, and TMT Part-A. Higher GAI accounted for the CAS and BRIEF-A GEC association. Longer time since pandemic onset was only associated with decreasing CA. Exploratory factor analysis supported a unidimensional structure for the CAS. Conclusions: Clinically elevated CA is rare in patients with PASC seen for neuropsychological evaluation. Higher CA is associated with worse mood and subjective executive dysfunction, though the latter was accounted for by general anxiety. Patients with PASC who endorse a high level of CA would likely benefit from interventions to reduce emotional distress.

Lipedema: A Disease Triggered by M2 Polarized Macrophages?

Background/Objectives: Lipedema is a progressive disease that results in the bilateral and symmetrical accumulation of subcutaneous fat in the legs and/or arms, affecting almost exclusively women. Methods: A comprehensive review of the peer-reviewed literature was conducted between November 2024 and February 2025. Results: The pathophysiology of lipedema is complex and, especially in the early stages, shows similarities to obesity, involving adipocytes, adipose tissue-resident macrophages, and endothelial cells. In lipedema, systemic levels and the adipocyte expression of the classical adipokines adiponectin and leptin appear normal, while it remains unclear if markers of inflammation and oxidative stress are increased. Macrophages in the adipose tissue of patients have an anti-inflammatory M2 phenotype and express high levels of the scavenger receptor CD163. These cells affect adipogenesis and seem to have a central role in adipose tissue accumulation. Increased lymphatic and blood vessel permeability are comorbidities of lipedema that occur in early disease states and may contribute to disease progression. Conclusions: This review summarizes our current understanding of the pathophysiology of lipedema with a focus on the role of stromal vascular localized M2 macrophages.

Persisting blood-brain barrier disruption following cisplatin treatment in a mouse model of chemotherapy-associated cognitive impairment

Chemotherapy-related cognitive impairment, commonly referred to as "chemobrain," significantly affects cancer survivors' quality of life, yet its underlying mechanisms remain unclear. Most chemotherapeutic agents cannot cross the blood-brain barrier (BBB), yet they cause central nervous system side effects, suggesting alternative pathways of toxicity. Given that these drugs interact with the cerebrovascular endothelium at their highest concentrations, it is logical to hypothesize that endothelial damage contributes to these effects. Our recent studies demonstrated that paclitaxel-induced cognitive impairment in a mouse model results in a partial BBB disruption and subsequent neuroinflammation, mediated by chemotherapy-induced endothelial senescence. In this pilot study, we used two-photon microscopy to assess BBB permeability in mice receiving a clinically relevant cisplatin regimen, evaluating the leakage of fluorescent dextran tracers of varying molecular weights. Two months post-treatment, cisplatin-treated mice exhibited significantly increased BBB permeability to smaller molecular tracers (40 kDa, 3 kDa, and 0.3 kDa) compared to controls, indicating sustained BBB disruption. These results align with our findings for paclitaxel and suggest that chemotherapy-induced endothelial damage and senescence play a central role in cognitive impairments. Interventions targeting endothelial health could mitigate these long-term effects, improving cognitive outcomes for cancer survivors.

Serum HDL-C levels in children with epilepsy: a single-center retrospective study

Purpose

This study aims to compare the difference in serum high-density lipoprotein cholesterol (HDL-C) levels between children with epilepsy and healthy children and to assess its potential influencing factors.

Methods

For comparison, we retrospectively collected data on 1,002 children with epilepsy who visited the Department of Neurology at the Children's Hospital of Nanjing Medical University. Additionally, we included 127 healthy children who underwent routine health examinations at our hospital's Health Examination Center. This study also incorporated 98 recently diagnosed epilepsy patients who had not yet received treatment with anti-seizure medications (ASMs) as a source of baseline data. Demographic information and laboratory test results were retrieved from the hospital information system. The Kolmogorov-Smirnov test, the Mann-Whitney test, the Fisher's exact test, odds ratios (OR), Spearman or Pearson correlation coefficients, and post-hoc analysis were used to conduct statistical analysis.

Results

Healthy children exhibited significantly higher serum levels of HDL-C compared to children with epilepsy and the baseline values. Notably, a higher percentage of children with epilepsy exhibited a low HDL-C levels (<1.0 mmol/L) compared to healthy children, showing an increased risk of dyslipidemia (OR, 2.773; 95% CI, 0.9879-7.457). The type of ASMs had a notable effect on serum HDL-C levels, particularly with hepatic enzyme-inducing ASMs like oxcarbazepine, which significantly raised the serum HDL-C levels. The serum HDL-C levels were also associated with factors such as age, epilepsy history, and brain magnetic resonance imaging findings. Additionally, there was a weak negative association between serum vitamin D levels and serum HDL-C levels (R = -0.37, p = 0.0014). Moreover, children who received vitamin D supplementation demonstrated a higher level of HDL-C than those without such supplementation.

Conclusion

Serum HDL-C levels are notably lower in children with epilepsy than in healthy children. Treatment with ASMs can partially increase the serum HDL-C levels, potentially approaching those found in healthy children. Therefore, the decrease in serum HDL-C levels in children with epilepsy irrespective of receiving ASMs treatment should warrant ongoing attention.

Anti-inflammatory Therapies for Ischemic Heart Disease

PURPOSE OF REVIEW

The inclusion of immunomodulatory strategies as supportive therapies in ischemic heart disease (IHD) has garnered significant support over recent years. Several such approaches appear to be unified through their ultimate target, the NLRP3 inflammasome. This review presents a brief update on immunomodulatory strategies in the continuum of conditions constituting ischemic heart disease and emphasising on the seemingly unifying mechanism of NLRP3 activation as well as modulation across these conditions.

RECENT FINDINGS

The NLRP3 inflammasome is a multiprotein complex assembled upon inflammatory stimulation, causing the release of pro-inflammatory cytokines and initiating pyroptosis. The NLRP3 pathway is relevant in inflammatory signalling of cardiac immune cells as well as non-immune cells in the myocardium, including cardiomyocytes, fibroblasts and endothelial cells. In addition to a focus on clinical outcome and efficacy trials of targeting NLRP3-related pathways, the potential connection between immunomodulation in cardiology and the NLRP3 pathway is currently being explored in preclinical trials. Colchicine, cytokine-based approaches and SGLT2 inhibitors have emerged as promising agents. However, the conditions comprising IHD including atherosclerosis, coronary artery disease (CAD), myocardial infarction (MI) and ischemic cardiomyopathy/heart failure (iCMP/HF) are not equally amenable to immunomodulation with the respective drugs. Atherosclerosis, coronary artery disease and ischemic cardiomyopathy are affected by chronic inflammation, but the immunomodulatory approach to acute inflammation in the post-MI setting remains a pharmacological challenge, as detrimental and regenerative effects of myocardial inflammation are initiated in unison. The NLRP3 inflammasome lies at the center of cell mediated inflammation in IHD. Recent trial evidence has highlighted anti-inflammatory effects of colchicine, interleukin-based therapy as well as SGLT2i in IHD and that the respective drugs modulate the NLRP3 inflammasome.

Roadmap for alleviating the manifestations of ageing in the cardiovascular system

Ageing of the cardiovascular system is associated with frailty and various life-threatening diseases. As global populations grow older, age-related conditions increasingly determine healthspan and lifespan. The circulatory system not only supplies nutrients and oxygen to all tissues of the human body and removes by-products but also builds the largest interorgan communication network, thereby serving as a gatekeeper for healthy ageing. Therefore, elucidating organ-specific and cell-specific ageing mechanisms that compromise circulatory system functions could have the potential to prevent or ameliorate age-related cardiovascular diseases. In support of this concept, emerging evidence suggests that targeting the circulatory system might restore organ function. In this Roadmap, we delve into the organ-specific and cell-specific mechanisms that underlie ageing-related changes in the cardiovascular system. We raise unanswered questions regarding the optimal design of clinical trials, in which markers of biological ageing in humans could be assessed. We provide guidance for the development of gerotherapeutics, which will rely on the technological progress of the diagnostic toolbox to measure residual risk in elderly individuals. A major challenge in the quest to discover interventions that delay age-related conditions in humans is to identify molecular switches that can delay the onset of ageing changes. To overcome this roadblock, future clinical trials need to provide evidence that gerotherapeutics directly affect one or several hallmarks of ageing in such a manner as to delay, prevent, alleviate or treat age-associated dysfunction and diseases.

Sepsis-induced cardiac dysfunction: mitochondria and energy metabolism

Sepsis is a life-threatening multi-organ dysfunction syndrome caused by dysregulated host response to infection, posing a significant global healthcare challenge. Sepsis-induced myocardial dysfunction (SIMD) is a common complication of sepsis, significantly increasing mortality due to its high energy demands and low compensatory reserves. The substantial mitochondrial damage rather than cell apoptosis in SIMD suggests disrupted cardiac energy metabolism as a crucial pathophysiological mechanism. Therefore, we systematically reviewed the mechanisms underlying energy metabolism dysfunction in SIMD, including alterations in myocardial cell energy metabolism substrates, excitation-contraction coupling processes, mitochondrial dysfunction, and mitochondrial autophagy and biogenesis, summarizing potential therapeutic targets within them.

The association between features of epicardial adipose tissue and the risks of early recurrence after catheter ablation in patients with atrial fibrillation

Background

Epicardial adipose tissue (EAT) remodeling is associated with atrial fibrillation (AF). However, there is limited research on the contribution of EAT to the risk of AF recurrence (AFR). The purpose of this research was to assess the relationship between the risk of AFR after radiofrequency catheter ablation and the volume and attenuation of the EAT.

Methods

We included a total of 123 consecutive individuals who received AF ablation, 31 of whom suffered AFR. The volume and mean density of the whole-heart and periatrial EAT were measured on computed tomography images using four attenuation ranges. The clinical, atrial, and EAT characteristics of patients with and without AFR were compared. Logistic regression was used to identify independent risk factors and to build a model to predict recurrence. The relationship between EAT characteristics and recurrence was analyzed for the subtypes of AF.

Results

The AFR group had a larger left atrial anteroposterior diameter (47.4 ± 7.4 vs. 43.7 ± 8.0 mm), left-right diameter (78.6 ± 7.9 vs. 74.7 ± 9.1 mm), and volume (145.9 vs. 127.0 mL) than the non-recurrence group (P = 0.021, 0.037, 0.015, respectively). The total EAT volume in the AFR group was significantly larger than that in the non-recurrence group, for both the overall and persistent AF groups (all P < 0.1). The periatrial EAT volume of the AFR group was significantly larger than that of the non-recurrence group for those with persistent AF (P = 0.047, 0.048, 0.048, 0.031 for four attenuation ranges). The total EAT volume and left atrial anteroposterior diameter were independent risk factors for AFR (P = 0.035, 0.045, respectively).

Conclusion

The EAT volume and left atrial anteroposterior diameter were of great significance in predicting AFR.

The Impact of Obesity on Cardiovascular Diseases: Heart Failure

Obesity and heart failure (HF) are two intersecting public health challenges, each with rising prevalence worldwide. Obesity alters cardiac structure and function, leading to ventricular systolic and diastolic dysfunction. However, weight loss interventions, whether through lifestyle changes, pharmacological agents, or bariatric surgery, can improve cardiac function, reduce symptoms, and lower hospitalization rates. Interestingly, the "obesity paradox" suggests that HF patients with obesity may experience better survival outcomes than HF patients with normal weight despite the adverse cardiac effects of obesity. Most importantly, focusing on strategies that aim to prevent HF in patients with obesity can potentially curb the burden of this chronic condition. This review explores the complex relationship between obesity and HF, emphasizing pathophysiological mechanisms, the paradoxical survival benefit, and the impact of weight loss strategies. A deeper understanding of this relationship is critical for optimizing care and outcomes in HF patients with obesity.

Protective Role and Enhanced Intracellular Uptake of Curcumin in Retinal Cells Using Self-Emulsifying Drug Delivery Systems (SNEDDS)

Background: Sirtuin-1 (SIRT1), a histone deacetylase enzyme expressed in ocular tissues with intracellular localization, plays a critical protective role against various degenerative ocular diseases. The link between reduced SIRT1 levels and diabetic retinopathy (DR) has prompted the exploration of natural therapeutic compounds that act as SIRT1 agonists. Curcumin (CUR), which has been shown to upregulate SIRT1 expression, is one such promising compound. However, effective delivery of CUR to the deeper ocular tissues, particularly the retina, remains a challenge due to its poor solubility and limited ocular penetration following topical administration. Within this context, the development of self-nanoemulsifying drug delivery systems (SNEDDS) for CUR topical ocular delivery represents a novel approach. Methods: In accordance with our prior research, optimized SNEDDS loaded with CUR were developed and characterized post-reconstitution with simulated tear fluid (STF) at a 1:10 ratio, showing suitable physicochemical and technological parameters for ocular delivery. Results: An entrapment efficiency (EE%) of approximately 99% and an absence of drug precipitation were noticed upon resuspension with STF. CUR-SNEDDS resulted in a better stability and release profile than free CUR under simulated ocular conditions. In vitro analysis of mucoadhesive properties revealed that CUR-SNEDDS, modified with a cationic lipid, demonstrated enhanced interactions with mucin, indicating the potential for improved ocular retention. Cytotoxicity tests demonstrated that CUR-SNEDDS did not affect the viability of human corneal epithelial (HCE) cells up to concentrations of 3 μM and displayed superior antioxidant activity compared to free CUR in an oxidative stress model using retinal pigment epithelial (ARPE-19) cells exposed to hydroquinone (HQ). Cell uptake studies confirmed an enhanced accumulation of CUR within the retinal cells following exposure to CUR-SNEDDS compared to neat CUR. CUR-SNEDDS, at lower concentrations, were found to effectively induce SIRT1 expression. Conclusions: The cytocompatibility, antioxidant properties, and enhanced cellular uptake suggest that these developed systems hold promise as formulations for the delivery of CUR to the retina.