The role of oxidative stress in diabetes mellitus-induced vascular endothelial dysfunction

Chemical composition, antioxidant activities, and enzyme inhibitory effects of Lespedeza bicolour Turcz. essential oil

Lespedeza bicolour Turcz. is a traditional medicinal plant with a wide range of ethnomedicinal values. The main components of L. bicolour essential oil (EO) were β-pinene (15.41%), β-phellandrene (12.43%), and caryophyllene (7.79%). The EO of L. bicolour showed antioxidant activity against ABTS radical and DPPH radical with an IC50 value of 0.69 ± 0.03 mg/mL and 10.44 ± 2.09 mg/mL, respectively. The FRAP antioxidant value was 81.96 ± 6.17 μmol/g. The EO had activities against acetylcholinesterase, α-glucosidase, and β-lactamase with IC50 values of 309.30 ± 11.16 μg/mL, 360.47 ± 35.67 μg/mL, and 27.54 ± 1.21 μg/mL, respectively. Molecular docking showed methyl dehydroabietate docked well with all tested enzymes. Sclareol and (+)-borneol acetate showed the strongest binding affinity to α-glucosidase and β-lactamase, respectively. The present study provides a direction for searching enzyme inhibitors for three tested enzymes and shows L. bicolour EO possesses the potential to treat a series of diseases.

Bisphenol AF induces lipid metabolism disorders, oxidative stress and upregulation of heat shock protein 70 in zebrafish

Bisphenol AF (BPAF) is a widespread endocrine disruptor in the environment, and the use of BPAF has been strongly associated with the development of several diseases. In this study, we investigated the effects of BPAF on growth, development, oxidative stress and lipid metabolism in zebrafish. We chose the concentrations based on the measured LC50 at 96 h post-fertilization (96 hpf), and the zebrafish embryos were exposed to three different concentrations (0.125, 0.5 and 2 μmol/L). The findings indicated that BPAF exposure in zebrafish leaded to alterations in heart rate, body length and hatching rate, as well as an accumulation of red blood cells in the heart. Additionally, BPAF exposure resulted in increased levels of neutrophils, reactive oxygen species (ROS) and malondialdehyde (MDA), and decreased activity of antioxidant enzymes (superoxide dismutase (SOD) and catalase (CAT)), thus disturbing the balance between oxidative and antioxidative systems. BPAF promoted fatty acid catabolism and inhibited fatty acid synthesis, ultimately leading to a reduction in fatty acid content. Mechanistically, RNA-seq analysis and RT-qPCR revealed a significant upregulation of heat shock protein 70 (hsp70) after BPAF exposure. Inhibition of hsp70 with VER-155008 ameliorated BPAF-induced oxidative stress. These data provided a novel approach to investigate BPAF-induced oxidative stress and suggested that regulation of hsp70 is a crucial target for alleviating this process.

Vascular actions of Ang 1-7 and Ang 1-8 through EDRFs and EDHFs in non-diabetes and diabetes mellitus

The renin-angiotensin system (RAS) plays a pivotal role in regulating vascular homeostasis, while angiotensin 1-8 (Ang 1-8) traditionally dominates as a vasoconstrictor factor. However, the discovery of angiotensin 1-7 (Ang 1-7) and Ang 1-8 has revealed counter-regulatory mechanisms mediated through endothelial-derived relaxing factors (EDRFs) and endothelial-derived hyperpolarizing factors (EDHFs). This review delves into the vascular actions of Ang 1-7 and Ang 1-8 in both non-diabetes mellitus (non-DM) and diabetes mellitus (DM) conditions, highlighting their effects on vascular endothelial cell (VECs) function as well. In a non-DM vasculature context, Ang 1-8 demonstrate dual effect including vasoconstriction and vasodilation, respectively. Additionally, Ang 1-7 induces vasodilation upon nitric oxide (NO) production as a prominent EDRFs in distinct mechanisms. Further research elucidating the precise mechanisms underlying the vascular actions of Ang 1-7 and Ang 1-8 in DM will facilitate the development of tailored therapeutic interventions aimed at preserving vascular health and preventing cardiovascular complications.

Tropisetron attenuates high-glucose-induced vascular endothelial dysfunction via inhibition of calcineurin/NFAT signalling

Vascular endothelial dysfunction (VED) is considered an important initiating factor in pathogenesis of diabetic vascular disease. In this process, oxidative insult, cellular hypertrophy, and activation of the calcineurin/nuclear factor of activated T-cell (NFAT) pathway play key roles. Herein, we investigated the effects of tropisetron (TRS), a calcineurin inhibitor, on high glucose (HG)-induced hypertrophy and apoptosis in human umbilical vein endothelial cells (HUVECs). To this end, HUVECs and chorioallantoic membranes (CAMs) were exposed to HG with or without TRS or cyclosporine A (CsA), and the effects of the treatments were evaluated on oxidative stress generation, cell number (proliferation and apoptosis), cell size (hypertrophy), and vessel formation. We also explored the possible role of calcineurin-NFAT signalling in the potential protective effects of TRS on hypertrophy and apoptosis associated with HG. The average size and protein content of the cells exposed to HG for 48h were significantly increased compared with normal glucose (NG). HG significantly increased apoptosis, altered the cell cycle, and elevated oxidative and nitrosative stress in HUVECs. Further, exposing cells to HG resulted in elevated calcineurin activity and NFATc1 translocation to the nuclei. HG also caused a significant decrease in the formation of new blood vessels in CAMs. Inhibition of calcineurin/NFAT pathway by TRS or CsA protected against these pathological changes. Our data demonstrated that inhibition of calcineurin/NFAT signalling by TRS, as a safe calcineurin inhibitor, may ameliorate HG-induced VED. Further in vivo and clinical studies are required to fully determine the protective effects of TRS against VED in diabetes.

Construction and validation of risk prediction models for different subtypes of retinal vein occlusion

Purpose

While prognostic models for retinal vein occlusion (RVO) exist, subtype-specific risk prediction tools for central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) remain limited. This study aimed to construct and validate distinct CRVO and BRVO risk stratification nomograms.

Methods

We retrospectively analyzed electronic medical records from a tertiary hospital in Guangzhou (January 2010-November 2024). Non-RVO controls were matched 1:4 (CRVO) and 1:2 (BRVO) by sex and year of admission. The final cohorts included 630 patients (126 CRVO cases and 504 controls) and 813 patients (271 BRVO cases and 542 controls). Predictors encompassed clinical histories and laboratory indices. Multivariate regression identified independent risk factors, and model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results

The CRVO-nom and BRVO-nom highlighted significant predictors, including the neutrophil-to-lymphocyte ratio (NLR). Additional risk factors for CRVO included high-density lipoprotein cholesterol (HDL-C), platelet distribution width (PDW), history of diabetes, cerebral infarction, and coronary artery disease (CAD). For BRVO, significant predictors included a history of hypertension, age, and body mass index (BMI). The AUC for CRVO-nom was 0.80 (95% CI: 0.73-0.87) in the training set and 0.77 (95% CI: 0.65-0.86) in the validation set, while BRVO-nom yielded an AUC of 0.95 (95 ​%CI: 0.91-0.97) in the training set and 0.95 (95% CI: 0.89-0.98) in the validation set.

Conclusions

CRVO and BRVO exhibit distinct risk profiles. The developed nomograms-CRVO-nom and BRVO-nom-provide subtype-specific risk stratification with robust discrimination and clinical applicability. An online Shiny calculator facilitates real-time risk estimation, enabling targeted prevention for high-risk populations.

Exposure to phenols mixture, oxidative stress, and fasting blood glucose: Association and potential mediation analyses

Phenols exposure may affect glucose metabolism and increase the risk of type 2 diabetes (T2D). However, the underlying biological mechanisms were poorly understood. In this longitudinal panel study of 122 Chinese adults with three repeated measurements, we aimed to evaluate the associations of multiple phenols exposure with fasting blood glucose (FBG), odds of impaired fasting glucose (IFG) and T2D, and further assess the mediating role of oxidative stress in the above associations. FBG and urinary concentrations of 6 phenols and 3 oxidative stress biomarkers were repeatedly measured for each participant. Linear mixed-effect (LME) models, generalized estimating equations (GEEs), quantile g-computation models, and structural equation models (SEM) were employed to estimate the associations. We observed that urinary methyl paraben (MeP), ethyl paraben (EtP), and propyl paraben (PrP) at multiple lag days were independently associated with increased FBG (all P-FDR <0.05). Exposure to phenols mixture at lag 0 day was positively correlated with FBG, and urinary PrP was the predominant contributor. Meanwhile, exposure to phenols mixture at lag 1 day or at lag 3 day was marginally linked to increased FBG. No significant relationships of phenols exposure at different lag days with risk of IFG and T2D were observed. In addition, we found that 8-hydroxy-deoxyguanosine (8-OHdG) mediated 35.7 % of the association of urinary phenols mixture at lag 1 day with FBG. Our study revealed that phenols exposure, either separately or as a mixture, was related to increased FBG, and oxidative stress is a potential mediating mechanism.

Oxidative stress in vascular surgical diseases: mechanisms, impacts and therapeutic perspectives

The role of oxidative stress in vascular surgical diseases has increasingly been recognized as significant. This paper systematically reviews the specific mechanisms of oxidative stress in a various vascular surgical condition, including aortic dissection, abdominal aortic aneurysm, thrombosis, diabetic foot, and thromboangiitis obliterans, while also exploring related therapeutic strategies. Oxidative stress arises from an imbalance between free radicals and antioxidants, where excess reactive oxygen species and other free radicals can exacerbate inflammatory response. This paper delves into the pathogenic mechanisms of oxidative stress in the aforementioned diseases and discusses potential methods for utilizing antioxidants to reduce oxidative stress levels. Additionally, this paper highlights the challenges faced by current antioxidant therapies and identifies future research directions. By summarizing current research progress, this paper aims to provide a theoretical basis for more effective treatment strategies of vascular surgical diseases, with the hope of advancing the field.

The impact of environmental and dietary exposure on gestational diabetes mellitus: a comprehensive review emphasizing the role of oxidative stress

Gestational diabetes mellitus (GDM) is a common pregnancy complication closely associated with maternal oxidative and antioxidant imbalance, known as oxidative stress. Environmental and dietary exposure plays an important role in inducing oxidative stress during pregnancy. This review aims to provide an in-depth analysis of the role of oxidative stress induced by environmental and dietary exposure in GDM while incorporating current research frontiers. Environmental pollution, smoking, excessive nutrition, and unhealthy eating habits such as a high-fat diet and vitamin deficiency, may contribute to the generation and accumulation of reactive oxygen species (ROS), leading to oxidative stress. Within the pathway of oxidative stress in GDM, the production and clearance mechanisms of ROS play a pivotal role. Relevant studies have demonstrated that ROS production is closely linked to insulin resistance, adipose tissue accumulation, inflammation, and other pathological processes. Antioxidant substances like vitamins C and E or glutathione can mitigate oxidative stress damage on pregnant women and fetuses by scavenging ROS. Currently, there remain several cutting-edge issues regarding the involvement of the oxidative stress pathway in GDM pathogenesis as well as its relationship with environmental and dietary factors, for instance: how to reduce maternal oxidative stress levels through dietary adjustments or lifestyle modifications; how antioxidant substances can be utilized for intervention treatment; and accurate assessment methods for maternal oxidative stress status along with its association with GDM risk. In conclusion, environmental and dietary factors exert significant influence on GDM pathogenesis while highlighting increasing attention toward understanding the role played by the oxidative stress pathway within this context. In-depth research endeavors within this field are anticipated to offer novel insights into prevention strategies as well as therapeutic approaches for GDM.

Transcriptomics and proteomics characterizing the antioxidant mechanisms of semaglutide in diabetic mice with cognitive impairment

The aim of the present study was to investigate the neuroprotective effects of semaglutide in diabetes‑associated cognitive decline (DACD), while also exploring the underlying mechanisms targeting anti‑oxidative effects. The present study evaluated the antioxidant properties of semaglutide using a DACD model of inflammation. To investigate the underlying mechanisms, omics technologies were employed. Comprehensive transcriptomic and proteomic analysis of the cells was conducted to identify the pathways responsible for the observed antioxidant effects. Semaglutide demonstrated the potential to enhance learning and memory functions while mitigating hippocampal pathological damage. RNA‑sequencing and data‑independent acquisition proteomics analyses identified 13,511 differentially expressed genes and 588 differentially expressed proteins between the control and type 2 diabetes mellitus (T2DM) groups. In addition, 1,378 genes and 2,394 proteins exhibited a differential expression between the T2DM and semaglutide (10 µg/kg) treatment groups. A combined transcriptomic and proteomic analysis unveiled 40 common pathways. Acyl‑CoA oxidase 1 (ACOX1) was observed to be activated during oxidative stress and subsequently suppressed by semaglutide. Of note, the antioxidant and anti‑apoptotic properties of semaglutide in high glucose (HG) conditions were partially reversed upon ACOX1 overexpression. Overall, the present data provided molecular evidence to elucidate the physiological connections between semaglutide and neuronal function, and contribute to clarifying the role of semaglutide in combating oxidative stress and HG‑induced cognitive impairment.

The prognostic significance of stress hyperglycemia ratio in evaluating all-cause and cardiovascular mortality risk among individuals across stages 0-3 of cardiovascular-kidney-metabolic syndrome: evidence from two cohort studies

BACKGROUND

The American Heart Association (AHA) proposed the concept of cardiovascular-kidney-metabolic (CKM) syndrome, underscoring the interconnectedness of cardiovascular, renal, and metabolic diseases. The stress hyperglycemia ratio (SHR) represents an innovative indicator that quantifies blood glucose fluctuations in patients experiencing acute or subacute stress, correlating with detrimental clinical effects. Nevertheless, the prognostic significance of SHR within individuals diagnosed with CKM syndrome in stages 0 to 3, particularly with respect to all-cause or cardiovascular disease (CVD) mortality risks, has not been fully understood yet.

METHODS

The current study analyzed data from 9647 participants with CKM syndrome, covering stages 0 to 3, based on the NHANES (National Health and Nutrition Examination Survey) collected from 2007 to 2018. In this study, the primary exposure variable was the SHR, computed as fasting plasma glucose divided by (1.59 * HbA1c - 2.59). The main endpoints of study were all-cause mortality as well as CVD mortality, with death registration data sourced through December 31, 2019. The CHARLS database (China Health and Retirement Longitudinal Study) was utilized as validation to enhance the reliability of the findings.

RESULTS

This study included 9647 NHANES participants, who were followed for a median duration of 6.80 years. During this period, 630 all-cause mortality cases and 135 CVD-related deaths in total were recorded. After full adjustment for covariates, our results displayed a robust positive association of SHR with all-cause mortality (Hazard ratio [HR] = 1.09, 95% Confidence interval [CI] 1.04-1.13). However, the SHR exhibited no significant relationship with CVD mortality (HR = 1.00, 95% CI 0.91-1.11). The mediation analysis results suggested that the relationship between SHR and all-cause mortality risk is partially mediated by RDW, albumin, and RAR. Specifically, the mediating effects were - 17.0% (95% CI - 46.7%, - 8.7%), - 10.1% (95% CI - 23.9%, - 4.7%), and - 23.3% (95% CI - 49.0%, - 13.0%), respectively. Additionally, analyses of the CHARLS database indicated a significant positive correlation between SHR and all-cause mortality among individuals diagnosed with CKM across stages 0-3 during the follow-up period from 2011 to 2020.

CONCLUSIONS

An increased SHR value is positively associated with an elevated likelihood of all-cause mortality within individuals diagnosed with CKM syndrome across stages 0-3, yet it shows no significant association with CVD mortality. SHR is an important tool for predicting long-term adverse outcomes in this population. Cardiovascular-kidney-metabolic (CKM) syndrome emphasizes the interconnectedness of cardiovascular, kidney, and metabolic diseases. The stress hyperglycemia ratio (SHR) is a novel marker reflecting stress-induced glucose fluctuations, but its prognostic value in individuals with CKM syndrome (stages 0-3) remains uncertain. This study explores the association between SHR and all-cause and cardiovascular disease (CVD) mortality in this population. Our findings indicate that SHR is significantly associated with an increased risk of all-cause mortality (HR = 1.09, 95% CI 1.04-1.13), but not with CVD mortality (HR = 1.00, 95% CI: 0.91-1.11). Mediation analysis results suggested that the relationship between SHR and all-cause mortality risk is partially mediated by RDW, albumin, and RAR. Specifically, the mediating effects were - 17.0% (95% CI - 46.7%, - 8.7%), - 10.1% (95% CI - 23.9%, - 4.7%), and - 23.3% (95% CI - 49.0%, - 13.0%), respectively. Validation using the CHARLS database supports these findings. These results suggest that SHR could serve as a prognostic biomarker for long-term mortality risk in CKM patients, offering potential clinical utility in risk stratification and management.

Cerebromicrovascular senescence in vascular cognitive impairment: does accelerated microvascular aging accompany atherosclerosis?

Vascular cognitive impairment (VCI) is a leading cause of age-related cognitive decline, driven by cerebrovascular dysfunction and cerebral small vessel disease (CSVD). Emerging evidence suggests that cerebromicrovascular endothelial senescence plays an important role in the pathogenesis of VCI by promoting cerebral blood flow dysregulation, neurovascular uncoupling, blood-brain barrier (BBB) disruption, and the development of cerebral microhemorrhages (CMHs). This review explores the concept of cerebromicrovascular senescence as a continuum of vascular aging, linking macrovascular atherosclerosis with microvascular dysfunction. It examines the mechanisms by which endothelial senescence drives neurovascular pathology and highlights the impact of cardiovascular risk factors in accelerating these processes. We examine preclinical and clinical studies that provide compelling evidence that atherosclerosis-induced microvascular senescence exacerbates cognitive impairment. In particular, findings suggest that targeting senescent endothelial cells through senolytic therapy can restore cerebrovascular function and improve cognitive outcomes in experimental models of atherosclerosis. Given the growing recognition of microvascular senescence as a therapeutic target, further research is warranted to explore novel interventions such as senolytics, anti-inflammatory agents, and metabolic modulators. The development of circulating biomarkers of vascular senescence (e.g., senescence-associated secretory phenotype [SASP] components and endothelial-derived extracellular vesicles) could enable early detection and risk stratification in individuals at high risk for VCI. Additionally, lifestyle modifications, including the Mediterranean diet, hold promise for delaying endothelial senescence and mitigating cognitive decline. In conclusion, cerebromicrovascular senescence is a key mechanistic link between atherosclerosis and cognitive impairment. Addressing microvascular aging as a modifiable risk factor through targeted interventions offers a promising strategy for reducing the burden of VCI and preserving cognitive function in aging populations.

The Role of Endothelial Cell Glycolysis in Schwann Cells and Peripheral Nerve Injury Repair: A Novel and Important Research Area

Endothelial cell glycolysis plays a novel and significant role in Schwann cells and peripheral nerve injury repair, which represents an emerging and important area of research. Glycolysis in endothelial cells is a conserved and tightly regulated biological process that provides essential energy (ATP) and intermediates by ultimately converting glucose into lactate. This metabolic pathway is crucial for maintaining the normal function of endothelial cells. During peripheral nerve injury repair, endothelial cell glycolysis influences the function of Schwann cells and the efficiency of nerve regeneration. Beyond glycolysis, endothelial cells also secrete various factors, including growth factors and extracellular vesicles, which further modulate Schwann cell activity and contribute to the repair process. This review will summarize the role of endothelial cell glycolysis in Schwann cell function and peripheral nerve injury repair, aiming to provide new insights for the development of novel strategies for peripheral nerve injury treatment.

Aptamer Functionalized Liposomes Co-Loaded with Exenatide-4 and Coenzyme Q10 Ameliorate Type 2 Diabetes Mellitus by Improving Pancreatic β Cell Function

Introduction

Oxidative stress has been shown to disrupt β-cell function and promote the development of type 2 diabetes mellitus (T2DM). Exenatide-4 (Ext-4) is a widely used anti-glycemic drug but cannot restore pancreatic β-cells' structure and function. Coenzyme Q10 (CoQ10) has great antioxidant activities but shows suboptimal therapeutic effects because of its poor solubility and poor bioavailability. To further enhance the therapeutic efficacy of the drugs, a pancreas-targeting liposomal co-delivery system encapsulating Ext-4 and CoQ10 ((E+Q)-Lip-Apt) was designed, using the aptamers as the targeting ligands.

Methods

(E+Q)-Lip-Apt was prepared by thin film dispersion method and its optimal formulation was obtained through single-factor experiments and orthogonal experiments. The pancreatic β-cell protecting effect of (E+Q)-Lip-Apt was investigated both in vitro and in vivo.

Results

(E+Q)-Lip-Apt exhibited uniform size, good dispersion, and high encapsulation efficiency (EE) for both Ext-4 and CoQ10. The in vitro results showed that (E+Q)-Lip-Apt manifested superior capacity in scavenging ROS, enhancing mitochondrial membrane potential, and reducing malondialdehyde (MDA) content compared to Ext-4 in MIN6 cells. In vivo investigations demonstrated that (E+Q)-Lip-Apt significantly improved glucose tolerance, insulin sensitivity, hepatic lipid metabolism, oxidative stress, and enhanced antioxidant enzyme activity in diabetic mice. Moreover, Hematoxylin-eosin staining (H&E) and Immunohistochemistry (IHC) results indicated that (E+Q)-Lip-Apt could improve liver and pancreatic lesions, restoring the structure and function of β-cells in diabetic mice.

Conclusion

(E+Q)-Lip-Apt could improve oxidative stress, thereby restoring pancreatic β-cell function, and alleviating diabetes.

Hyperbaric oxygen therapy attenuated limb ischemia in mice with high-fat diet by restoring Sirtuin 1 and mitochondrial function

Hyperbaric oxygen therapy (HBO) shows promise as a treatment for peripheral artery disease (PAD), particularly when complicated by metabolic syndrome and diabetes. However, its precise effects on endothelial function remain unclear. This study explored the impact of HBO on angiogenesis and apoptosis in high-fat diet (HFD)-fed mice with limb ischemia, focusing on the role of sirtuin 1 (SIRT1). After 8 weeks on a chow or HFD, mice underwent unilateral femoral artery ligation and received HBO (3 ATA, 1 h/day for 5 days). HBO improved blood flow, enhanced vascular density, and reduced apoptosis in ischemic calf muscles of HFD-fed mice. In vitro, human umbilical vein endothelial cells (HUVECs) were subjected to high-glucose and oxygen-glucose deprivation (OGD) conditions, with or without HBO. HBO restored cell proliferation, migration, and tube formation under these conditions, reduced mitochondrial dysfunction, and decreased reactive oxygen species (ROS) production. However, these benefits were reversed by treatment with sirtinol, a SIRT1 inhibitor. HBO also increased SIRT1 expression and shifted mitochondrial dynamics toward fusion. Additionally, HBO upregulated angiogenesis-related proteins (VEGF, VEGFR, and SIRT1) while downregulating apoptosis-associated proteins (Bax, caspase-3, and p53). Collectively, these findings suggest that HBO enhances angiogenesis and reduces apoptosis in both in vivo and in vitro ischemia models, primarily through SIRT1 activation.

Correlation between chronic kidney disease and all-cause mortality in diabetic foot ulcers: evidence from the 1999-2004 national health and nutrition examination survey (NHANES)

Background

The poor prognosis of diabetic foot ulcers (DFUs) often leads to amputation and high mortality rates, becoming a heavy economic burden on the healthcare system. Several clinical studies have been conducted to investigate the risk factors for DFU mortality and to provide clinical guidance for better prevention and control of DFU mortality.

Methods

We used R to organize the mortality data of patients with DFU, collected from the NHANES database during the 1994-2004 period, along with three kidney function indicators including Albumin-to-Creatinine Ratio (ACR), estimated Glomerular Filtration Rate (eGFR) and cystatin C, used to assess chronic kidney disease (CKD). We explored the relationship between CKD and the risk of death in DFU patients through multiple kidney function indicators. Baseline characteristics of the surviving group and the mortality group of patients with DFU were analyzed using the 'svyby' function in the 'survey' package. We used Kaplan-Meier curves, multivariable logistic regression models, Cox proportional risk regression models, and time-dependent ROC curves to analyze the relationship between CKD and the risk of death in patients with DFU.

Results

This study included a total of 112 patients with DFU. The overall sample had an average age of 65 years, with 43 females (38.39%) and 69 males (61.61%). During the follow-up time, 29 survived and 89 died. All-cause mortality in DFU patients was analyzed based on clinical classifications of ACR, eGFR, and cystatin C, with Kaplan-Meier curves illustrating survival variability. Multivariable logistic regression analysis showed no significant correlation between the risk of death in patients with DFU and CKD. However, analysis of Cox proportional risk regression model that accounted for time effects found a significant association between all-cause mortality and cystatin C levels in patients with DFU. Time-dependent ROC curve analysis demonstrated that cystatin C had superior diagnostic accuracy and stability for predicting all-cause mortality in DFU patients.

Conclusions

In this study, we found that cystatin C demonstrated greater stability and accuracy in assessing the risk of death and predicting mortality in patients with DFU.

Dual-responsive stem cell microspheres modified with BDNF for enhanced neural repair in diabetic erectile dysfunction

We previously established an effective method to ameliorate erectile dysfunction (ED) using intracavernous injection (ICI) of mesenchymal stem cell (MSC) microspheres. However, the expression of a key neurotrophic factor, brain-derived neurotrophic factor (BDNF), was low in both MSCs and MSC microspheres, restricting the associated neural repair. Based on the hypoxia and oxidative stress microenvironments within cell spheroids and lesion areas, BDNF-expressing nanocomplexes that are dual-responsive to hypoxia and reactive oxygen species were designed to modify MSCs, achieving high BDNF expression in MSC spheroids. Using the pelvic ganglion as an in vitro model, conditioned medium derived from stimuli-responsive MSC microspheres (SRMs) significantly promoted the growth of axons and alleviated the death of neural and smooth muscle cells. In rats with diabetes-induced ED, SRMs that underwent ICI effectively remained in the penis, demonstrating a potent therapeutic outcome. Penile erectile function, smooth muscle content, and neuropathological changes improved after treatment with SRMs compared to unmodified MSCs.

The impact of probiotics on oxidative stress and inflammatory markers in patients with diabetes: a meta-research of meta-analysis studies

Objective

Probiotic supplementation has gained attention for its potential to modulate inflammatory and oxidative stress biomarkers, particularly in metabolic disorders. This meta-analysis evaluates the effects of probiotics on C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), malondialdehyde (MDA), total antioxidant capacity (TAC), glutathione (GSH), and nitric oxide (NO) in patients with diabetes.

Methods

A Meta-Research was conducted on 15 meta-analyses of unique 33 randomized controlled trials (RCTs) published between 2015 and 2022, involving 26 to 136 participants aged 26 to 66 years. Data were synthesized using standardized mean differences (SMD), with sensitivity analysis using a random-effect model.

Results

Probiotic supplementation significantly reduced CRP (SMD = -0.79, 95% CI: -1.19, -0.38), TNF-α (SMD = -1.35, 95% CI: -2.05, -0.66), and MDA levels (WMD: -0.82, 95% CI: -1.16, -0.47). Probiotics increased GSH (SMD = 1.00, 95% CI: 0.41, 1.59), TAC (SMD = 0.48, 95% CI: 0.27, 0.69), and NO (SMD = 0.60, 95% CI: 0.30, 0.91). Result on IL-6 was not significant (SMD = -0.29, 95% CI: -0.66, 0.09). Sensitivity analyses confirmed robustness.

Conclusion

Probiotics significantly improved inflammatory and oxidative stress biomarkers in patients with diabetes, with variations influenced by population and dosage. Future studies should explore novel probiotic strains and longer interventions.

The multiple biological activities of hyperoside: from molecular mechanisms to therapeutic perspectives in neoplastic and non-neoplastic diseases

In recent years, hyperoside (quercetin 3-O-β-D-galactopyranoside) has garnered significant attention due to its diverse biological effects, which include vasoprotective, antioxidant, anti-inflammatory, and anti-tumor properties. Notably, hyperoside has shown remarkable potential in cancer therapy by targeting multiple mechanisms; it induces apoptosis, inhibits proliferation, blocks angiogenesis, and reduces the metastatic potential of cancer cells. Furthermore, hyperoside enhances the sensitivity of cancer cells to chemotherapy by modulating key signaling pathways. Beyond neoplastic diseases, hyperoside also presents promising therapeutic applications in managing non-cancerous conditions such as diabetes, Alzheimer's disease, and pulmonary fibrosis. This review comprehensively examines the molecular mechanisms underlying hyperoside's anti-cancer effects and highlights its role in the treatment of cancers, including lung and colorectal cancers. Additionally, it explores the latest research on hyperoside's potential in addressing non-neoplastic conditions, such as pulmonary fibrosis, diabetes, and Parkinson's disease. By summarizing current findings, this review underscores the unique therapeutic value of hyperoside and its potential as a multifunctional treatment in both neoplastic and non-neoplastic contexts.

Plasma Atrial Natriuretic Peptide Predicts Oxidized Low-Density Lipoprotein Levels in Type 2 Diabetes Mellitus Patients Independent of Circulating Adipokine and Cytokine

Atrial natriuretic peptide (ANP) and oxidized low-density lipoprotein (ox-LDL) play essential roles in the development and progression of vascular complications associated with type 2 diabetes mellitus (T2DM), and both are independently linked to cardiovascular diseases (CVD). However, the relationship between ANP and ox-LDL in patients with T2DM remains unclear as previous studies have primarily focused on circulating levels in various diseases. This study investigated the relationship between ANP and ox-LDL levels in obese individuals with T2DM. The cohort included 57 patients with T2DM (mean age 61.14 ± 9.99 years; HbA1c 8.66 ± 1.60%; BMI 35.15 ± 6.65 kg/m2). Notably, 95% of the patients had hypertension, 82% had dyslipidemia, 59% had an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, 14% had coronary artery disease (CAD), and 5% had a history of stroke. Plasma concentrations of ANP and ox-LDL were measured using ELISA. Adipokines and cytokines levels were measured using the multiplex® MAP Human Adipokine Magnetic Beads Spearman's correlation analysis which revealed a negative correlation between ANP and ox-LDL (r = -0.446, p = 0.001) as well as with the ox-LDL/apoB ratio (r = -0.423, p = 0.001) and ox-LDL/LDLc ratio (r = -0.307, p = 0.038). Multivariable regression analysis indicated that ANP was independently associated with ox-LDL (β = -115.736, p = 0.005). Stepwise linear regression further identified TNFα, leptin, and adiponectin as the strongest predictors influencing the relationship between ANP and ox-LDL levels (β = -64.664, p = 0.0311, and r2 = 0.546 for the model). However, these factors did not significantly mediate this association. This study emphasizes the need for further exploration of the complex interaction between ANP and ox-LDL in larger patient populations. This could provide valuable insights into potential therapeutic approaches for managing vascular complications in obese individuals with T2DM.

Association between air pollution and cardiovascular disease risk in middle-aged and elderly individuals with diabetes: inflammatory lipid ratio accelerate this progression

BACKGROUND

Long-term exposure to air pollution significantly increases the risk of cardiovascular disease (CVD); however, the association and underlying mechanisms in individuals with diabetes remain unconfirmed.

METHODS

We used data from the China Health and Retirement Longitudinal Study (CHARLS) to follow 5,430 adults over a four-year period. Baseline CVD and diabetes status were determined, and high-resolution data were used to assess air pollution exposure to PM1, PM2.5, PM10, and O3. The inflammatory lipid ratio (ILR) was calculated to reflect inflammatory and lipid metabolic states. A generalized linear model (GLM) was employed to analyze the effects of air pollution and ILR on diabetes-related CVD risk.

RESULTS

The prevalence of CVD was 8.5% in the healthy population and 13.8% in the diabetic population. Air pollution exposure was significantly associated with an increased risk of CVD among diabetic individuals. For each interquartile range (IQR) increase in concentrations of pollutants O3, PM1, PM10, and PM2.5, CVD risk in the diabetic group rose by 21%, 19%, 28%, and 19%, respectively. Higher ILR values were positively associated with CVD incidence (OR = 1.019, 95% CI: 1.001-1.037, P < 0.05), with a nonlinear relationship observed between ILR levels and CVD risk (PNonlinear = 0.0381), indicating that higher ILR values exacerbate the impact of air pollution on diabetic individuals.

CONCLUSION

Among middle-aged and older adults with diabetes, exposure to air pollution is associated with an increased risk of CVD, and ILR intensifies this process. Therefore, implementing effective public health interventions to reduce air pollution exposure in diabetic populations is essential.

Trajectory Analysis in FBG and the Incidence of Chronic Kidney Disease: A Nationwide Population-Based Study

OBJECTIVES

This study aimed to classify fasting blood glucose (FBG) trajectories by sex and examine their associations with the risk of chronic kidney disease (CKD).

METHODS

Using data from the National Health Insurance Service-National Sample Cohort in Korea, participants aged 40 years and above, without CKD or diabetes mellitus (DM), were followed from 2002 to 2009. Based on their FBG trajectories, participants were categorized into two classes and stratified by sex. CKD incidence rates were analyzed according to these FBG trajectories, and the impact of additional risk factors on CKD incidence was assessed.

RESULTS

A total of 91,131 participants were analyzed. Among individuals classified in Class 1, FBG levels gradually increased from 90.7 (men) and 88.7 (women) in 2002 to 96.6 (men) and 93.2 (women) in 2009. In contrast, participants classified as Class 2 exhibited a rapid increase in FBG levels, rising from 106 (men) and 106 (women) in 2002 to 144 (men) and 132 (women) in 2009. The incidence of CKD increased over time in both men and women classified as Class 2 compared to Class 1, with respective hazard ratios (HR) of 1.35 for men and 1.53 for women. Additionally, increased age, hypertension, and body mass index (BMI) were independently associated with an elevated risk of CKD.

CONCLUSIONS

The Class 2 group demonstrated a significantly higher incidence of CKD compared to the Class 1 group. This finding indicates the need for the proactive management of individuals with relatively high FBG levels featuring rapid FBG increases in order to mitigate the risk of CKD development.

PFKFB3 Connects Glycolytic Metabolism with Endothelial Dysfunction in Human and Rodent Obesity

Obesity and type 2 diabetes (T2D) increase cardiovascular risk, largely due to altered metabolic state. An early consequence of T2D/obesity is the loss of endothelial function and impaired nitric oxide (NO) signaling. In blood vessels, endothelial nitric oxide synthase (eNOS) synthesizes NO to maintain vessel homeostasis. The biological actions of NO are compromised by superoxide that is generated by NADPH oxidases (NOXs). Herein we investigated how altered metabolism affects superoxide/NO balance in obesity. We found that eNOS expression and NO bioavailability are significantly decreased in endothelial cells (ECs) from T2D patients and animal models of obesity. In parallel, PFKFB3, a key glycolytic regulatory enzyme, is significantly increased in ECs of obese animals. EC overexpression of wild-type and a cytosol-restricted mutant PFKFB3 decreased NO production due to increased eNOS-T495 phosphorylation. PFKFB3 also blunted Akt-S473 phosphorylation, reducing stimulus-dependent phosphorylation of S1177 and the activation of eNOS. Furthermore, PFKFB3 enhanced the activities of NOX1 and NOX5, which are major contributors to endothelial dysfunction. Prolonged exposure of ECs to high glucose or TNFα, which are hallmarks of T2D, leads to increased PFKFB3 expression. These results demonstrate a novel functional relationship between endothelial metabolism, ROS, and NO balance that may contribute to endothelial dysfunction in obesity.

Association of oxidative balance score with the risk of all-cause and CVD mortality in younger US adults with diabetes

Oxidative balance score (OBS) is a composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual's diet and lifestyle, with higher scores indicating greater antioxidant exposure. Despite its potential significance, there is a limited body of research exploring the relationship between OBS and all-cause and cardiovascular disease (CVD) mortality specifically in younger patients with diabetes. We aimed to investigate the possible relationship between OBS and all-cause and CVD mortality in younger patients with diabetes. Data for this study were obtained from the 2003-2018 NHANES. This study enrolled 3501 participants. The endpoints were all-cause and CVD mortality, determined by the National Death Index (NDI). OBS, which consists of 16 dietary factors and 4 lifestyle factors, is categorized into pro-oxidants and antioxidants. The OBS was categorized into four quartiles (Q1-Q4). We used multivariable Cox proportional hazards regression models to examine the association between continuous and quartile measures of OBS, lifestyle OBS (lifestyle antioxidants such as physical activity, etc., and lifestyle pro-oxidants such as alcohol, smoking, etc.), and dietary OBS (dietary antioxidants such as fiber, β-carotene, riboflavin, etc., and dietary pro-oxidants, such as total fat, etc.) with all-cause and CVD mortality. Additionally, we explored restricted cubic spline (RCS) analysis and also performed subgroup analyses and interaction tests. The occurrence of 409 all-cause deaths (11.7%) and 108 CVD-related deaths (3.1%) was recorded during the follow-up period. Our results found that OBS, lifestyle OBS, and dietary OBS were negatively associated with patients' all-cause and CVD mortality. The RCS analysis further validated the association of a linear negative correlation between OBS and all-cause and CVD mortality. The results of our subgroup analyses revealed that the negative association between OBS and CVD mortality may be influenced by alcohol use. In conclusion, results from a nationally representative study of younger American patients with diabetes suggest a negative association between OBS, lifestyle OBS, and dietary OBS and all-cause and CVD mortality. Antioxidant-rich diets and lifestyle improvements are essential for reducing all-cause and CVD mortality in patients.

The prognostic association of triglyceride-glucose index and its derived indicators with stable coronary artery disease patients undergoing percutaneous coronary intervention

Aims

Research on the triglyceride-glucose (TyG) index in patients with stable coronary artery disease (SCAD) remains relatively limited. Therefore, this study aims to investigate the association of the TyG index and its derived indicators, including the baseline TyG index, the baseline triglyceride glucose-body mass index (TyG-BMI), the mean TyG index, and the triglyceride glucose index-standard deviation (TyG-SD), with the prognosis of SCAD patients undergoing percutaneous coronary intervention (PCI).

Methods

This retrospective study enrolled 2,306 patients. The Cox proportional hazards model was utilized to evaluate the association between the four TyG indicators and major adverse cardiovascular and cerebrovascular events (MACCE). The predictive ability of the four TyG indicators for MACCE was assessed using the time-dependent receiver operating characteristic (ROC) curve. Kaplan-Meier survival analysis was employed to assess the prognostic differences among groups.

Results

After a median follow-up of 26.1 months, a total of 352 patients (15.3%) experienced MACCE. The Cox regression analysis revealed that under a fully adjusted model, when the four TyG indicators were stratified by tertiles, patients in the highest tertile of each TyG indicator had a significantly increased risk of MACCE compared to those in the lowest tertile. Specifically, the hazard ratio for baseline TyG index was 1.653 (95% confidence intervals (CI): 1.234-2.214), for baseline TyG-BMI was 2.467 (95%CI: 1.849-3.293), for mean TyG index was 2.451 (95%CI: 1.794-3.349), and for TyG-SD was 1.896 (95%CI: 1.430-2.513). Time-dependent ROC curve demonstrated that the mean TyG index had the strongest predictive ability for MACCE at each follow-up time point. The Kaplan-Meier analysis results showed that when the four TyG indicators were grouped by tertiles, there were significant differences in the cumulative incidence of MACCE among the three groups for each indicator (P < 0.05).

Conclusion

Higher levels of the TyG index and its derived indicators were each independently and positively associated with the risk of MACCE in SCAD patients undergoing PCI. Among these indicators, the mean TyG index demonstrated the greatest predictive value for the risk of MACCE at each follow-up time point. Consequently, tracking the long-term trends of the TyG index may be prioritized in clinical practice.

High glucose induces podocyte ferroptosis through BAP1/SLC7A11 pathway

Background

Ferroptosis plays an important role in the development of diabetic nephropathy (DN). However, its specific regulatory mechanisms remain unclear.

Methods

MPC5 cells were cultured in high glucose (HG) medium to stimulate the HG environment in vitro. Ferroptosis and oxidative stress were assessed by measuring malondialdehyde (MDA) levels, cystine uptake capacity, and reactive oxygen species (ROS). C91A and wild type (WT) MPC5 cells were constructed to further explore the specific regulatory mechanism of BAP1 on SLC7A11.

Results

Erastin-induced ferroptosis was sensitized by HG, leading to a significant reduction in glutathione (GSH) levels, increased oxidative stress, and inhibited cystine uptake in podocytes. HG suppressed the expression of SLC7A11. Overexpression of SLC7A11 improved cystine uptake and reduced oxidative stress. Furthermore, HG increased BAP1 levels. Silencing BAP1 up-regulated SLC7A11 and mitigated ferroptosis. Cell proliferation was reduced after SLC7A11 knockdown. In BAP1 WT cells, but not in its C91A mutant cells, the transcription of SLC7A11 was downregulated and the level of ferroptosis was increased.

Conclusion

HG inhibits cystine uptake in podocytes by promoting the expression of BAP1 and inhibiting H2Aub deubiquitination on SLC7A11, leading to lipid peroxide accumulation and ferroptosis in podocytes.

From oxidative stress to metabolic dysfunction: The role of TRPM2

Metabolic syndromes including atherosclerosis, diabetes, obesity, and hypertension are increasingly prevalent worldwide. The disorders are the primary attributes of oxidative stress and inflammation. The transient receptor potential M2 (TRPM2) channel is a pivotal mediator linking oxidative stress to metabolic dysfunction. TRPM2, a non-selective cation channel activated by reactive oxygen species (ROS) and adenosine diphosphate ribose (ADPR), regulates calcium influx, inflammation, and cell death across various tissues. This review explores the structural and activation mechanisms of TRPM2, emphasizing its significance in metabolic diseases. Elevated levels of TRPM2 play a vital role in the disease progression by influencing physiological and cellular processes such as endothelial dysfunction, immune cell activation, and mitochondrial impairment. In conditions such as atherosclerosis, ischemic stroke, diabetes, obesity, and hypertension; TRPM2 exacerbates oxidative damage, amplifies inflammatory responses, and disrupts metabolic homeostasis. Recent research highlights the potential of TRPM2 as a therapeutic target, developing specified inhibitors. This review underscores the multifaceted role of TRPM2 in metabolic disorders and its promise as a target for therapeutic interventions.

Retinoic Acid Improves Vascular Endothelial Dysfunction by Inhibiting PI3K/AKT/YAP-mediated Ferroptosis in Diabetes Mellitus

BACKGROUND

Vascular endothelial dysfunction is the initial factor involved in cardiovascular injury in patients with diabetes. Retinoic acid is involved in improving vascular complications with diabetes, but its protective mechanism is still unclear. This study aimed to evaluate the effect and mechanism of All-trans Retinoic Acid (ATRA) on endothelial dysfunction induced by diabetes.

METHODS

In the present study, streptozotocin (STZ)-induced diabetic rats and high glucose (HG)-induced human umbilical vein endothelial cells (HUVECs) were observed, and the effects of ATRA on HG-induced endothelial dysfunction and ferroptosis were evaluated.

RESULTS

ATRA treatment improved impaired vasorelaxation in diabetic aortas in an endothelium-dependent manner, and this effect was accompanied by an increase in the NO concentration and eNOS expression. Ferroptosis, characterized by lipid peroxidation and iron overload induced by HG, was improved by ATRA administration, and a ferroptosis inhibitor (ferrostatin-1, Fer-1) improved endothelial function to a similar extent as ATRA. In addition, the inactivation of phosphoinositol-3-kinase (PI3K)/protein kinases B (AKT) and Yes-associated Protein (YAP) nuclear localization induced by HG were reversed by ATRA administration. Vascular ring relaxation experiments showed that PI3K/AKT activation and YAP inhibition had similar effects on ferroptosis and endothelial function. However, the vasodilative effect of retinoic acid was affected by PI3K/AKT inhibition, and the inhibitory effects of ATRA on ferroptosis and the improvement of endothelial function were dependent on the retinoic acid receptor.

CONCLUSION

ATRA could improve vascular endothelial dysfunction by inhibiting PI3K/AKT/YAP-mediated ferroptosis induced by HG, which provides a new idea for the treatment of vascular lesions in diabetes.

Circular RNA 14580 promotes papillary thyroid cancer progression by interacting with CTSW/fibrosis singling pathway

Papillary thyroid cancer (PTC) is an increasingly prevalent endocrine malignancy, with a subset exhibiting aggressive features such as lymphatic metastasis and resistance to iodine therapy. Recent studies suggest that circular RNAs (circRNAs) play a significant role in PTC pathology. High throughput circRNA sequencing identified circRNA_14580 as notably upregulated in PTC tissues. This circRNA is implicated in crucial tumorigenic processes, including apoptosis, proliferation, and migration of PTC cells. Mechanistic investigations reveal that circ_14580 interacts with cathepsin W (CTSW), a key player in PTC-associated fibrosis. Notably, silencing circ_14580 diminishes the activation and collagen production of cancer-associated fibroblasts (CAFs), highlighting its role in modulating the tumor microenvironment. These findings underscore circ_14580 as a critical oncogene in PTC and suggest that targeting the circ_14580/CTSW/fibrosis axis could offer novel therapeutic strategies for controlling PTC progression.

A multifactorial lens on risk factors promoting the progression of Alzheimer's disease

The prevalence of Alzheimer's disease (AD) among adults has continued to increase over the last two decades, which has sparked a significant increase in research that focuses on the topic of "brain health." While AD is partially determined by a genetic predisposition, there are still numerous pathophysiological factors that require further research. This research requirement stems from the acknowledgment that AD is a multifactorial disease that to date, cannot be prevented. Therefore, addressing and understanding the potential AD risk factors is necessary to increase the quality of life of an aging population. To raise awareness of critical pathways that impact AD progression, this review manuscript describes AD etiologies, structural impairments, and biomolecular changes that can significantly increase the risk of AD. Among them, a special highlight is given to inflammasomes, which have been shown to bolster neuroinflammation. Alike, the role of brain-derived neurotrophic factor, an essential neuropeptide that promotes the preservation of cognition is presented. In addition, the functional role of neurovascular units to regulate brain health is highlighted and contrasted to inflammatory conditions, such as cellular senescence, vascular damage, and increased visceral adiposity, who all increase the risk of neuroinflammation. Altogether, a multifactorial interventional approach is warranted to reduce the risk of AD.

F2RL1 Inhibition Alleviates Lipotoxicity-Induced Kidney Injury Through the Hippo Pathway in Diabetic Kidney Disease

Diabetic kidney disease (DKD), which is emerging as a pervasive global health concern and a considerable economic burden, is characterized by a detrimental effect on renal function and structure. Recent research indicates that the progression of DKD is facilitated by lipotoxic injury to tubular epithelial cells (TECs). However, the specific mechanisms that contribute to this cellular damage have yet to be fully elucidated. Our results revealed a significant upregulation of F2RL1 in vivo and in vitro models, which was positively correlated with the expression of inflammatory factors. Knockdown of F2RL1 significantly reduced inflammatory response in palmitate-stimulated HK-2 cells. Mechanistically, F2RL1 might exacerbate lipotoxicity-induced DKD through the modulation of the Hippo signaling pathway. Collectively, these findings suggest that modulating F2RL1 expression may be a strategic approach to mitigate the inflammatory damage to RTECs associated with DKD, potentially through its involvement in the Hippo signaling pathway. Given these findings, F2RL1 merits consideration as a candidate therapeutic target for DKD.

Association between stress hyperglycemia ratio and mortality in patients with heart failure complicated by sepsis

Individuals afflicted with heart failure complicated by sepsis often experience a surge in blood glucose levels, a phenomenon known as stress hyperglycemia. However, the correlation between this condition and overall mortality remains unclear. 869 individuals with heart failure complicated by sepsis were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and categorized into five cohorts based on their stress hyperglycemia ratio (SHR). The primary endpoints evaluated were mortality within the intensive care unit (ICU), all-cause mortality within 28 days, and all-cause mortality during hospitalization. Cox proportional hazards regression and restricted cubic spline analyses were employed to unravel the association between SHR and mortality. The ICU mortality, in-hospital mortality, and 28-day all-cause mortality were 10.01%, 13.69%, and 16.46%, respectively. Multivariable Cox proportional hazards regression analysis revealed a significant association between elevated SHR and all-cause mortality. After adjusting for confounding variables, elevated SHR was significantly associated with increased risk of ICU mortality (hazard ratio [HR] = 1.67; 95% confidence interval [CI], 1.03-2.70)), in-hospital mortality (HR = 1.53; 95% CI, 1.00-2.33)), and 28-day all-cause mortality (HR = 1.49; 95% CI, 1.02-2.17)). Restricted cubic spline analysis demonstrated a significant U-shaped relationship between SHR and the risk of all-cause mortality. This study revealed that stress hyperglycemia ratio is an independent prognostic factor in patients with heart failure complicated by sepsis. Notably, both very high and very low SHR values were associated with increased mortality risk.

Diagnosis, Pathophysiology and Management of Microvascular Dysfunction in Diabetes Mellitus

Microcirculation is an essential system that regulates oxygen and nutrients to cells and tissues in response to various environmental stimuli and pathophysiological conditions. Diabetes mellitus can cause microvascular complications including nephropathy, neuropathy, and retinopathy. The pathogenesis of microvascular dysfunction in diabetes is associated with hyperglycemia and the result of an interplay of various factors. Research studies have demonstrated that functional microvascular dysfunction appears much earlier than structural alterations in vasculature in diabetes. This finding of the progression from microvascular dysfunction to macrovascular disease establishes a foundation for the screening and early diagnosis of diabetes by assessing the microvascular function. This comprehensive review discusses technologies (laser Doppler, transcutaneous oximetry, infrared thermography and near-infrared spectroscopy) with computational methods (linear (time and frequency domains), nonlinear and machine learning approaches) for diagnosing microvascular dysfunction in diabetes. Pathophysiological changes of microvascular dysfunction leading to impaired vasomotion and blood flow oscillations in diabetes are reviewed. Recent findings in managing microvascular dysfunction using lifestyle modifications and force-based modulations are evaluated. A consensus endorsed by the American Diabetes Association has been reached that an effective exercise program would greatly slow down the progression of microvascular dysfunction and its impact on diabetic foot ulcers, muscle fatigue and weakness and peripheral neuropathy. However, it is imperative to determine the dose-response relationship of exercise and microvascular responses in patients with diabetes. Research studies have demonstrated that local vibration and whole-body vibration can improve microcirculation in various pathological conditions, including diabetes. Due to the complex nature of microvascular regulation, various computational methods have been developed to shed light on the influence of diabetes on microvascular dysfunction. This comprehensive review will contribute to the diagnosis and management of microvascular dysfunction in diabetes.

Machine Learning-Driven Metabolic Syndrome Prediction: An International Cohort Validation Study

Background/Objectives: This study aimed to develop and validate a machine learning (ML)-based metabolic syndrome (MetS) risk prediction model. Methods: We examined data from 6155 participants of the China Health and Retirement Longitudinal Study (CHARLS) in 2011. The LASSO regression feature selection identified the best MetS predictors. Nine ML-based algorithms were adopted to build predictive models. The model performance was validated using cohort data from the Korea National Health and Nutrition Examination Survey (KNHANES) (n = 5297), the United Kingdom (UK) Biobank (n = 218,781), and the National Health and Nutrition Examination Survey (NHANES) (n = 2549). Results: The multilayer perceptron (MLP)-based model performed best in the CHARLS cohort (AUC = 0.8908; PRAUC = 0.8073), the logistic model in the KNHANES cohort (AUC = 0.9101, PRAUC = 0.8116), the xgboost model in the UK Biobank cohort (AUC = 0.8556, PRAUC = 0.6246), and the MLP model in the NHANES cohort (AUC = 0.9055, PRAUC = 0.8264). Conclusions: Our MLP-based model has the potential to serve as a clinical application for detecting MetS in different populations.

Traditional versus intensive blood glucose control: long-term target range duration and cardiovascular disease risk and all-cause mortality - a real-world cohort study

Objective

For a long time, the dispute about whether improved glycemic control can bring significant benefits has remained unresolved. We aimed to investigate the association of time spent in different fasting glucose target ranges with cardiovascular risk and all-cause mortality in a population with type 2 diabetes (T2DM).

Method

A total of 3460 T2DM patients in the Kailuan cohort were included in this study. The Time in Target Range (TITRE) was calculated as the proportion of time that fasting blood glucose (FBG) was within the usual glycemic control range and the intensive glycemic control range between 2006 and 2016. The Cox proportional hazards regression model analyzed the relationship between TITRE, defined by different glucose ranges, and cardiovascular disease and all-cause mortality.

Results

During a median follow-up of 4.23 years, a total of 360 CVDs and 238 deaths were recorded. After correcting for traditional risk factors, we observed that in the conventional blood glucose control group, each increase of 1 standard deviation in TITRE was associated with a 23% (HR, 0.77; 95%CI, 0.68-0.87) reduction in CVD risk and a 20% reduction in all-cause mortality (HR, 0.80; 95%CI, 0.69-0.92). Similar results were also observed in the intensified blood glucose control group. In the conventional blood glucose control group, participants with TITRE of 50% or more had an absolute incidence rate of CVD of 16.77%, whereas in the intensified blood glucose control group, participants with TITRE of 50% or more had an absolute incidence rate of CVD of 11.82%.

Conclusions

In patients with type 2 diabetes, achieving near-normal blood glucose levels appears to significantly reduce the risk of diabetes-related cardiovascular outcomes.

Crosstalk between periodontitis and cardiovascular risk

Recent demographic developments resulted in an aged society with a rising disease burden of systemic and non-communicable diseases (NCDs). In cardiovascular disease (CVD), a NCD with high morbidity and mortality, recent preventive strategies include the investigation of comorbidities to reduce its significant economic burden. Periodontal disease, an oral bacterial-induced inflammatory disease of tooth-supporting tissue, is regulated in its prevalence and severity by the individual host response to a dysbiotic oral microbiota. Clinically, both NCDs are highly associated; however, shared risk factors such as smoking, obesity, type II diabetes mellitus and chronic stress represent only an insufficient explanation for the multifaceted interactions of both disease entities. Specifically, the crosstalk between both diseases is not yet fully understood. This review summarizes current knowledge on the clinical association of periodontitis and CVD, and elaborates on how periodontitis-induced pathophysiological mechanisms in patients may contribute to increased cardiovascular risk with focus on atherosclerosis. Clinical implications as well as current and future therapy considerations are discussed. Overall, this review supports novel scientific endeavors aiming at improving the quality of life with a comprehensive and integrated approach to improve well-being of the aging populations worldwide.

Effect of Saffron (Crocus sativus) Supplementation on Oxidative Stress, Inflammatory Indices, and Renal and Liver Function Parameters in Patients With Type 2 Diabetes Mellitus: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Clinical Trials

CONTEXT

Clinical investigation has shown that the addition of saffron or crocin to standard antidiabetic medications improves a patient's metabolic profile, oxidative stress (OS), and inflammatory response. Despite a large number of studies examining the impact of saffron supplementation on OS, inflammation, and renal and liver function parameters, no systematic review or meta-analysis has been conducted to compile the outcomes in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVE

The current systematic review and meta-analysis was performed to investigate the effect of saffron or crocin intake on OS, inflammation, and renal and liver function parameters in patients with T2DM.

DATA SOURCES

Online databases including PubMed, Scopus, ISI Web of Science, and Cochrane Library were searched up to December 2023.

DATA EXTRACTION

The mean differences and their respective SDs were extracted. Using a random-effects model, the pooled data were calculated as standardized mean difference (SMD) with 95% CI.

DATA ANALYSIS

17 eligible randomized controlled trials were included in this meta-analysis. The pooled findings showed that saffron supplementation remarkably decreased the levels of tumor necrosis factor-α (SMD: -0.37; 95% CI: -0.69 to -0.05; I2 = 40.77%, P = .15), interleukin-6 (IL-6) (SMD: -0.38; 95% CI: -0.65 to -0.10; I2 = 0%, P = .68), and malondialdehyde (MDA) (SMD: -0.36; 95% CI: -0.65 to -0.07; I2= 20.51%, P = .02) compared with the control. In addition, based on subgroup analyses, taking ≥100 mg of saffron daily in individuals with T2DM reduced the serum levels of IL-6 (SMD: -0.50; 95% CI: -0.90 to -0.10; I2 = 0%, P = .50) and MDA (SMD: -0.36; 95% CI: -0.68 to -0.03; I2 = 0, P = .97). Furthermore, the level of alanine transaminase was decreased (SMD: -0.43; 95% CI: -0.73 to -0.12; I2 = 0, P = .66) with a treatment period of <60 days of saffron or crocin supplementation.

CONCLUSION

Larger studies with more follow-up and higher doses of both saffron and crocin are needed in order to understand the efficacy and safety of these herbs for long-term use as routine therapies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023458119.

Antioxidant effects of a novel pioglitazone analogue (PA9) in a rat model of diabetes: Modulation of redox homeostasis and preservation of tissue architecture

Oxygen-free radicals have been implicated in the initiation of diabetic complications. Thiazolidinediones (TZDs), known for their antidiabetic properties, also demonstrate notable antioxidant and anti-inflammatory effects. Although a recently developed imidazolyl analogue of pioglitazone (PA9) has exhibited superior glucose-lowering efficacy compared to pioglitazone, its antioxidant effects remain unexplored. Thus, the objective of this study is to evaluate the antioxidant properties of PA9 in animal models with diabetes. Rats were randomly separated into the following four groups: control, diabetic, and two groups treated orally with pioglitazone as a standard drug and PA9 for ten days. Upon completion of the experiment, tissues from the liver, heart, brain, pancreas, spleen, and kidneys were collected to assess oxidant/antioxidant markers and histological alterations. The administration of PA9 resulted in a noteworthy reduction in malondialdehyde (MDA) levels compared to the diabetic group (p < 0.05). The group receiving PA9 displayed elevated levels of three antioxidant markers, catalase (CAT), superoxide dismutase (SOD), and total thiol, in pancreatic tissue compared to diabetic rats (p < 0.05). Furthermore, increased content of CAT was evident in the heart (p < 0.05), spleen (p < 0.001), brain, and kidney tissues in the PA9-treated group, along with augmented thiol content in the spleen compared to the diabetic group. Remarkably, no significant histological changes were observed in the liver, pancreas, heart, brain, spleen, and kidneys of the PA9-treated groups relative to diabetic rats. PA9 effectively mitigates oxidative stress, modulates redox homeostasis, and shows promise in preventing diabetic complications. The proven safety profile of this analogue underscores its potential, warranting comprehensive clinical evaluation to thoroughly understand its therapeutic scope and efficacy in the management of diabetes.

New insights of DsbA-L in the pathogenesis of metabolic diseases

Metabolic diseases, such as obesity, diabetes mellitus, and non-alcoholic fatty liver disease (NAFLD), are abnormal conditions that result from disturbances of metabolism. With the improvement of living conditions, the morbidity and mortality rates of metabolic diseases are steadily rising, posing a significant threat to human health worldwide. Therefore, identifying novel effective targets for metabolic diseases is crucial. Accumulating evidence has indicated that disulfide bond A oxidoreductase-like protein (DsbA-L) delays the development of metabolic diseases. However, the underlying mechanisms of DsbA-L in metabolic diseases remain unclear. In this review, we will discuss the roles of DsbA-L in the pathogenesis of metabolic diseases, including obesity, diabetes mellitus, and NAFLD, and highlight the potential mechanisms. These findings suggest that DsbA-L might provide a novel therapeutic strategy for metabolic diseases.

Bioenergetic shift and proteomic signature induced by lentiviral-transduction of GFP-based biosensors

Fluorescent proteins (FPs) stand as pivotal tools extensively employed across diverse biological research endeavors in various model systems. However, long-standing concerns surround their use due to the numerous side effects associated with their expression. Recent investigations have brought to light the significance of hydrogen peroxide (H2O2) that is associated with the maturation process of green fluorescent protein (GFP) fluorophores. The structural and functional impairments associated with GFP expression are possibly linked to this amount of H2O2. In this study, we assess the impact of the GFP-based HyPer7 biosensor on cellular homeostasis and proteome changes, aiming to identify potential risks related to oxidative stress responses that potentially risks the application of such tools. Cells expressing genome-integrated HyPer7 demonstrated altered mitochondrial membrane potential (MMP), which was alleviated by the addition of antioxidants or culturing cells at physiological normoxia (5 kPa O2). Additionally, HyPer7-expressing cells also exhibited significant impairment in mitochondrial oxidative respiration, suggesting broader mitochondrial dysfunction. Through untargeted proteomics analysis, we identified 26 proteins exhibiting differential expression in HyPer7-expressing cells compared to respective control cells. Functional annotation analysis showed that the list of the delineated proteins is associated with cellular responses to stress and the regulation of antioxidant mechanisms. Our findings underscore the significance of caution and validation in ensuring a thorough comprehension of cellular responses when using fluorescent protein-based tools, thereby enhancing the reliability of the results.

Impact of apoptosis and oxidative stress on pancreatic beta cell pathophysiology in streptozotocin-induced Type 1 diabetes mellitus

AIMS

Hyperglycemia plays a crucial role in the islet cells, especially pancreatic beta cell death in type 1 diabetes mellitus (T1DM). However, a few research have concentrated on the pathophysiology of apoptosis and oxidative stress in T1DM. The aim of this study was to determine the expression of Caspase 3, Caspase 9, 8-OHdG, Glutathione Reductase, endothelial and inducible nitric oxide synthase in the pancreatic tissue of streptozotocin (STZ)-induced T1DM patients and to compare the cellular mechanisms underlying this metabolic disorder.

METHODS

For this purpose, a total of 20 Wistar albino rats were divided into two groups: Control (C) and Diabetes Mellitus (DM). In the DM group, T1DM was induced by STZ. Rats in the C group were injected intravenously with buffer solution. At the end of the day 20, rats were necropsied and immunohistochemical procedures were applied.

RESULTS

The immunohistochemical examination revealed, strong positive immunoreactions were observed in the islet cells of the DM groups, particularly when all antibody stains were considered. On the other hand, the C groups showed minimal changes. The difference between the C and DM groups in terms of all antibodies was statistically significant (p<0.01).

CONCLUSIONS

In the present study, it was concluded that apoptosis, oxidative stress and NOS expressions were involved in islet cell destruction in pancreatic tissue in STZ-induced T1DM.

Neutrophil-Lymphocyte Ratio and Urine Albumin-Creatinine Ratio As Indicators of Microvascular Complications in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Background Type 2 diabetes mellitus (T2DM) is associated with a high risk of developing microvascular complications such as diabetic nephropathy, diabetic neuropathy (DN), and diabetic retinopathy (DR), leading to significant morbidity. Early detection of these complications is crucial for improving patient outcomes. Neutrophil-lymphocyte ratio (NLR) and urine albumin-creatinine ratio (UACR) show promise as cost-effective and accessible biomarkers for the early detection of microvascular complications in T2DM. Their integration into routine care could enhance risk stratification, facilitate timely interventions, and improve patient outcomes, reducing the burden of diabetes-related morbidity. However, their clinical utility in diabetic populations remains underexplored.  Objective The study aims to evaluate the predictive value of NLR and UACR for microvascular complications, specifically DN and DR, in patients with T2DM. Methods This cross-sectional study included 130 patients diagnosed with T2DM undergoing routine investigations at the Department of General Medicine, Kempegowda Institute of Medical Sciences, Bengaluru. NLR and UACR, along with other secondary variables were measured, and their associations with DN and DR were analysed using various statistical tests to assess the viability of these biomarkers in predicting microvascular complications in clinical practice. Results UACR emerged as a strong predictor for both DR and DN. UACR achieved an accuracy of 91% for DR (area under the curve (AUC) 0.97) and 81.5% for DN (AUC 0.90). NLR showed 85% accuracy for DR (AUC 0.87) and 75% accuracy for DN (AUC 0.851). However, NLR was not a significant predictor in multivariate analyses, suggesting that other variables may affect its predictive ability. Logistic regression analyses identified UACR, duration of diabetes, and glycosylated haemoglobin (HbA1C) as significant predictors of microvascular complications. The models had adjusted R² values of 0.751 for DN and 0.881 for DR. Conclusion The study highlights the predictive value of NLR and UACR in detecting microvascular complications, particularly DN and DR, in patients with T2DM. UACR demonstrated superior utility compared to NLR, underscoring its clinical relevance in early screening for complications. Additionally, glycaemic control and diabetes duration were significant predictors, emphasising the importance of comprehensive monitoring in preventing diabetic complications. Further research is warranted to explore the role of NLR in larger, more diverse populations.

Obesity-driven changes in breast tissue exhibit a pro-angiogenic extracellular matrix signature

Obesity has reached epidemic proportions in the United States, emerging as a risk factor for the onset of breast cancer and a harbinger of unfavorable outcomes [1], [2], [3]. Despite limited understanding of the precise mechanisms, both obesity and breast cancer are associated with extracellular matrix (ECM) rewiring [4], [5], [6]. Utilizing total breast tissue proteomics, we analyzed normal-weight (18.5 to < 25 kg/m2), overweight (25 to < 30 kg/m2), and obese (≥30 kg/m2) individuals to identify potential ECM modifying proteins for cancer development and acceleration. Obese individuals exhibited substantial ECM alterations, marked by increased basement membrane deposition, angiogenic signatures, and ECM-modifying proteins. Notably, the collagen IV crosslinking enzyme peroxidasin (PXDN) emerged as a potential mediator of the ECM changes in individuals with an elevated body mass index (BMI), strongly correlating with angiogenic and basement membrane signatures. Furthermore, glycan-binding proteins galectin-1 (LGALS1) and galectin-3 (LGALS3), which play crucial roles in matrix interactions and angiogenesis, also strongly correlate with ECM modifications. In breast cancer, elevated PXDN, LGALS1, and LGALS3 correlate with reduced relapse-free and distant-metastatic-free survival. These proteins were significantly associated with mesenchymal stromal cell markers, indicating adipocytes and fibroblasts may be the primary contributors of the obesity-related ECM changes. Our findings unveil a pro-angiogenic ECM signature in obese breast tissue, offering potential targets to inhibit breast cancer development and progression.

Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction

Objective

To explore the role of oxidative stress on glycogen synthase kinase-3 in lymphocytes of diabetes mellitus (DM) patients complicated with cerebral infarction (CI).

Materials and methods

A total of 186 DM patients were enrolled according to the inclusion criteria and exclusion criteria, including 89 DM patients alone (DM group) and 97 DM patients with CI (DM + CI) group. Eighty-one patients with CI were selected as the CI group, and 80 normal subjects over 50 years were selected as the control group. Superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, and malondialdehyde (MDA) content in serum were determined by colorimetric assays. Phosphorylation of GSK-3β was measured by enzyme-linked immunosorbent assay.

Results

(1) Compared with the control group, the SOD and GSH-Px activities in the DM group and DM + CI group were decreased, accompanied by higher MDA content. Furthermore, phosphorylation of GSK-3β was decreased. (2) In the DM + CI group, SOD activity was decreased on days 7 and 10 and month 3 compared to the CI group and was decreased on day 7 compared to the DM group. MDA content was increased from day 0 to month 3 compared to the CI group. On days 1, 7, and 10, GSH-Px activity was lower than the DM group, and on day 10 and month 3, it was lower than the CI group. Phosphorylation of GSK-3β was decreased on days 7 and 10 compared to the DM group and was decreased from day 1 to month 3 compared to the CI group.

Conclusion

In the present study, we demonstrated that the oxidative stress in peripheral lymphocytes of DM patients complicated with CI was stronger, and the GSK-3 activity was higher. It suggested that oxidative stress might enhance the GSK-3 activity, which might provide a diagnostic and therapeutic approach for DM complicated with CI, and targeting GSK-3 is a promising therapeutic target for the treatment of type 2 diabetes and its complications.

Exploring the bidirectional link between erectile dysfunction and 10-year cardiovascular risk in men with diabetes and hypertension

Erectile dysfunction (ED) shares common risk factors with cardiovascular (CV) disease, such as a sedentary lifestyle, obesity, and metabolic syndrome. However, the relationship between ED and CV risk in Vietnam remains unknown. To investigate this, we conducted a multi-center observational study, randomly selecting 2,936 men aged 40 to 69 years in Vietnam, with 385 participants included after exclusions. The study evaluated the 10-year CV risk using the Systematic Coronary Risk Evaluation 2-Diabetes (SCORE2-Diabetes) score and assessed ED using the International Index of Erectile Function (IIEF-5) score. Results showed that men with diabetes mellitus and hypertension had significantly lower IIEF-5 scores compared to healthy individuals (18 [15-22] vs. 23 [20-24], p < 0.001). Additionally, the IIEF-5 score proved effective in identifying patients at very high CV risk, with an area under the curve (AUC) of 0.747, a cutoff point of 18.5, sensitivity of 69.6%, and specificity of 69.9%. Furthermore, we found a significant inverse correlation between SCORE2-Diabetes and IIEF-5 (ρ = -0.45 and p < 0.001). These findings establish a significant connection between ED and CV risk in men with diabetes, underscoring the need for integrated screening and management strategies to address both conditions concurrently.

Organic vs. inorganic nitrates: Metabolic and vascular outcomes in STZ-induced diabetes in mice

BACKGROUND

Diabetic animals often display dysregulated nitric oxide (NO) metabolism, contributing to vascular dysfunction. This study evaluates the metabolic and vascular effects of organic nitrate isosorbide mononitrate (ISMN) versus inorganic sodium nitrate (NaNO3) in mice with type 1 diabetes mellitus (T1DM) induced by streptozotocin (STZ).

EXPERIMENTAL APPROACH

T1DM was induced in male C57Bl6 mice with STZ ip and confirmed by fasting glucose. Mice were treated with ISMN (10 mg·kg-1) or NaNO3 (85 mg·L-1) for 14 days. A combination of in vivo, in vitro, and ex vivo studies assessed cardiometabolic benefits.

RESULTS

Both nitrates reduced blood and urinary hyperglycemia in T1DM mice, with ISMN exhibiting more significant reductions in blood glucose. ISMN and NaNO3 similarly reduced water and food intake, urinary volume, glucose intolerance, and insulin resistance while increasing insulin and nitrite levels in serum and urine. Both nitrates improved endothelium-independent vascular function and attenuated reactive oxygen species (ROS) while increasing NO levels in the aortic rings of T1DM mice. Furthermore, both nitrates similarly reduced mean arterial pressure in T1DM mice.

CONCLUSION AND IMPLICATIONS

ISMN and NaNO₃ have demonstrated comparable hypotensive and antioxidant effects, offering metabolic and vascular benefits in STZ-TDM1 mice. The more pronounced reduction in blood glucose with ISMN treatment compared to NaNO₃ is particularly promising. The antihyperglycemic effects of both nitrates were linked to increased serum insulin levels and enhanced insulin sensitivity. These results provide a foundation for future clinical studies to evaluate the potential of ISMN or NaNO3 as antidiabetogenic and antihypertensive adjuvant therapies in diabetic patients.

Lipophilic index of serum phospholipids in patients with type 2 diabetes and atherosclerotic cardiovascular disease: links with metabolic control, vascular inflammation and platelet activation

BACKGROUND

Little is known about the mechanisms underlying the association of the serum phospholipid lipophilic index (LI) with atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes (T2D). Therefore, we investigated whether the LI is associated with glucometabolic control, meta-inflammation, thrombin generation, fibrin clot properties, endothelial function and platelet activation in T2D patients with angiographically documented ASCVD.

METHODS

We studied 74 T2D patients with ASCVD, aged 65.6 ± 6.8 years, with a median diabetes duration of 10 years and median HbA1c of 7.0%. Serum phospholipid fatty acids (FAs) were measured by gas chromatography. The serum phospholipid LI was calculated as the sum of the products of the proportion (% of total FAs) with the melting points (°C) of each individual FA, divided by the sum of the proportions of all FAs. Levels of HbA1c, insulin, leptin, adiponectin, lipid profiles, inflammatory markers (hsCRP, interleukin-6, TNF-α), Lp-PLA2 (a biomarker of vascular inflammation), endothelial function (sICAM-1, sVCAM-1, FMD, NMD), thrombin generation, fibrin clot properties and platelet activation, measured by light transmission aggregometry with arachidonic acid [AA] and adenosine diphosphate [ADP], were assessed.

RESULTS

Patients with LI > 16.9 °C (median) had higher HbA1c concentrations by 5.9% compared to the remaining subjects (p = 0.035). In this group, HbA1c levels ≥ 7.0% were found more often than in individuals with LI ≤ 16.9 °C (62.2 vs. 35.1%; p = 0.020). Subjects with LI > 16.9 °C had higher levels of TCh by 17.1% (p = 0.012), LDL-Ch by 29.4% (p = 0.003), interleukin-6 by 22.2% (p = 0.031) and Lp-PLA2 by 32.4% (p = 0.040), compared to the remaining patients. Moreover, they had increased maximal platelet aggregation induced by AA (p = 0.045), but not by ADP. Serum phospholipid LI correlated with HbA1c (r = 0.24; p = 0.037), TCh (r = 0.36; p = 0.002), LDL-Ch (r = 0.38; p < 0.001), interleukin-6 (r = 0.27; p = 0.020) and Lp-PLA2 (r = 0.26; p = 0.026). There were no intergroup differences in endothelial function, thrombin generation and fibrin clot properties. Regression analysis showed that HbA1c ≥ 7.0% and serum levels of LDL-Ch, interleukin-6 and Lp-PLA2 were predictors of LI > 16.9 °C in adjusted models.

CONCLUSIONS

In well-controlled T2D patients with ASCVD, the higher serum phospholipid LI is associated with worse glucometabolic control, enhanced vascular inflammation and higher platelet reactivity during aspirin treatment at cyclooxygenase-1-selective doses.

Elevated glucose levels increase vascular calcification risk by disrupting extracellular pyrophosphate metabolism

BACKGROUND

Vascular calcification is a major contributor to cardiovascular disease, especially diabetes, where it exacerbates morbidity and mortality. Although pyrophosphate is a recognized natural inhibitor of vascular calcification, there have been no prior studies examining its specific deficiency in diabetic conditions. This study is the first to analyze the direct link between elevated glucose levels and disruptions in extracellular pyrophosphate metabolism.

METHODS

Rat aortic smooth muscle cells, streptozotocin (STZ)-induced diabetic rats, and diabetic human aortic smooth muscle cells were used to assess the effects of elevated glucose levels on pyrophosphate metabolism and vascular calcification. The techniques used include extracellular pyrophosphate metabolism assays, thin-layer chromatography, phosphate-induced calcification assays, BrdU incorporation for DNA synthesis, aortic smooth muscle cell viability and proliferation assays, and quantitative PCR for enzyme expression analysis. Additionally, extracellular pyrophosphate metabolism was examined through the use of radiolabeled isotopes to track ATP and pyrophosphate transformations.

RESULTS

Elevated glucose led to a significant reduction in extracellular pyrophosphate across all diabetic models. This metabolic disruption was marked by notable downregulation of both the expression and activity of ectonucleotide pyrophosphatase/phosphodiesterase 1, a key enzyme that converts ATP to pyrophosphate. We also observed an upregulation of ectonucleoside triphosphate diphosphohydrolase 1, which preferentially hydrolyzes ATP to inorganic phosphate rather than pyrophosphate. Moreover, tissue-nonspecific alkaline phosphatase activity was markedly elevated across all diabetic models. This shift in enzyme activity significantly reduced the pyrophosphate/phosphate ratio. In addition, we noted a marked downregulation of matrix Gla protein, another inhibitor of vascular calcification. The impaired pyrophosphate metabolism was further corroborated by calcification experiments across all three diabetic models, which demonstrated an increased propensity for vascular calcification.

CONCLUSIONS

This study demonstrated that diabetes-induced high glucose disrupts extracellular pyrophosphate metabolism, compromising its protective role against vascular calcification. These findings identify pyrophosphate deficiency as a potential mechanism in diabetic vascular calcification, highlighting a new therapeutic target. Strategies aimed at restoring or enhancing pyrophosphate levels may offer significant potential in mitigating cardiovascular complications in diabetic patients, meriting further investigation.

Association of inflammatory cytokines with type 2 diabetes mellitus and diabetic nephropathy: a bidirectional Mendelian randomization study

Objective

Previous observational studies have suggested associations between various inflammatory cytokines with type 2 diabetes mellitus and diabetic nephropathy. However, the causal association remains uncertain.

Method

Summary statistics for type 2 diabetes mellitus and diabetic nephropathy were obtained from a publicly available genome-wide association study. Data on inflammatory cytokines were sourced from a genome-wide association study on protein quantitative trait loci. The inverse variance-weighted method was applied as the primary method for causal inference. MR-Egger, weighted mode, and weighted median method were employed as supplementary analyses. Sensitivity analyses were performed to detect heterogeneity and potential horizontal pleiotropy in the study.

Result

Genetic evidence indicated that elevated levels of fibroblast growth factor 19 levels promoted the occurrence of type 2 diabetes mellitus, and increased concentrations of fibroblast growth factor 21 levels, C-C motif chemokine 19 levels, eotaxin levels, and interleukin-10 mitigated the risk of developing type 2 diabetes mellitus, while type 2 diabetes mellitus did not exert a significant influence on said proteins. Elevated levels of tumor necrosis factor ligand superfamily member 14 and TNF-related activation-induced cytokine were associated with an increased risk of diabetic nephropathy, and increased concentrations of interleukin-1-alpha and transforming growth factor-alpha were potentially correlated with a diminished risk of diabetic nephropathy. Sensitivity analyses further ensure the robustness of our findings.

Conclusion

Mendelian randomization analysis highlights a causal association between inflammatory cytokines with type 2 diabetes mellitus and diabetic nephropathy, offering valuable evidence and reference for future research.

The Influence of Atorvastatin Treatment on Homocysteine Metabolism and Oxidative Stress in an Experimental Model of Diabetic Rats

OBJECTIVE

In our experimental study, we evaluated the influence of treatment with atorvastatin on the antioxidant activity of intracellular and extracellular systems factors, homocysteine levels (Hcy), and lipid profiles in obese and diabetic rats.

METHOD

Twenty-one male Wistar rats, aged 6 months, 450-550 g, were allocated into three groups. From the beginning of the study, the first group (G-I, control) received only standard food, while the second and third groups (G II-obese, G III-diabetic) were administered a high-fat diet (HFD) with 2% cholesterol. After 2 weeks of accommodation, the specimens in G-III were injected intraperitoneal (i.p.) streptozotocin (35 mg of body weight, pH 4.5), intervention followed by the onset of type 2 diabetes mellitus. Following confirmation of diabetes onset, the specimens in G III were administered concomitantly with the HFD a daily gavage of atorvastatin 20 mg of body weight/day for 20 days. We measured, at the beginning and the end of the study, the Hcy levels, lipid profile, vitamin B12, B6, folic acid, and various parameters of oxidative stress (OS)-total antioxidant status (TAS), glutathione peroxidase (GPX) and superoxide dismutase (SOD).

RESULTS

After treatment with atorvastatin, the lipid profile in G III significantly improved compared to the other two groups, but enzymatic markers of oxidative stress did not closely parallel this trend. However, after the treatment of statin, we observed an important reduction in Hcy values.

CONCLUSION

Our results demonstrate that treatment with atorvastatin can be used not only for its lipid-lowering properties and antioxidant effects but also to reduce Hcy concentration in this experimental model of diabetic rats. Moreover, atorvastatin therapy improves lipid profiles, reduces inflammation, suppresses oxidation, and decreases Hcy levels, potentially preventing major adverse cardiovascular events.

Cardiovascular health metrics and diabetic nephropathy: a nationally representative cross-sectional study

BACKGROUND

The pathogenesis of diabetic nephropathy is well-documented to be multifactorial. However, research available on the association between cardiovascular health and diabetic nephropathy is limited. Thus, this study aimed to investigate these potential associations and provide guidance for disease prevention.

METHODS

We applied Life's Essential 8 (LE8) identified by the American Heart Association, which integrates multiple health behaviors and health factors to measure cardiovascular health. This study covered 4207 adults with diabetes from the National Health and Nutrition Examination Survey spanning 2007-2018. Weighted regression models assessed the estimated effect of LE8 score on the prevalence of diabetic nephropathy as well as their corresponding clinical indicators. Weighted restricted cubic spline models discussed the possible nonlinear dose-response relationships further. Subgroup analyses clarified the effects of other covariates on correlations.

RESULTS

After adjusting for all covariates, participants with moderate or high cardiovascular health showed a decreased prevalence of diabetic nephropathy (odds ratio [OR]:0.52; 95% confidence interval [CI]:0.42-0.63), and also a decrease in the urinary albumin-to-creatinine ratio [UACR] (β: - 0.83; 95% CI:- 1.00 to - 0.65). The prevalence of diabetic nephropathy and the level of UACR tended to decrease linearly as the total LE8 score increased (P for nonlinear > 0.05). Subgroup analyses showed that the effects of increased overall LE8 score and the specific cardiovascular health construct varied across age and obesity strata.

CONCLUSION

Elevated overall LE8 score was significantly associated with a lower prevalence of diabetic nephropathy in U.S. adults, and the effects of the specific cardiovascular health construct on diabetic nephropathy and their corresponding clinical indicators varied. In all, maintaining good cardiovascular health by refining LE8 metrics may help reduce the adverse effects.