Use of laboratory studies for the design, explanation, and validation of human micronutrient intervention studies

Understanding the Significance of Hypoxia-Inducible Factors (HIFs) in Glioblastoma: A Systematic Review

BACKGROUND

The study aims to investigate the role of hypoxia-inducible factors (HIFs) in the development, progression, and therapeutic potential of glioblastomas.

METHODOLOGY

The study, following PRISMA guidelines, systematically examined hypoxia and HIFs in glioblastoma using MEDLINE (PubMed), Web of Science, and Scopus. A total of 104 relevant studies underwent data extraction.

RESULTS

Among the 104 studies, global contributions were diverse, with China leading at 23.1%. The most productive year was 2019, accounting for 11.5%. Hypoxia-inducible factor 1 alpha (HIF1α) was frequently studied, followed by hypoxia-inducible factor 2 alpha (HIF2α), osteopontin, and cavolin-1. Commonly associated factors and pathways include glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3) receptors, vascular endothelial growth factor (VEGF), phosphoinositide 3-kinase (PI3K)-Akt-mechanistic target of rapamycin (mTOR) pathway, and reactive oxygen species (ROS). HIF expression correlates with various glioblastoma hallmarks, including progression, survival, neovascularization, glucose metabolism, migration, and invasion.

CONCLUSION

Overcoming challenges such as treatment resistance and the absence of biomarkers is critical for the effective integration of HIF-related therapies into the treatment of glioblastoma with the aim of optimizing patient outcomes.

Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE)

An increasing recognition has emerged of the complexities of the global health agenda—specifically, the collision of infections and noncommunicable diseases and the dual burden of over- and undernutrition. Of particular practical concern are both 1) the need for a better understanding of the bidirectional relations between nutritional status and the development and function of the immune and inflammatory response and 2) the specific impact of the inflammatory response on the selection, use, and interpretation of nutrient biomarkers. The goal of the Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE) is to provide guidance for those users represented by the global food and nutrition enterprise. These include researchers (bench and clinical), clinicians providing care/treatment, those developing and evaluating programs/interventions at scale, and those responsible for generating evidence-based policy. The INSPIRE process included convening 5 thematic working groups (WGs) charged with developing summary reports around the following issues: 1) basic overview of the interactions between nutrition, immune function, and the inflammatory response; 2) examination of the evidence regarding the impact of nutrition on immune function and inflammation; 3) evaluation of the impact of inflammation and clinical conditions (acute and chronic) on nutrition; 4) examination of existing and potential new approaches to account for the impact of inflammation on biomarker interpretation and use; and 5) the presentation of new approaches to the study of these relations. Each WG was tasked with synthesizing a summary of the evidence for each of these topics and delineating the remaining gaps in our knowledge. This review consists of a summary of the INSPIRE workshop and the WG deliberations.

Evidence in multiple micronutrient nutrition: from history to science to effective programs

The workshop involved key researchers from academic and development organizations reviewing what we have learned about multiple micronutrients and applying that knowledge to providing guidance to public health policy and program design. The participants highlighted the importance of evidence-based interventions, not to restrict evidence slanted toward one single origin but to appreciate the totality of evidence from history, epidemiology, basic science, randomized-controlled studies, and meta-analyses to inform policy and guideline development for the implementation of effective programs. It has to be understood and accepted that although the need for an evidence-based approach to nutritional recommendations is fundamental and cannot be disputed, there are distinct differences between evidence-based medicine and evidence-based nutrition practice. The level of confidence and certainty needed to launch programs to reduce micronutrient deficiencies can be different from what is required to treat a disease. An effective approach would be to ensure that both research and programs at scale are running in parallel and that both receive adequate attention and funding to fine tune the program or stop it when it is no longer required. There was much valuable discussion on the topic of what types of research methodologies are suitable for what type of intervention and, importantly, what is required before public health policy can be set. This paper is an introduction to a series of articles in this supplement that discuss the evidence on multiple micronutrients and what is required to establish policies and launch effective multiple micronutrient programs.

Multiple micronutrient interventions are efficacious, but research on adequacy, plausibility, and implementation needs attention

Evidence for the efficacy of multiple micronutrient (MMN) supplementation has been established by state-of-the-art randomized controlled trials (RCT). These efficacy trials have also provided strong evidence of the widespread occurrence of deficiencies. Trials intended to demonstrate a public health benefit must show that the magnitude of benefit is adequate for policy considerations. In the MMN efficacy studies the magnitude of impact was generally inadequate. The extent to which this was due to various factors that affect individuals' potential to respond to MMN supplementation has not been examined, and trials have not been designed to provide insights into why impact is below expectation. For instance, when birth weight was the outcome of concern, impact was not related to presumed need, judged by baseline birth-weight values. Also, contrary to expectations, the impacts were greater among the heavier mothers. Our inability to examine issues of adequacy, plausibility, and implementation with efficacy trial approaches as they are currently conducted, calls into question the present standards for designing and interpreting community RCT in nutrition. Improving the capacity of efficacy studies to yield more meaningful data requires a number of modifications to current practices, such as including measures of the intermediary behavioral and biological steps between intervention and biological outcomes to assess the adequacy and plausibility of the findings. The progression from RCT to program interventions must also extend research to program delivery and uptake to ascertain the full program impact pathway. This in turn requires novel organizations of relationships between research and program development and implementation.