Pathophysiology Of Progression Research Articles

The case for regulatory approval of amyloid-lowering immunotherapies in Alzheimer's disease based on clearcut biomarker evidence.

Decades of research have provided evidence that Alzheimer's disease (AD) is caused in part by cerebral accumulation of amyloid beta-protein (Aβ). In 2023, the US Food and Drug Administration gave full regulatory approval to a disease-modifying Aβ antibody for early AD. Secondary prevention trials with Aβ antibodies are underway. We summarize peer-reviewed evidence for targeting Aβ and argue that regulators should consider approving new agents working by similar mechanisms (Aβantibodies and vaccines) based on robust amyloid lowering and reasonable safety. The urgent need to provide treatments to millions of mildly symptomatic patients suggests that AD should join other diseases for which standard approval is based on significant changes in mechanistically meaningful biomarkers coupled with safety. Robust amyloid lowering in secondary prevention trials of people who have amyloid plaques but are asymptomatic could also provide evidence of a change in the pathophysiological progression of AD as a basis for regulatory approval. HIGHLIGHTS: Thirteen key findings support amyloid beta as a cause of Alzheimer's disease (AD). Three immunotherapies lower amyloid and slow decline, allowing regulatory approval. New such agents could be considered for approval due to amyloid lowering and safety. Urgency suggests AD may join diseases with approval due to a key biomarker + safety.

Genetically modified E. Coli secreting melanin (E.melanin) activates the astrocytic PSAP-GPR37L1 pathway and mitigates the pathogenesis of Parkinson’s disease

The characteristic neuropathology of Parkinson’s disease (PD) involves the abnormal accumulation of phosphorylated α-synuclein (αSyn), as well as a significant decrease in neuromelanin (NM) levels within dopamine neurons (DaNs). Unlike αSyn aggregates, the relationship between NM levels and PD pathogenesis is not well understood. In this study, we engineered an E. coli MG1655 strain to produce exosomes containing melanin (E.melanin), and investigated its potential neuroprotective effects on DaNs in the context of PD. By employing a combination of cell cultures, biochemical studies, single nuclear RNA sequencing (snRNA seq), and various in vivo validations, we found that administration of E.melanin effectively alleviated DaNs loss and improved motor behavior impairments observed in both pharmacological and transgenic PD mouse models. Mechanistically, snRNA seq data suggested that E.melanin activated the PSAP-GPR37L1 signaling pathway specifically within astrocytes, leading to a reduction in astrocytic engulfment of synapses. Notably, activation of the GPR37L1 receptor using Tx14(A) peptide successfully rescued motor defects as well as protected against DaNs degeneration in mice with PD. Overall, our findings provide novel insights into understanding the molecular mechanisms underlying melanin’s protective effects on DaNs in PD while offering potential strategies for manipulating and treating its pathophysiological progression.

Association between GDF-15 levels and cardiac morphology and function in cardiac magnetic resonance imaging: insights from UK Biobank data analysis

Abstract Background/Introduction Growth Differentiation Factor-15 (GDF-15) has emerged as a biomarker associated with cardiovascular disease and adverse cardiac outcomes. Cardiac morphology and function, assessed through cardiac magnetic resonance imaging (CMR), are critical indicators of cardiovascular pathology. Understanding the relationship between GDF-15 levels and LV characteristics could provide valuable insights into cardiac pathophysiology and disease progression. Purpose This study aims to investigate the association between GDF-15 levels and cardiac morphology and function, utilizing data from the UK Biobank and CMR. By analyzing various CMR-derived parameters, including LV strain, myocardial mass, LV mass-to-volume ratio, ventricular and atrial volumes, we seek to elucidate the impact of GDF-15 on cardiac structure and function. Methods Data from the UK Biobank, including 2,264 participants, were analyzed. The median age of the analyzed participants was 55 years, with a median BMI of 26.0. Among the participants, 53% were females and 47% were males. CMR-derived variables related to cardiac morphology and function, along with GDF-15 levels, were examined. Multiple linear regression models were constructed to assess the association between GDF-15 levels and cardiac parameters, adjusting for age, sex, and other relevant covariates. Confidence intervals (CI) and p-values were calculated to determine the significance of observed associations. Results Analysis of the UK Biobank data revealed significant associations between GDF-15 levels and specific cardiac parameters (table1). Notably, GDF-15 levels were negatively associated with LV myocardial mass (LVM)(coefficient = -1.146, p = 0.0071), LV end-diastolic volume LVEDV)(coefficient = -3.321, p < 0.0001), LV end-systolic volume (coefficient = -1.876, p < 0.0001), as well as right atrial maximum volume (coefficient = -3.025, p < 0.0001) and minimum volume (coefficient = -1.858, p = 0.0003). In addition, LVM/LVEDV was positively associated with GDF-15 level (p<0.03). However, no significant associations were observed between GDF-15 levels and LV strain parameters, ejection fraction, or left atrial volumes. Conclusion This study provides evidence of a significant association between GDF-15 levels and selected parameters of cardiac morphology and function, as assessed by CMR in the UK Biobank population. These findings suggest a potential role of GDF-15 in modulating specific aspects of cardiac structure, function and left ventricle concentric remodeling warranting further investigation.GDF 15

Age-Related Macular Degeneration (AMD): Pathophysiology, Drug Targeting Approaches, and Recent Developments in Nanotherapeutics

The most prevalent reason for vision impairment in aging inhabitants is age-related macular degeneration (AMD), a posterior ocular disease with a poor understanding of the anatomic, genetic, and pathophysiological progression of the disease. Recently, new insights exploring the role of atrophic changes in the retinal pigment epithelium, extracellular drusen deposits, lysosomal lipofuscin, and various genes have been investigated in the progression of AMD. Hence, this review explores the incidence and risk factors for AMD, such as oxidative stress, inflammation, the complement system, and the involvement of bioactive lipids and their role in angiogenesis. In addition to intravitreal anti-vascular endothelial growth factor (VEGF) therapy and other therapeutic interventions such as oral kinase inhibitors, photodynamic, gene, and antioxidant therapy, as well as their benefits and drawbacks as AMD treatment options, strategic drug delivery methods, including drug delivery routes with a focus on intravitreal pharmacokinetics, are investigated. Further, the recent advancements in nanoformulations such as polymeric and lipid nanocarriers, liposomes, etc., intended for ocular drug delivery with pros and cons are too summarized. Therefore, the purpose of this review is to give new researchers an understanding of AMD pathophysiology, with an emphasis on angiogenesis, inflammation, the function of bioactive lipids, and therapy options. Additionally, drug delivery options that focus on the development of drug delivery system(s) via several routes of delivery can aid in the advancement of therapeutic choices.

Platelet-derived extracellular vesicles in cardiovascular disease and treatment - from maintaining homeostasis to targeted drug delivery.

Cardiovascular disease (CVD) remains a major global health burden. Rising incidences necessitate improved understanding of the pathophysiological processes underlying disease progression to foster the development of novel therapeutic strategies. Besides their well recognized role in CVD, platelet-derived extracellular vesicles (PEVs) mediate inter-organ cross talk and contribute to various inflammatory diseases. PEVs are readily accessible diagnostic biomarkers that mirror pathophysiological disease progression but also may confer cardioprotective properties. Monitoring the effects of modulation of PEV signatures through pharmacotherapies has also provided novel insights into treatment efficacy. Furthermore, exploiting their inherent ability to infiltrate thrombi, atherosclerotic plaques and solid tumours, PEVs as well as platelet-membrane coated nanoparticles are emerging as novel effective and targeted treatment options for CVD and cancer. Collectively, in-depth characterization of PEVs in various diseases ultimately enhances their use as diagnostic or prognostic biomarkers and potential therapeutic targets, making them clinically relevant candidates to positively impact patient outcomes.

Applications of optical coherence tomography angiography in glaucoma: current status and future directions.

Glaucoma is a leading cause of irreversible blindness worldwide, with its pathophysiology remaining inadequately understood. Among the various proposed theories, the vascular theory, suggesting a crucial role of retinal vasculature deterioration in glaucoma onset and progression, has gained significant attention. Traditional imaging techniques, such as fundus fluorescein angiography, are limited by their invasive nature, time consumption, and qualitative output, which restrict their efficacy in detailed retinal vessel examination. Optical coherence tomography angiography (OCTA) emerges as a revolutionary imaging modality, offering non-invasive, detailed visualization of the retinal and optic nerve head microvasculature, thereby marking a significant advancement in glaucoma diagnostics and management. Since its introduction, OCTA has been extensively utilized for retinal vasculature imaging, underscoring its potential to enhance our understanding of glaucoma's pathophysiology, improving diagnosis, and monitoring disease progression. This review aims to summarize the current knowledge regarding the role of OCTA in glaucoma, particularly its potential applications in diagnosing, monitoring, and understanding the pathophysiology of the disease. Parameters pertinent to glaucoma will be elucidated to illustrate the utility of OCTA as a tool to guide glaucoma management.

Low Thyroid Hormones Level Attenuates Mitochondrial Dysfunction and Right Ventricular Failure in Pulmonary Hypertensive Rats.

This study is to investigate the repercussions of hypothyroidism in the pathophysiological progression of pulmonary arterial hypertension (PAH). While the control (CTL, n = 5) male Wistar rats received vehicle, PAH was induced with monocrotaline (MCT group, n = 15). Hypothyroidism was induced in a subset of rats by methimazole 3weeks prior to the MCT injection (MMZ + MCT group, n = 15). Plasma thyroid hormones were measured by radioimmunoassay. Electrocardiographic, echocardiographic, and hemodynamic analyses were performed to evaluate the progression of PAH. Gene expression of antioxidant enzymes and cardiac hypertrophy markers were assessed by qPCR. Mitochondrial respiration, ATP levels, and ROS production were measured in right ventricular (RV) samples. Plasma T3 and T4 decreased in both MCT and MMZ + MCT groups (p < 0.05). Right ventricular systolic pressure (RVSP) increased, and RV - dP/dt, + dP/dt, and contractility index decreased in the MCT versus the CTL group and remained within control levels in the MMZ + MCT group (p < 0.05). Relative RV weight, RV wall thickness, RV diastolic area, and relative lung weight were augmented in the MCT versus the CTL group, whereas all parameters were improved to the CTL levels in the MMZ + MCT group (p < 0.05). Only the MCT group exhibited an increased duration of QTc interval compared to the baseline period (p < 0.05). ADP-induced mitochondrial respiration and ATP levels were decreased, and ROS production was increased in MCT versus the CTL group (p < 0.05), while the MMZ + MCT group exhibited increased mitochondrial respiration versus the MCT group (p < 0.05). Hypothyroidism attenuated the RV mitochondrial dysfunction and the pathophysiological progression of MCT-induced PAH.

Abnormal postcentral gyrus voxel-mirrored homotopic connectivity as a biomarker of mild cognitive impairment: A resting-state fMRI and support vector machine analysis

BackgroundWhile patients affected by mild cognitive impairment (MCI) exhibit characteristic voxel-mirrored homotopic connectivity (VMHC) alterations, the ability of such VMHC abnormalities to predict the diagnosis of MCI in these patients remains uncertain. As such, this study was performed to evaluate the potential role of VMHC abnormalities in the diagnosis of MCI. MethodsMCI patients and healthy controls (HCs) were enrolled and subjected to resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological testing. VMHC and support vector machine (SVM) techniques were then used to examine the collected imaging data. ResultsTotally, 53 MCI patients and 68 healthy controls were recruited. Compared to HCs, MCI patients presented with an increase in postcentral gyrus VMHC. SVM classification demonstrated the ability of postcentral gyrus VMHC values to classify HCs and MCI patients with accuracy, sensitivity, and specificity values of 63.64 %, 71.69 %, and 89.71 %, respectively. ConclusionVMHC abnormalities in the postcentral gyrus may be mechanistically involved in the pathophysiological progression of MCI patients, and these abnormal VMHC patterns may also offer utility as a neuroimaging biomarker for MCI patient diagnosis.

Effect of Pravastatin on Placental Expression of Epidermal Growth Factor-like Domain 7 in Early-Onset Pre-Eclampsia: A New Potential Mechanism of Action.

The primary intervention for pre-eclampsia (PE) remains iatrogenic delivery, which can be very preterm and not optimal for the fetus. Although many efforts have been made to prevent and manage PE, there is still a dearth of drugs to treat its pathophysiological progression. Pravastatin (PRA), a hydrophilic statin, has gained interest for the prevention and treatment of PE. The aim of the present study was to evaluate the ability of PRA to modulate factors involved in placentation, such as Epidermal Growth Factor-Like Domain 7 (EGFL7), in human chorionic villous culture from healthy controls and women with PE. A total of 18 women were enrolled: 10 controls and 8 cases. Chorionic villous explants were maintained in culture for 24 h with or without 10 μM Pravastatin, and the expression of EGFL7 and NOTCH1 pathway members was evaluated by qRT-PCR and Western blot analysis. The rationale of the present study was to establish an ex vivo model to identify potential different responses to PRA treatment of chorionic villous explants in order to clarify the molecular mechanism of PRA in the prevention and treatment of PE and to predict whether there are specific clinical conditions that modulate the response to the drug treatment. Within PE patients, two different groups were identified: the high responders, whose villous cultures exhibit significantly increased expressions of the EGFL7 and Notch pathways after PRA incubation; and the low responders, who are high-risk PE patients in which prophylaxis failed to prevent PE and PRA was not able to modulate EGFL7 expression. In conclusion, we identified EGFL7 as a new factor regulated by PRA, placing interest in early discrimination between low- and high- risk women, in which the well-known pharmacological prophylaxis seems to be ineffective, and to explore new potential prevention strategies.

Lipocalin-2 inhibition alleviates neural injury by microglia ferroptosis suppression after experimental intracerebral hemorrhage in mice via enhancing ferritin light chain expression

IntroductionMicroglia play pivotal roles in post-intracerebral hemorrhage (ICH) neural injury. Iron metabolism, which is dysregulated after ICH, participates in microglial dysfunction. Previous studies have shown that iron metabolism-related lipocalin-2 (LCN2) is involved in regulating microglial function following ICH. In this study, we investigated the role of LCN2 in microglial function following ICH. MethodsThe BV2 (microglia) cell line, transfected with LCN2 for overexpression/interference, received a blood infusion from C57BL/6 mice in vitro. For the in vivo study of LCN2 function, an LCN2 knockout was conducted in mice. Liproxstatin-1 and RSL3 were used to manipulate ferroptosis and to study the effects of LCN2 on microglia after ICH. A BV2 (microglia) cell line, transfected with ferritin light chain (FTL) for overexpression/interference, was co-cultured with primary cultured neurons for a study on the mechanism of LCN2. Behavioral tests were conducted pre-ICH and on days 3, 7, and 28 post-ICH, and the brains and cultured cells were collected for protein, histological, and morphological studies. ResultsBrain LCN2 expression was upregulated in microglia, astrocytes, and neurons and played hazardous roles after ICH. In microglia, LCN2 promoted ferroptosis, which facilitated neural injury after ICH. LCN2-mediated FTL deficiency was shown to be responsible for microglial ferroptosis-induced neural injury. ConclusionOur study suggests that LCN2-enhanced microglial ferroptosis plays a detrimental role by inducing FTL deficiency after ICH. The current study reveals a novel molecular mechanism involved in the pathophysiological progression of ICH.

Proteome-wide analysis identifies plasma immune regulators of amyloid-beta progression

While immune function is known to play a mechanistic role in Alzheimer’s disease (AD), whether immune proteins in peripheral circulation influence the rate of amyloid-β (Aβ) progression – a central feature of AD – remains unknown. In the Baltimore Longitudinal Study of Aging, we quantified 942 immunological proteins in plasma and identified 32 (including CAT [catalase], CD36 [CD36 antigen], and KRT19 [keratin 19]) associated with rates of cortical Aβ accumulation measured with positron emission tomography (PET). Longitudinal changes in a subset of candidate proteins also predicted Aβ progression, and the mid- to late-life (20-year) trajectory of one protein, CAT, was associated with late-life Aβ-positive status in the Atherosclerosis Risk in Communities (ARIC) study. Genetic variation that influenced plasma levels of CAT, CD36 and KRT19 predicted rates of Aβ accumulation, including causal relationships with Aβ PET levels identified with two-sample Mendelian randomization. In addition to associations with tau PET and plasma AD biomarker changes, as well as expression patterns in human microglia subtypes and neurovascular cells in AD brain tissue, we showed that 31 % of candidate proteins were related to mid-life (20-year) or late-life (8-year) dementia risk in ARIC. Our findings reveal plasma proteins associated with longitudinal Aβ accumulation, and identify specific peripheral immune mediators that may contribute to the progression of AD pathophysiology.

Cardiac function in congenital diaphragmatic hernia

Cardiac function is known to play critical role in the pathophysiological progression and ultimate clinical outcome of patients with congenital diaphragmatic hernia (CDH). While often anatomically normal, the fetal and neonatal heart in CDH can suffer from both right and left ventricular dysfunction. Here we explore the abnormal fetal heart, early postnatal right and left ventricular dysfunction, the interplay between cardiac dysfunction and pulmonary hypertension, evaluation and echocardiographic assessment of the heart, and therapeutic strategies for managing and supporting the pathophysiologic heart and CDH. Further, we take a common clinical scenario and provide clinically relevant guidance for the diagnosis and management of this complex process.

UNLOCKING HOPE: OVERCOMING THERAPEUTIC CHALLENGES IN PROGRESSIVE MULTIPLE SCLEROSIS

Progressive forms of multiple sclerosis (MS) present significant therapeutic challenges, underscoring the pressing need for effective treatments in this domain. While relapsing-remitting MS (RRMS) transitions to secondary progressive MS (SPMS) for many patients, others experience primary progressive MS (PPMS) from the diseases onset. Despite similarities in pathophysiology and clinical progression between SPMS and PPMS, treatment options remain limited. The recent approval of ocrelizumab for PPMS marks a notable advancement, though its efficacy is modest. This retrospective study, conducted at the Neurology Department of Mohammed VI University Hospital, evaluates the tolerance and therapeutic efficacy of various treatments in progressive MS. Nineteen patient records spanning six years were analyzed, with therapeutic interventions including Fingolimod, Rituximab, cyclophosphamide-solumedrol, and ocrelizumab. Assessments utilizing the Expanded Disability Status Scale (EDSS) revealed stabilization or improvement in 15.7% of secondary progressive MS and 21% of primary progressive MS patients after 12 months of treatment. The duration of the progressive phase emerged as a key predictor of therapeutic response. Despite the approval of ocrelizumab in Morocco for PPMS, its utilization remains limited, suggesting the need for targeted studies focusing on early-stage clinical progression. Overall, this study underscores the unmet need for effective treatments in progressive MS and highlights ongoing research efforts aimed at addressing this challenge.

Advanced Cardiac Patches for the Treatment of Myocardial Infarction.

Myocardial infarction is a cardiovascular disease characterized by a high incidence rate and mortality. It leads to various cardiac pathophysiological changes, including ischemia/reperfusion injury, inflammation, fibrosis, and ventricular remodeling, which ultimately result in heart failure and pose a significant threat to global health. Although clinical reperfusion therapies and conventional pharmacological interventions improve emergency survival rates and short-term prognoses, they are still limited in providing long-lasting improvements in cardiac function or reversing pathological progression. Recently, cardiac patches have gained considerable attention as a promising therapy for myocardial infarction. These patches consist of scaffolds or loaded therapeutic agents that provide mechanical reinforcement, synchronous electrical conduction, and localized delivery within the infarct zone to promote cardiac restoration. This review elucidates the pathophysiological progression from myocardial infarction to heart failure, highlighting therapeutic targets and various cardiac patches. The review considers the primary scaffold materials, including synthetic, natural, and conductive materials, and the prevalent fabrication techniques and optimal properties of the patch, as well as advanced delivery strategies. Last, the current limitations and prospects of cardiac patch research are considered, with the goal of shedding light on innovative products poised for clinical application.

Unveiling the role of copper metabolism and STEAP2 in idiopathic pulmonary fibrosis molecular landscape.

Idiopathic pulmonary fibrosis (IPF) is a debilitating interstitial lung disease characterized by progressive fibrosis and poor prognosis. Despite advancements in treatment, the pathophysiological mechanisms of IPF remain elusive. Herein, we conducted an integrated bioinformatics analysis combining clinical data and carried out experimental validations to unveil the intricate molecular mechanism of IPF. Leveraging three IPF datasets, we identified 817 upregulated and 560 downregulated differentially expressed genes (DEGs). Of these, 14 DEGs associated with copper metabolism were identified, shedding light on the potential involvement of disrupted copper metabolism in IPF progression. Immune infiltration analysis revealed dysregulated immune cell infiltration in IPF, with a notable correlation between copper metabolism-related genes and immune cells. Weighted gene co-expression network analysis (WGCNA) identified a central module correlated with IPF-associated genes, among which STEAP2 emerged as a key hub gene. Subsequent invivo and invitro studies confirmed the upregulation of STEAP2 in IPF model. Knockdown of STEAP2 using siRNA alleviated fibrosis invitro, suggesting potential pathway related to copper metabolism in the pathophysiological progression of IPF. Our study established a novel link between immune cell infiltration and dysregulated copper metabolism. The revelation of intracellular copper overload and upregulated STEAP2 unravelled a potential therapeutic option. These findings offer valuable insights for future research and therapeutic interventions targeting STEAP2 and associated pathways in IPF.

Identification of key genes affecting ventilator-induced diaphragmatic dysfunction in diabetic mice.

Mechanical ventilation (MV) is often required in critically ill patients. However, prolonged mechanical ventilation can lead to Ventilator-induced diaphragmatic dysfunction (VIDD), resulting in difficulty in extubation after tracheal intubation, prolonged ICU stay, and increased mortality. At present, the incidence of diabetes is high in the world, and the prognosis of diabetic patients with mechanical ventilation is generally poor. Therefore, the role of diabetes in the development of VIDD needs to be discovered. MV modeling was performed on C57 mice and DB mice, and the control group was set up in each group. After 12h of mechanical ventilation, the muscle strength of the diaphragm was measured, and the muscle fiber immunofluorescence staining was used to verify the successful establishment of the MV model. RNA sequencing (RNA-seq) method was used to detect mRNA expression levels of the diaphragms of each group, and then differential expressed gene analysis, Heatmap analysis, WGCNA analysis, Venn analysis, GO and KEGG enrichment analysis were performed. qRT-PCR was used to verify the expression of the selected mRNAs. Our results showed that, compared with C57 control mice, the muscle strength and muscle fiber cross-sectional area of mice after mechanical ventilation decreased, and DB mice showed more obvious in this respect. RNA-seq showed that these differential expressed (DE) mRNAs were mainly related to genes such as extracellular matrix, collagen, elastic fiber and Fbxo32. GO and KEGG enrichment analysis showed that the signaling pathways associated with diabetes were mainly as follows: extracellular matrix (ECM), protein digestion and absorption, PI3K-Akt signaling pathway, calcium signaling pathway, MAPK signaling pathway and AGE-RAGE signaling pathway in diabetic complications, etc. ECM has the closest relationship with VIDD in diabetic mice. The key genes determined by WGCNA and Venn analysis were validated by quantitative real-time polymerase chain reaction (qRT-PCR), which exhibited trends similar to those observed by RNA-seq. VIDD can be aggravated in diabetic environment. This study provides new evidence for mRNA changes after mechanical ventilation in diabetic mice, suggesting that ECM and collagen may play an important role in the pathophysiological mechanism and progression of VIDD in diabetic mice, and provides some clues for the research, diagnosis, and treatment of VIDD in diabetic context.

Therapeutic Interventions for Diabetes Mellitus-Associated Complications.

Diabetes Mellitus (DM) is an alarming health concern, affecting approximately 537 million people worldwide. As a leading cause of morbidity and mortality, DM demands a comprehensive understanding of its diverse pathophysiological mechanisms and disease progression. This traditional review has consolidated literature on the pathogenesis of hyperglycemia, its progression into complications, and advances in optimal treatment strategies. The literature in the last two decades has been reviewed using several keywords, including "diabetes," "diabetes-associated complications", "novel therapeutic interventions for diabetes-associated diseases", "phyto-extracts as antidiabetic drugs", etc. in prominent databases, such as PubMed, Scopus, Google Scholar, Web of Science, and ClinicalTrials.gov. We have discussed macrovascular and microvascular complications, such as atherosclerosis, cardiovascular disease, Peripheral Arterial Disease (PAD), stroke, diabetic nephropathy, retinopathy, and neuropathy, as well as various pharmacological and non-pharmacological interventions that are currently available for the management of DM. We have also focused on the potential of natural products in targeting molecular mechanisms involved in carbohydrate metabolism, insulin production, repair of pancreatic cells, and reduction of oxidative stress, thereby contributing to their antidiabetic activity. Additionally, novel therapeutic approaches, like genetic, stem cell, and immunomodulatory therapies, have been explored. We have also discussed the benefits and limitations of each intervention, emerging research and technologies, and precision medicine interventions. This review has emphasized the need for an improved understanding of these advancements, which is essential to enhance clinicians' ability to identify the most effective therapeutic interventions.

Physiopathological Mechanisms of Type 1 Cardiorenal Syndrome Induced by Acute Myocardial Infarction

Objectives: Cardiovascular diseases are the leading global cause of mortality. Approximately 20 to 31% of acute myocardial infarction (AMI) cases progress to renal dysfunction, indicating concurrent cardiac and renal alterations, characterizing Cardiorenal Syndrome Type 1 (CS1). Therefore, this study evaluates the CS1 onset and progression three days after AMI by examining renal and cardiac function and their inflammatory responses. The study hypothesizes that inflammatory mediators are a key component contributing significantly to the onset and progression of CS1 pathophysiology. Methods: Male Sprague-Dawley rats (250-300g) were divided into AMI-SHAM (undergoing sham surgery for AMI) and AMI (left coronary artery ligation) groups. Samples were collected three days post-AMI from blood, urine, heart, and renal tissues. Assessments included osmolality (plasma and urine), creatinine (plasma and urine), glomerular filtration rate (GFR), and tissue cytokine levels. Left ventricular end-diastolic pressure (LVEDP) represented cardiac function. Results are presented as mean ± standard error. Results: LVEDP measurements (mmHg) demonstrated similar results from SHAM (5.89 ± 0.61, n=14) and AMI groups (6.38 ± 0.43, n=6). Tumor Necrosis Factor-Alpha (TNF-α) levels (pg/mg of tissue) from the heart [SHAM (2.74 ± 0.50, n=10) vs AMI (5.05 ± 0.83, n=8)] and renal tissue [SHAM (2.37 ± 0.69, n=7) vs AMI (5.53 ± 0.41, n=5)] were significantly different (p&lt;0.05) concerning their respective groups. Of note, molecular biochemical analyses revealed similar results. Plasma Osmolality (kgH2O): SHAM (310.8 ± 5, n=13) vs AMI (310.4 ± 2.57, n=10); Urinary Osmolality: SHAM (1653 ± 140, n=14) vs AMI (2054 ± 166.9, n=9); Plasma Creatinine (mg/dL): SHAM (0.35 ± 0.21, n=14) vs AMI (0.39 ± 0.25, n=10); Urinary Creatinine: SHAM (118.9 ± 12.35, n=14) vs AMI (126.5 ± 18.90, n=10). GFR (mL/min/100g) was also similar: SHAM (1.22 ± 0.18, n=14) vs AMI (1.22 ± 0.12, n=9). Conclusions: The study shows that the increase of TNF-α is contributing to the onset and progression of the pathophysiology of CS1, in line with the original hypothesis. On the other hand, because the three-day post-surgery timeframe addressed the primary mechanisms triggering the CS1, it seems that the functional impairment of the heart and kidneys was not manifest yet. Support or Funding Information: FAPESP Process 2020/06043-7. CNPq Processes 306994/21-6 and 423999/21-4; FAEPA; CAPES/PROEX. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Interleukin-6/Glycoprotein130 Signaling Inhibition Ameliorates Renal Mitochondrial Dysfunction And Associated Renal Injury In Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and polycystic ovaries. Renal injury, increased central adiposity, and chronic low-grade systemic inflammation are common characteristics of PCOS. Renal inflammation can induce mitochondrial dysfunction, which plays a pivotal role in renal pathophysiology and chronic kidney disease progression. Interleukin-6 (IL-6) is a key inflammatory cytokine that is involved in renal injury progression by activating its soluble receptor (sIL-6R) and a membrane-bound glycoprotein130 (gp130). Serum IL-6 levels are elevated in women with PCOS; however, its role in inducing renal mitochondrial dysfunction and consequently PCOS-mediated renal injury is unknown. Therefore, we aimed to test the hypothesis that hyperandrogenemia increases systemic and renal IL-6 levels, leading to the activation of IL-6/gp130 signaling, which in turn triggers intrarenal mitochondrial dysfunction and renal injury in a well-characterized mouse model of PCOS. Methods: Three-week-old peripubertal female mice were implanted with Silastic tubes filled with the non-aromatizable androgen dihydrotestosterone (DHT, 8 mg) or vehicle for 12 weeks. Eight weeks post-Silastic tubes implantation, the animals were treated with the IL-6/gp130 signaling inhibitor SC144 (10 mg/kg, SC, 3x/week) or its vehicle for 4 weeks. Body weight (gravimetry), fat mass (EchoMRI), kidney weight (gravimetry), serum IL-6 (Bioplex), glomerular filtration rate (GFR, transcutaneous fluorescence), as well as the renal injury markers urinary albumin to creatinine ratio (UACR, clinical chemistry analyzer), and NGAL (ELISA) were assessed. Renal gp130 protein and IL-6 mRNA expression were quantified by Western blot and RT-qPCR, respectively. The mitochondrial markers cytochrome C, succinate dehydrogenase A (SDHA), the mitochondrial stress protein HSP60, and voltage-dependent anion channel (VDAC) were assessed in the renal tissue by Western blot. H&amp;E stained renal sections were used for histopathological analysis. Freshly isolated kidney mitochondria were used to measure mitochondrial reactive oxygen species (mtROS) by Amplex Red assay. Moreover, mitochondrial complex I and complex II-driven respiration along with complex IV activity were assessed using Oroboros Fluorespirometer. Results: DHT significantly (p&lt;0.05) increased body weight (26.2±0.9 vs. 22.23±0.4 g), fat mass (3.2±0.4 vs. 1.9±0.4 g), kidney weight (365.6 ± 13.1 vs. 257.1 ± 3.7 mg), UACR (1,227±420 vs. 404±169 μg albumin/mg creatinine), urinary NGAL (2-fold), and serum IL-6 levels (2.2-fold). Additionally, DHT increased the expression of renal gp130 and IL-6 (1.5-fold) and decreased GFR (1067.2 ± 59.9 vs. 1335.6 ± 60.3 uL/min/100g body weight). Moreover, cytochrome c levels in PCOS mice were significantly lower (32%), while HSP60 levels were higher (4-fold). The latter changes were associated with higher mtROS generation (2-fold), as well as lower complexes I, II, III, and IV respiration (43-71%). PCOS mice also showed a worsen renal histological structure with congested glomeruli, exfoliation of luminal epithelial lining, and interstitial hemorrhage. SC144 therapy had no effect on kidney weight or GFR; however, it abolished DHT-induced increases in body weight and fat mass. Excitingly, SC144 treatment normalized the levels of UACR, and decreased both glomerular and tubular injury in PCOS mice. It also decreased renal HSP60 levels and mtROS generation and increased complex IV derived respiration. Conclusion and significance: Our findings suggest that IL-6/gp130 activation plays a significant role in renal outcomes in PCOS. Targeting IL-6 signaling could be a novel therapeutic approach to ameliorate renal injury in PCOS women. Supported by NIH grants NIGMS P20GM121334 to KSE, LLYC, and DGR; NIH-NIGMS P30GM149404 to SR. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Dim light at night shifts microglia to a pro-inflammatory state after cerebral ischemia, altering stroke outcome in mice

Circadian rhythms are endogenous biological cycles that regulate physiology and behavior and are set to precisely 24-h by light exposure. Light at night (LAN) dysregulates physiology and function including immune response; a critical component that contributes to stroke pathophysiological progression of neuronal injury and may impair recovery from injury. The goal of this study is to explore the effects of dim LAN (dLAN) in a murine model of ischemic stroke to assess how nighttime lighting from hospital settings can affect stroke outcome. Further, this study sought to identify mechanisms underlying pathophysiological changes to immune response after circadian disruption. Male and female adult Swiss Webster (CFW) mice were subjected to transient or permanent focal cerebral ischemia, then were subsequently placed into either dark night conditions (LD) or one night of dLAN (5 lx). 24 h post-stroke, sensorimotor impairments and infarct sizes were quantified. A single night of dLAN following MCAO increased infarct size and sensorimotor deficits across both sexes and reduced survival in males after 24 h. Flow cytometry was performed to assess microglial phenotypes after MCAO, and revealed that dLAN altered the percentage of microglia that express pro-inflammatory markers (MHC II+ and IL-6) and microglia that express CD206 and IL-10 that likely contributed to poor ischemic outcomes. Following these results, microglia were reduced in the brain using Plexxikon 5622 (PLX 5622) a CSFR1 inhibitor, then the mice received an MCAO and were exposed to LD or dLAN conditions for 24 h. Microglial depletion by PLX5622 resulted in infarct sizes that were comparable between lighting conditions. This study provides supporting evidence that environmental lighting exacerbates ischemic injury and post-stroke mortality by a biological mechanism that exposure to dLAN causes a fundamental shift of activated microglial phenotypes from beneficial to detrimental at an early time point after stroke, resulting in irreversible neuronal death.