Complex Disease Research Articles

Symptoms after Lyme disease: What's past is prologue.

Protracted fatigue and other symptoms can occur after Lyme disease and other infections, with numerous possible drivers. Studies on posttreatment Lyme disease have been inconclusive, with no confirmed biomarker emerging. Prolonged antibiotic therapy provides no benefit. Thus, a holistic approach toward understanding and treating this complex disease is necessary.

Abstract 4138690: A Case of Hypertrophic Cardimyopathy: Digenic Variants of Uncertain Significance Mutations in MHY7 and RYR2 Genes

Introduction: Hypertrophic Cardiomyopathy (HCM) is primarily a disease caused by mutations in single genes, but around 5% of HCM patients, exhibit 2 (digenic) or more (oligogenic) causal mutations in the same gene or in different genes. We present a case of familial HCM with variants of uncertain significance (VUS) mutations in the MYH7 and RYR2 genes, highlighting the complexity of genetic inheritance and its implications on disease severity. Case presentation: A 40-year-old male presented with a history of hypertension, HCM, and two prior myocardial infarctions. He had syncope, non-sustained ventricular tachycardia, and a family history of sudden cardiac death (SCD) in his maternal grandfather. A dual-chamber ICD was placed for primary prevention of SCD because of his high-risk profile. Echocardiography demonstrated normal LV size and function with moderate asymmetric septal hypertrophy. Cardiac MRI indicated diffuse asymmetric hypertrophy and a 10.9% LV myocardial scar burden. Left heart catheterization revealed normal coronary arteries with LVOT gradient up to 60 mmHg, consistent with HCM. Genetic testing revealed VUS in the MYH7 (c.1305G>A, p.Met435Ile) and RYR2 (c.10528C>A, p.Arg3510Ser) genes (Figure 1). Further family genetic testing confirmed these VUS mutations in multiple relatives (Figure 2). Discussion: The identification of VUS mutations in MYH7 and RYR2 genes in multiple family members highlights the complexity of genetic inheritance in HCM. These findings underscore the challenges in clinical interpretation and risk stratification, as the co-occurrence of mutations in different genes may have synergistic effects on disease severity and phenotype expression. Comprehensive genetic evaluation, including family studies, is crucial for understanding the clinical significance of these mutations and guiding personalized management strategies. Further research is needed to elucidate the impact of VUS mutations on the clinical outcomes of HCM patients.

USO DA BIOLOGIA MOLECULAR NA PRODUÇÃO DE NOVOS MEDICAMENTOS

INTRODUCTION: Molecular biology, by acting in the development of biotechnological drugs, such as Zidovudine and Sofosbuvir, offers significant innovations in modern pharmacology, providing more specific and effective therapies for complex diseases. These drugs, although promising, still face challenges related to high costs and limited accessibility. The field is constantly evolving, seeking to improve the specificity and sensitivity of therapies for better prognoses. GENERAL OBJECTIVE: To explore the applications of molecular biology in the production of new drugs and its impact on the creation of personalized treatments. METHODOLOGY: This work is a qualitative, exploratory bibliographic review, which analyzes 7 articles published between 2020 and 2024 on molecular biology correlated to drug development. The research used databases such as BVS, DrugBank, PubMed and others, applying rigorous criteria for their selection. RESULTS: This study analyzes the potential of molecular biology for the development of new drugs, highlighting techniques such as PCR, DNA sequencing and CRISPR/Cas9. A review highlights the importance of these approaches in personalizing therapies and identifying molecular targets, in addition to discussing the pharmacodynamics and pharmacokinetics of drugs. Advances in molecular pharmacology offer new opportunities for more targeted and specific treatments with several drugs in complex diseases. CONCLUSION: The integrative review highlighted the importance of molecular biology techniques, such as DNA sequencing, PCR and CRISPR/Cas9, in drug development and personalized medicine, demonstrating their effectiveness in the treatment of genetic and infectious diseases. It is urgent to carry out new studies to explore the interactions of these technologies and their clinical applications, evolving towards better pharmacological treatments.

Emerging Role of Ubiquitin Proteasome System and Autophagy in Pediatric Demyelinating Leukodystrophies and Therapeutic Opportunity

Leukodystrophies represent a heterogeneous group of disorders characterized by specific genetic mutations, metabolic abnormalities, and degeneration of white matter in the central nervous system. These disorders are classified into several categories, with X-linked adrenoleukodystrophy (X-ALD), metachromatic leukodystrophy (MLD), and globoid cell leukodystrophy (GLD) being the most prevalent demyelinating leukodystrophies in pediatric populations. Maintaining proteostasis, which is critical for normal cellular function, relies fundamentally on the ubiquitin–proteasome system (UPS) and autophagy for the degradation of misfolded and damaged proteins. Compelling evidence has highlighted the critical roles of UPS and autophagy dysfunction in the pathogenesis of neurodegenerative diseases. Given the complex and poorly understood pathomechanisms underlying demyelinating leukodystrophies, coupled with the pressing need for effective therapeutic strategies, this review aims to systemically analyze the molecular and pathological evidence linking UPS and autophagy dysfunction to demyelinating leukodystrophies, specifically X-ALD and GLD. Furthermore, we will assess the therapeutic potential of autophagy modulators in the management of X-ALD and GLD, with the objective to inspire further research into therapeutic approaches that target autophagy and UPS pathways. Novel therapies that enhance autophagy and UPS function hold promise as complementary regimens in combination therapies aimed at achieving comprehensive correction of the pathogenic mechanisms in demyelinating leukodystrophies.

Frexalimab(SAR441344) as a potential multi-autoimmune disorder tackling mAB targeting the CD40-CD40L pathway undergoing clinical trials: A Review

Autoimmune disorders exhibit intricate pathology. Their mechanisms are complex, which attenuates the need for novel therapeutic interventions. Frexalimab, a potent monoclonal antibody targeting the dysregulated CD40-CD40L pathway, stands out as a formidable weapon against the assault of inflammation and tissue devastation. Diverse electronic databases were searched using relevant keywords to extract data on the role of Frexalimab in combating various autoimmune diseases. This review highlights Frexalimab’s efficacy in improving various disability indicators of relapsing multiple sclerosis (RMS), alleviating fatigue in primary Sjögren’s syndrome (PSJS), and improving glycemic control in diabetic patients. Across multiple trials, its favorable safety profile has proven its superiority over first-generation drugs in minimizing side effects. Indeed, Frexalimab has become a harbinger of hope in the fight against autoimmune diseases and has pioneered a unique and unchallenging way for tackling complex autoimmune diseases in the clinical realm, however, further large-scale trials are needed to establish its therapeutic benefits across different autoimmune conditions.

Type 2 diabetes pathway-specific polygenic risk scores elucidate heterogeneity in clinical presentation, disease progression and diabetic complications in 18,217 Chinese individuals with type 2 diabetes.

Type 2 diabetes is a complex and heterogeneous disease and the aetiological components underlying the heterogeneity remain unclear in the Chinese and East Asian population. Therefore, we aimed to investigate whether specific pathophysiological pathways drive the clinical heterogeneity in type 2 diabetes. We employed newly developed type 2 diabetes hard-clustering and soft-clustering pathway-specific polygenic risk scores (psPRSs) to characterise individual genetic susceptibility to pathophysiological pathways implicated in type 2 diabetes in 18,217 Chinese patients from Hong Kong. The 'total' type 2 diabetes polygenic risk score (PRS) was summed by genome-wide significant type 2 diabetes signals (n=1289). We examined the associations between psPRSs and cardiometabolic profile, age of onset, two glycaemic deterioration outcomes (clinical requirement of insulin treatment, defined by two consecutive HbA1c values ≥69 mmol/mol [8.5%] more than 3 months apart during treatment with two or more oral glucose-lowering drugs, and insulin initiation), three renal (albuminuria, end-stage renal disease and chronic kidney disease) outcomes and five cardiovascular outcomes. Although most psPRSs and total type 2 diabetes PRS were associated with an earlier and younger onset of type 2 diabetes, the psPRSs showed distinct associations with clinical outcomes. In particular, individuals with normal weight showed higher psPRSs for beta cell dysfunction and lipodystrophy than those who were overweight. The psPRSs for obesity were associated with faster progression to clinical requirement of insulin treatment (adjusted HR [95% CI] 1.09 [1.05, 1.13], p<0.0001), end-stage renal disease (1.10 [1.04, 1.16], p=0.0007) and CVD (1.10 [1.05, 1.16], p<0.0001) while the psPRSs for beta cell dysfunction were associated with reduced incident end-stage renal disease (0.90 [0.85, 0.95], p=0.0001) and heart failure (0.83 [0.73, 0.93], p=0.0011). Major findings remained significant after adjusting for a set of clinical variables. Beta cell dysfunction and lipodystrophy could be the driving pathological pathways in type 2 diabetes in individuals with normal weight. Genetic risks of beta cell dysfunction and obesity represent two major genetic drivers of type 2 diabetes heterogeneity in disease progression and diabetic complications, which are shared across ancestry groups. Type 2 diabetes psPRSs may help inform patient stratification according to aetiology and guide precision diabetes care.

Abstract 4137829: Comprehensive Single-Cell Atlas of the Human Lung in Pulmonary Arterial Hypertension

Introduction: Pulmonary arterial hypertension (PAH) is a complex cardiopulmonary disease characterized by progressive vascular remodeling. Although various immune and vascular cell populations have been implicated in the pathobiology of PAH, a comprehensive assessment of the various cell types in human PAH lungs is still lacking. Methods: Single-nucleus RNA sequencing was performed on lung samples from the Pulmonary Hypertension Breakthrough Initiative using the 10x Genomics Chromium Fixed RNA Profiling workflow. Rigorous quality control measures were implemented, including the detection and removal of ambient RNA using CellBender and doublets using scDblFinder. Data normalization and dimensionality reduction were performed using Seurat, and alignment by sample and sequencing batch was conducted using Harmony. Cells were annotated by mapping onto the Human Lung Cell Atlas using Azimuth. Differential gene expression analysis was conducted using a robust pseudobulk approach with edgeR to limit false positive findings. Gene set enrichment analysis was performed using the Hallmark pathways. Results: Lung samples from a total of 67 individuals were profiled, including 42 PAH and 25 age- and sex-matched control lungs. After quality control filtering, over 800,000 cells were captured, with a median of 12,000 cells per sample. Clustering uncovered over 30 cell types, representing endothelial, stromal, immune, and epithelial lineages of the lung. A median of 2,500 transcripts and 1,500 genes were detected per cell. Differentially expressed genes between PAH and control were detected in all major cell populations (FDR &lt; 0.05). Comparative analysis across all cell types revealed interferon response in monocyte subpopulations and endothelial-to-mesenchymal transition in endothelial subpopulations as top upregulated pathways. Conclusion: Comprehensive single-nucleus profiling of human lungs in PAH revealed extensive gene and pathway dysregulation across diverse cell types. This rich dataset provides a valuable resource for the research community, offering opportunities to advance and refine our understanding of the cellular pathobiology of PAH.

Abstract 4112869: Development of a Sitosterolemia Risk Prediction Scale (SRPS): A Screening Tool

Introduction: Sitosterolemia, a hereditary disorder marked by elevated plant sterol levels, presents diagnostic challenges due to its similarity to other lipid disorders. The development of the Sitosterolemia Risk Prediction Scale (SRPS) aims to address this by synthesising genetic, clinical, and dietary data into a coherent risk assessment model. Research Question: We propose that a structured risk scale, integrating diverse factors known to affect sitosterolemia, can significantly improve the accuracy of predicting the disorder. The SRPS is hypothesised to facilitate early detection and inform targeted interventions. Aim: The primary aim is to conceptualise and outline the SRPS, which categorises individuals into risk categories based on a point system reflecting genetic predispositions, clinical symptoms, dietary habits, and response to treatments. This scale seeks to enhance the clinical identification of sitosterolemia, promoting timely and personalised management strategies. Methods: A detailed table was generated to present the SRPS, categorising risk factors into genetic, clinical, dietary, and response to treatment. This innovative method allowed for the efficient synthesis and visualisation of complex data. Results: The SRPS table methodically organizes risk factors into low (0-2 points), moderate (3-5 points), and high (6+ points) categories. This stratification guides further diagnostic actions, ranging from exploring alternative causes of hyperlipidemia to necessitating comprehensive genetic and lipid analyses. Conclusion: The SRPS represents an innovative framework for assessing sitosterolemia risk, highlighting the potential benefits of integrating genetic, clinical, and dietary information. It further underscores the importance of a multifactorial approach in the early detection and management of sitosterolemia.

Anxiety, memory, and social impairments in the YAC128 mouse model of Huntington’s disease

Background Huntington’s disease (HD) is an autosomal dominant hereditary disorder, caused by an expansion of polyglutamine in the huntingtin protein. HD is characterized by a progressive decline in motor functions. This decline includes involuntary movements (chorea) and the worsening of controlled motions caused mainly by neuronal dysfunction in the striatum. In addition to the deterioration of motor symptoms, HD patients also suffer from cognitive changes, mood swings, apathy, depression, outbursts of anger, psychosis, and social withdrawal. Objective A comprehensive examination of cognitive, affective, and social changes in the HD mouse model is required for the development of combined therapy for both motor and non-motor deficits in HD. Methods The behavioral tests for anxiety, memory, and social traits were used in this study. Results YAC128 HD transgenic mice exhibited anxiolytic behavior in the novel brightly illuminated environment of the open field and light-dark place preference tests. Moreover, YAC128 HD mice also suffered from a decline in their recognition memory during the novel object recognition test. YAC128 HD mice demonstrated reduced exploration interest during the open field with a non-social target as well as during the first day of the three-chamber social test. Social interaction was also impaired in YAC128 HD mice as it was shown in the social interaction with resident intruder test. Conclusions YAC128 HD mouse model may be used as a model system to test the possible treatments for both motor and non-motor symptoms including memory loss, agitation and social withdrawal.

Abstract 4137846: Smooth muscle expression of RNA editing enzyme ADAR1 controls vascular integrity and progression of atherosclerosis

Mapping the genomic architecture of complex disease has been predicated on the understanding that genetic variants influence disease risk through modifying gene expression. However, recent discoveries have revealed that a significant burden of disease heritability in common autoinflammatory disorders and coronary artery disease is mediated through genetic variation modifying post-transcriptional modification of RNA through adenosine-to-inosine (A-to-I) RNA editing. This common RNA modification is catalyzed by ADAR enzymes, where ADAR1 edits specific immunogenic double stranded RNA (dsRNA) to prevent activation of the double strand RNA (dsRNA) sensor MDA5 ( IFIH1 ) and stimulation of an interferon stimulated gene (ISG) response. Multiple lines of human genetic data indicate impaired RNA editing and increased dsRNA sensing to be an important mechanism of coronary artery disease (CAD) risk. Here, we provide a crucial link between observations in human genetics and mechanistic cell biology leading to progression of CAD. Through analysis of human atherosclerotic plaque, we implicate the vascular smooth muscle cell (SMC) to have a unique requirement for RNA editing, and that ISG induction occurs in SMC phenotypic modulation, implicating MDA5 activation. Through culture of human coronary artery SMCs, generation of a conditional SMC specific Adar1 deletion mouse model on a pro-atherosclerosis background, and with incorporation of single cell RNA sequencing cellular profiling, we further show that Adar1 controls SMC phenotypic state, is required to maintain vascular integrity, and controls progression of atherosclerosis and vascular calcification. Our data implicates MDA5 activation to occur in SMC phenotypic modulation and accelerates formation of chondromyocytes in a distinct cellular lineage trajectory — indicating a cell type and context specific requirement of RNA editing. Through this work, we describe a fundamental new mechanism of CAD, where RNA editing and sensing of dsRNA in a cell type and context specific mechanism mediates disease progression, bridging our understanding of human genetics and disease causality.

Abstract 4125887: Aladyn Individual: Dynamic Individual Comorbidity Modeling for Genomic Discovery and Clinical Prediction

Intro: Considering comorbidity patterns for both discovery and prediction of individual disease trajectories is essential for personalized medicine. Existing methods often lack genetic integration and interpretability. We develop an approach suited for dynamic environments that combines genetics with individual and population level-trajectories for enhanced discovery and prediction. Method: Our method employs a dynamic Bayesian hierarchical latent allocation framework to learn and predict disease trajectories. Leveraging longitudinal electronic health care data from 485,698 UK Biobank participants and 287,012 All of Us Research Program participants, we aim to learn individual and population level disease trajectories for 352 distinct conditions. Genetic risks inform the model in two fundamental ways: First, we introduce a genetic warping parameter that recognizes the tendency of an individual to experience events earlier or later within these profiles while retaining the relative order of progression (1a). Second, we introduce a gaussian process to combine individual and population level trends in comorbidity profile prevalence over time (1b), whose mean is augmented by genetic predilection. Finally, we allow for profile weights to update with each new diagnoses, merging prediction and classification. Results: Our results indicate stark disparities in disease progression; individuals at high genetic risk for myocardial infarction experience events nearly a decade earlier than those at low risk (median age of onset 53.7 [53.1-53.9] vs 62.6 years [61.4-63.1]) (1b). Our model dynamically updates and predicts correct diagnoses 79.5% more frequently than existing topic-modeling approaches (1c,d). The dynamic approach adjusts disease profiles by at least 11.7% annually for 50% of individuals, with 65% experiencing over a 10% change in comorbidity profiles. Simulation results confirm the model's superior accuracy [51.4-41%], precision [50.9 vs 39.9%], and recall [48.4 vs 39.2%] compared to fixed-weight approaches. Summary: We offer a novel approach for integrating genetic risk with dynamic modeling of complex disease profiles for joint biologic discovery and personalized clinical prediction over the lifetime.

Abstract 4125893: Deciphering the Mechanism of Action of Drug Combinations by Boolean Modeling of Transcriptomes: a Case Study of Atorvastatin/Simvastatin and Ezetimibe

Introduction: Drug combinations offer increased therapeutic efficacy and reduced toxicity and plays a vital role in treating chronic complex diseases. Understanding a drug combination's mechanism of action (MoA) can provide important insights into its therapeutic efficacy. The MoA of many FDA-approved drugs, however, often remains unclear. Methods: In this study, we investigated the combination of a statin [atorvastatin (ATO) or simvastatin (SIM) plus ezetimibe (EZE)] and utilized drug-treated RNA-seq transcriptome data from SOAT2-only-HepG2 cells (treated with ATO 5 umol/L, EZE, 25 umol/L, their combination or vehicle) and from liver biopsies of patients with uncomplicated cholesterol gallstone disease in the Stockholm Study (a single-blind, randomized trial with SIM 80 mg daily, EZE 10 mg daily, their combination, or placebo) to decipher the underlying molecular mechanisms of the drug combination. We proposed a Boolean logical modeling framework to simulate the MoA of a drug combination. Specifically, fourteen two-variable Boolean models were used to describe the combinatory relationships of ATO/SIM and EZE. Thereafter, a pattern matching approach was applied to associate drug-induced differentially expressed genes with the idealized differential expression templates derived from Boolean models. Results: We found 1,560 and 594 genes differentially expressed in at least one treatment condition in SOAT2-only-HepG2 cells and liver biopsies, respectively. Our analysis revealed both expected and novel combinatorial modes of ATO/SIM and EZE. For example, ATO independently activates downstream genes (i.e. B 4 (ATO,EZE)=ATO), and ATO and EZE synergistically inhibits downstream genes (i.e. B 15 (ATO,EZE)=NOT (ATO AND EZE)) , as the two most prevalent MoAs in SOAT2-only-HepG2 cells (Figure 1). Similarly, the combination of SIM and EZE synergistically inhibiting downstream genes was also the most prevalent MoA in the liver biopsies. We mapped the downstream genes of each combinatorial mode to the human interactome and obtained underlying subnetworks, which are important for understanding the therapeutic effects of the drug combination. Functional enrichment and disease-association analyses of the downstream suggest the additional therapeutic indications of the drugs. Conclusion: Drug-induced transcriptomes are informative in deciphering the MoA of drug combinations using Boolean logical modeling. This framework can be easily extended to the combinations of three drugs.

WebTWAS 2.0: update platform for identifying complex disease susceptibility genes through transcriptome-wide association study.

Transcriptome-wide association study (TWAS) has successfully identified numerous complex disease susceptibility genes in the post-genome-wide association study (GWAS) era. Over the past 3 years, the focus of TWAS algorithms has shifted from merely identifying associations to understanding how single nucleotide polymorphisms(SNPs)regulate gene expression, with a growing emphasis on incorporating fine-mapping techniques. Additionally, the rapid increase in GWAS summary statistics, driven largely by the UK Biobank and other consortia, has made it essential to update our webTWAS resource. To address these challenges and meet the growing needs of researchers, we developed webTWAS 2.0, an updated platform for identifying susceptibility genes for human complex diseases using TWAS. Additionally, webTWAS 2.0 provides an online TWAS analysis tool that simplifies conducting TWAS analyses. The updated resource includes 7247 GWAS summary statistics covering 1588 complex human diseases from 192 publications. It also incorporates multiple TWAS methods, such as sTF-TWAS, 3'aTWAS and GIFT, along with an updated interactive visualization tool that allows users to easily explore significant associations across different methods. Other upgrades include a personalized online analysis tool for user-submitted GWAS data and a refined search function that makes it easier to identify relevant associations and meet diverse user needs more efficiently. webTWAS 2.0 is freely accessible at http://www.webtwas.net.

EPID-07. MAJOR CONGENITAL ANOMALIES AND RISK OF CHILDHOOD BRAIN TUMORS IN 9 STATES

Abstract Children with congenital anomalies have a higher risk of developing a childhood brain tumor (CBT), but it remains unclear if associations vary by cancer histology, which could inform our understanding of these associations. Thus, we characterized co-occurrences of major congenital anomalies with six CBTs. We leveraged a population-based registry linkage study of live births, congenital anomalies, and cancer from nine states. Dates of birth and last follow-up varied by state, ranging between January 1, 1990 to December 31, 2018, for a total of 22,599,099 live births. CBT classification was based on the International Classification of Childhood Cancer for children diagnosed up to age 18 years. Major congenital anomalies were classified based on the National Birth Defects Prevention Network Surveillance Guidelines. Children with any genetic anomalies were excluded. We used Cox regression to evaluate associations between major congenital anomalies and astrocytoma, medulloblastoma, ependymoma, atypical teratoid/rhabdoid tumor (ATRT), primitive neuroectodermal tumors (PNET), and mixed and unspecified gliomas (“mixed gliomas”), adjusting for sex, state, maternal education, maternal race/ethnicity, and maternal age. Sensitivity analyses were conducted stratifying by number of major anomalies (0, 1, 2+) and age at cancer diagnosis (&amp;lt;1, 1-4, 5-9, 10+ years). There were 5,685 diagnosed with any CBT. Having any major congenital anomaly was significantly associated with astrocytoma, ATRT, medulloblastoma, mixed glioma, and PNET (aHR range: 1.79-5.78) but not ependymoma. When stratified by number of major anomalies, effect estimates were similar. Due to small numbers when stratified by age at cancer diagnosis, unadjusted analyses were conducted. Associations were strongest in children diagnosed with astrocytoma, ATRT, medulloblastoma, mixed glioma, or PNET before age 1 (HR range: 3.03-5.47) compared to other age groups (HR range: 1.25-3.07). Children with any major congenital anomaly have an increased risk of developing astrocytoma, ATRT, medulloblastoma, mixed glioma, or PNET, particularly by 1 year.

Relationships Among the EmPHasis-10 Questionnaire, the Simplified Four-Strata Risk Assessment Tool, and Echocardiographic Parameters in Patients with Precapillary Pulmonary Hypertension

Background/Objectives: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are complex diseases that require precise diagnosis and management. The ESC risk score has been used in both conditions. We assessed the relationship between the EmPHasis-10 questionnaire (patient subjective evaluation) and objective assessment using endorsed tools (simplified four-strata risk assessment and right ventricular imaging by transthoracic echocardiography). Methods: The present study retrospectively extracted data from 40 adult patients (27 PAH and 13 CTEPH cases) diagnosed in a single center in Romania. The EmPHasis-10 questionnaire and the four-strata risk assessment (FSRA) tool were applied to each patient. Mean pulmonary artery pressure (mPAP), tricuspid annular plane systolic excursion (TAPSE), TAPSE/systolic pulmonary artery pressure (TAPSE/sPAP) ratio, and right ventricular outflow tract acceleration time (RVOT-AT) were assessed. Results: A significant correlation was observed between the EmPHasis-10 scores and the FSRA tool, the WHO functional class, and the 6 min walking distance. Emphasis-10 score did not correlate with any of the echocardiographic parameters. The FSRA tool showed a moderate positive correlation with mPAP (r = 0.42, p = 0.01) and a negative correlation with TAPSE (r = −0.46, p = 0.003); additionally, across the entire cohort, it was moderately negatively correlated with both RVOT-AT (r = −0.42, p = 0.01) and TAPSE/sPAP ratio (r = −0.43, p = 0.005). Conclusions: Our study evidenced the alignment between EmPHasis-10 scores and prognostic risk score, with poorer health-related quality of life corresponding to higher FSRA. The EmPHasis-10 questionnaire proves to be a valuable, easy-to-use instrument, offering meaningful insights into patients’ health-related quality of life, underscoring its utility in enhancing comprehensive patient assessment and management.

Diabetes and obesity: leveraging heterogeneity for precision medicine.

The increasing prevalence of diabetes, obesity, and their cardiometabolic sequelae present major global health challenges and highlight shortfalls of current approaches to the prevention and treatment of these conditions. Representing the largest global burden of morbidity and mortality, the pathobiological processes underlying cardiometabolic diseases are in principle preventable and, even when disease is manifest, sometimes reversable. Nevertheless, with current clinical and public health strategies, goals of widespread prevention and remission remain largely aspirational. Application of precision medicine approaches that reduce errors and improve accuracy in medical and health recommendations has potential to accelerate progress towards these goals. Precision medicine must also maintain safety and ideally be cost-effective, as well as being compatible with an individual's preferences, capabilities, and needs. Initial progress in precision medicine was made in the context of rare diseases, with much focus on pharmacogenetic studies, owing to the cause of these diseases often being attributable to highly penetrant single gene mutations. By contrast, most obesity and type 2 diabetes are heterogeneous in aetiology and clinical presentation, underpinned by complex interactions between genetic and non-genetic factors. The heterogeneity of these conditions can be leveraged for development of approaches for precision therapies. Adequate characterization of the heterogeneity in cardiometabolic disease necessitates diversity of and synthesis across data types and research methods, ideally culminating in precision trials and real-world application of precision medicine approaches. This State-of-the-Art Review provides an overview of the current state of the science of precision medicine, as well as outlining a roadmap for study designs that maximise opportunities and address challenges to clinical implementation of precision medicine approaches in obesity and diabetes.

Anti-Obesity Effects of Adzuki Bean Saponins in Improving Lipid Metabolism Through Reducing Oxidative Stress and Alleviating Mitochondrial Abnormality by Activating the PI3K/Akt/GSK3β/β-Catenin Signaling Pathway

Obesity is a chronic and complex disease defined by the excessive deposition of fat and is highly associated with oxidative stress. Adzuki bean saponins (ABS) showed anti-obesity activity in our previous in vivo study; however, the active saponins of adzuki beans and potential mechanisms are still unclear. This research aims to elucidate the anti-obesity effects of ABS in improving lipid metabolism and oxidative stress, exploring the effective ingredients and potential molecular mechanisms through UHPLC-QE-MS analysis, network pharmacology, bioinformatics, and in vitro experiments both in the 3T3-L1 cell line and HepG2 cell line. The results indicate that ABS can improve intracellular lipid accumulation, adipogenesis, oxidative stress, and mitochondrial damage caused by lipid accumulation including ROS generation, abnormal mitochondrial membrane potential, and ATP disorder. Fifteen saponin components were identified with the UHPLC-QE-MS analysis. The network pharmacology and bioinformatics analyses indicated that the PI3K/Akt signaling pathway is associated with the bioactive effect of ABS. Through Western blotting and immunofluorescence analysis, the anti-obesity effect of ABS is achieved through regulation of the PI3K/Akt/GSK3β/β-catenin signaling pathway and activation of downstream transcription factor c-Myc in the lipid accumulation cell model, and regulation of β-catenin signaling and inhibition of downstream transcription factor C/EBPα in the adipocyte cell model. These results illustrate the biological activity of ABS in improving fat metabolism and oxidative stress by restoring mitochondrial function through β-catenin signaling, the PI3K/Akt/GSK3β/β-catenin signaling pathway, laying the foundation for its further development.

Three Ophiostomatalean Fungi Associated with Bark Beetles from Pinus thunbergii Infested by Bursaphelenchus xylophilus in Laoshan Mountain (Shandong, China)

Pine wilt disease (PWD) is a devastating disease that occurs worldwide and affects conifers infested by the pine wood nematode (PWN, Bursaphelenchus xylophilus). PWD has caused serious economic and ecological losses in China. The mechanism of disease outbreak is complex, with the associated fungi, specifically ophiostomatoid fungi, thought to play an essential role. However, few ophiostomatoid fungal associates of PWD have been accurately identified. In the present study, we isolated fungi from bark beetles collected from Pinus thunbergii infested by the pine wood nematode on Laoshan Mountain, Shandong province. Three ophiostomatalean fungi were identified and assigned to Graphilbum and Ophiostoma based on phylogenetic analyses and comparison of morphological and cultural features, namely Gra. laoshanense sp. nov., Gra. translucens, and O. ips. This study increases the understanding of the diversity of ophiostomatoid fungi associated with PWD and provides resources for parsing this complex disease.

Polymer-drug conjugates: revolutionizing nanotheranostic agents for diagnosis and therapy.

Nanotheranostics, an amalgamation of therapeutic and diagnostic capabilities at the nanoscale, is revolutionizing personalized medicine. Polymer-drug conjugates (PDCs) stand at the forefront of this arena, offering a multifaceted approach to treat complex diseases such as cancer. This review explores the recent advancements in PDCs, highlighting their design principles, working mechanisms, and the therapeutic applications. We discuss the incorporation of imaging agents into PDCs that allow for real-time monitoring of drug delivery and treatment efficacy. With the aim of improving patient care, the review examines how PDCs enable targeted drug delivery, minimize side effects, and provide valuable diagnostic data, hence enhancing the precision of medical interventions. We also address the challenges facing the clinical translation of PDCs, such as scalability, regulatory hurdles, and cost-effectiveness, providing a comprehensive outlook on the future of nanotheranostics in patient management.

THE ROLE OF MITOCHONDRIAL DYSFUNCTION IN THE PATHOGENESIS AND TREATMENT OF INFLAMMATORY DISEASES IN THE ORAL CAVITY

Inflammatory diseases of the oral cavity (IOD) include many common diseases such as periodontitis and pulpitis. The main causes of IOD are microorganisms, trauma, occlusive factors, autoimmune diseases and radiation therapy. If not treated correctly, such diseases can not only affect oral health, but also pose a threat to people's overall health. Therefore, identifying IOD at an early stage and exploring new therapeutic strategies are important research goals related to oral therapy. Mitochondria are essential organelles for many cellular processes. Mitochondrial dysfunction not only affects cellular metabolism, but also indirectly affects people's health and life expectancy. Mitochondrial dysfunction is implicated in many common polygenic diseases, including cardiovascular and neurodegenerative diseases. Recently, increasing evidence suggests that mitochondrial dysfunction plays a critical role in the development and progression of IOD and associated systemic diseases. This review outlines critical insights into mitochondrial dysfunction and its role in inflammatory responses in IOD. The results of recent studies in the field of treatment of IOD, aimed at mitochondrial dysfunction, are presented, and the underlying mechanisms are also considered.