Search Results (8,089)

Background: Creatine deficiency syndromes (CDS) are rare neurometabolic disorders caused by defects in creatine biosynthesis (AGAT and GAMT deficiencies) or creatine transport (SLC6A8 deficiency). Early biochemical recognition is crucial for timely treatment of AGAT and GAMT deficiencies and for improving neurodevelopmental outcomes. In Morocco, expanding the liquid chromatography-tandem mass spectrometry (LC-MS/MS) biomarker panel for inherited metabolic disorders is a priority to strengthen diagnostic capacity and reduce diagnostic delay. Methods: We developed and validated a rapid LC-MS/MS method for the simultaneous quantification of creatine (Cr), guanidinoacetate (GAA), and creatinine (Crn) in plasma and urine using isotopically labelled internal standards and a standardized sample preparation procedure. Analytical performance, including linearity, precision, accuracy, sensitivity, matrix effects, carryover, inter-sample contamination, stability, and measurement uncertainty, was assessed in accordance with ISO 15189:2022 requirements. Results: The assay showed excellent linearity across the analytical range (r² > 0.99), with robust intra- and inter-day precision (CV < 10%). Limits of detection (LOD) were 0.05 µmol/L for Cr and 0.03 µmol/L for GAA in urine, and 0.05 µmol/L for Cr and GAA in plasma. The total run time was 1.1 min per sample, supporting high-throughput implementation. Method performance was further supported by satisfactory results in ERNDIM external quality assessment schemes. Preliminary internal reference ranges and expanded measurement uncertainty were calculated from the available anonymized dataset. Conclusions: This rapid LC-MS/MS method enables the measurement of key CDS biomarkers and contributes to expanding the LC-MS/MS biomarker panel for inherited metabolic disorders in Morocco. Full article

Background/Objectives: We aimed to evaluate the efficacy and safety of a short-term dietary intervention using trigonelline-rich Sakurajima radish on vascular endothelial function in patients with metabolic syndrome (MetS). Methods: In this multicenter, open-label, randomized, three-period crossover phase IIb trial, 21 patients with MetS were assigned to three 14-day sequences (Sakurajima radish powder, Aokubi radish powder, and a usual diet), separated by 14-day washouts. The primary outcome was flow-mediated dilation (FMD). Key Secondary outcomes included blood pressure (BP), urinary nitric oxide metabolites (NOx), and the oxidative stress marker 8-hydroxy-2′-deoxyguanosine (8-OHdG). Results: Sakurajima radish did not improve FMD versus the usual diet (p = 0.58) or Aokubi radish (p = 0.59), although a significant negative carryover effect following the Aokubi period likely confounded this estimation. Despite successfully stimulating NO production (elevated urinary NOx, p = 0.03), the intervention paradoxically increased oxidative stress (elevated 8-OHdG/creatinine, p = 0.02) and significantly elevated systolic BP compared with the usual diet (+9.67 mmHg, p = 0.03) and Aokubi radish (+8.86 mmHg, p = 0.04). Conclusions: Sakurajima radish does not appear to improve endothelial function in patients with MetS within the constraints of this short-term crossover design. Importantly, the unexpected negative carryover effect inherently limits the interpretability of this primary FMD outcome, as it may have masked potential physiological benefits. Despite boosting NO production, the intervention paradoxically exacerbated systemic oxidative stress and elevated systolic BP. These findings suggest that in the pro-oxidant environment of MetS, NO-boosting functional foods may induce unintended adverse hemodynamic responses, underscoring the need for careful risk–benefit evaluation and parallel-group trial designs in this specific population. Full article

Obesity is a growing public health concern linked to poor dietary habits, physical inactivity, and metabolic disturbances, which can be evaluated using complementary laboratory tests. Among pharmacological interventions, semaglutide, a GLP-1 receptor agonist, has shown promise by acting on the central nervous system to reduce appetite and stimulate insulin secretion, thereby improving the lipid profile and reducing inflammation biomarkers. This review focused on changes in lipid parameters and C-reactive protein (CRP) levels in overweight or obese individuals treated with semaglutide, based on phase 3 studies from the STEP program (“Semaglutide Treatment Effect in People with Obesity”). The STEP clinical trial program was conducted across 36 countries, reflecting a broad and diverse geographic representation. Key findings include significant reductions between placebo vs. semaglutide in body weight (−1.3 vs. −13.0 Kg), body mass index (−0.69 vs. −4.72 kg/m²), and waist circumference (−2.79 × −11.81 cm). Additionally, there were notable decreases in triglycerides (−0.67 vs. −20.89%), VLDL-C (−0.99 vs. 20.82%), and CRP levels (−15.45 vs. −55.55%). These changes reflect improvements in both inflammatory and metabolic markers. The observed benefits suggest that semaglutide may contribute to reducing comorbidities associated with metabolic syndrome and to the prevention of cardiovascular disease. Current evidence also supports its potential role in individualized treatment strategies based on patients’ clinical and biochemical profiles. However, despite these promising findings, further long-term studies are required to confirm the efficacy and safety of semaglutide across diverse populations. Full article

Background: Cancer-associated cachexia (CAC) is a multifactorial syndrome driven by a profound metabolic and inflammatory dysregulation. Due to the central role of the insulin-like growth factor 1 (IGF-1) pathway in regulating muscle mass, energy metabolism, and inflammation, this study evaluated the relevance of five IGF-1 axis-related single-nucleotide polymorphisms (SNPs), namely IGF1 rs6220, insulin-like growth factor 1 receptor (IGF1R) rs2016347 and rs2684788, growth hormone receptor (GHR) rs6873545, and insulin receptor substrate 1 (IRS1) rs1801278. Methods: The impact of these variants on CAC onset and overall survival (OS) was assessed in a cohort of 140 cancer patients. Results: While overall-cohort analyses did not reach statistical significance, exploratory analyses suggested potential associations between the IGF1 rs6220 GG and GHR rs6873545 CC genotypes and increased CAC risk in male patients. A trend for higher CAC prevalence was also noted in younger patients (<63 years) with the rs6873545 CC genotype. For pre-CAC and CAC patients, exploratory subgroup analyses on patients’ OS were conducted following no significant results in the overall cohort. Among older patients and those with high prognostic nutritional index (PNI; >44.2), the IGF1 rs6220 G allele was associated with longer OS. Conversely, the IGF1R rs2016347 G allele and rs2684788 T allele were linked to poorer OS across multiple pre-CAC and CAC subgroups. The effects of GHR rs6873545 varied across subgroups, suggesting context-dependent activity. Conclusions: This study highlights the functional heterogeneity of IGF-1 axis-related genetic variants, indicating potential to serve as predictors of CAC. Given the exploratory nature of these findings, validation in larger cohorts is required to confirm the associations found. Full article

Background/Objectives: Psoriasis is a chronic immune-mediated inflammatory disease increasingly recognized as a systemic disorder associated with significant metabolic and cardiovascular comorbidities. Among these, obesity (defined as BMI > 30 kg/m²) plays a pivotal role, acting both as a risk factor for psoriasis development and as a modifier of disease severity, clinical phenotype, and therapeutic response. The relationship between psoriasis and obesity is bidirectional and sustained by shared inflammatory and metabolic pathways. This review aims to provide a comprehensive and updated synthesis of the epidemiological association between psoriasis and obesity, to elucidate the underlying pathophysiological mechanisms, and to discuss the clinical and therapeutic implications of excess body weight in psoriasis management. Methods: A narrative review of the literature was conducted, including epidemiological studies, mechanistic research, clinical trials, and real-world evidence addressing the interplay between psoriasis and obesity. Relevant data were identified from peer-reviewed publications focusing on inflammatory pathways, metabolic dysfunction, cardiovascular risk, and treatment outcomes in obese patients with psoriasis. The graphical figures included in this manuscript were created with the assistance of a large language model–based image-generation tool, ChatGPT-5 by OpenAI, using author-defined prompts. The prompts requested schematic medical illustrations summarizing the pathophysiological links between obesity and psoriasis, including adipose tissue dysfunction, adipokine imbalance, systemic inflammation, and activation of the IL-23/Th17 axis. For the therapeutic algorithm, the prompt requested a stepwise clinical flowchart for obese patients with psoriasis, including BMI assessment, comorbidity screening, universal weight-management measures, psoriasis severity stratification, obesity-adapted biologic selection, and management of suboptimal response. The generated images were subsequently reviewed, edited, and approved by the authors to ensure scientific accuracy, clarity, and consistency with the manuscript content. Results: Epidemiological evidence consistently demonstrates a higher prevalence of obesity among patients with psoriasis, with obesity independently associated with increased disease severity. Shared mechanisms include adipose tissue–driven cytokine production, dysregulated adipokine secretion, insulin resistance, endothelial dysfunction, and activation of the IL-23/Th17 axis, collectively contributing to systemic inflammation and accelerated atherogenesis. Obesity negatively impacts the efficacy, pharmacokinetics, and long-term drug survival of conventional systemic agents and biologic therapies, leading to suboptimal clinical outcomes. Conclusions: Obesity is a key determinant of psoriasis burden, influencing disease expression, comorbidities, and therapeutic response. Integrating weight reduction strategies into personalized psoriasis management may improve both dermatological outcomes and overall cardiometabolic health, supporting a holistic approach to patient care. Full article

Background: Viral replication is a major factor in chronic hepatitis B (CHB). Still, the extent to which host metabolic dysfunction contributes to fibrosis risk remains unclear, particularly in studies that follow patients over time. Because most research relies solely on baseline assessments, it may overlook how metabolic changes and fibrosis interact as the disease progresses. Methods: We conducted a retrospective longitudinal cohort study of 304 adults with CHB using electronic medical records collected across 4 visits over 18 months. Repeated metabolic parameters and non-invasive fibrosis indices were examined using population-averaged and mixed-effects models. The associations we observed represent time-specific co-variation between exposures and outcomes measured at the same time point, rather than earlier predictors of later outcomes. Results: Across 1216 person-visits, 421 visit-level fibrosis risk events were recorded (34.6%). Incident clustered metabolic abnormalities occurred at a rate of 21.43 per 100 person-years. Among the metabolic syndrome components, insulin resistance showed the most consistent independent association with visit-level fibrosis risk status. In contrast, after adjustment, longitudinal trends in BMI, lipid measures, and transaminases did not independently distinguish patients with fibrotic progression. A practical clinical model based on age, AST, platelet count, and fasting glucose demonstrated moderate discrimination across risk strata (AUC = 0.772). Conclusions: In CHB, insulin resistance is consistently linked to visit-level fibrosis risk status. Longitudinal metabolic monitoring using routine clinical data provides a practical, scalable way to assess fibrosis risk, especially in resource-limited settings. These findings support incorporating time-based metabolic assessment into CHB care pathways alongside virological factors. Full article

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a global health priority affecting approximately 30% of the population. It represents the hepatic manifestation of metabolic syndrome, potentially progressing from simple steatosis to Metabolic Dysfunction-Associated Steatohepatitis (MASH), cirrhosis, and hepatocellular carcinoma. This review aims to compare current knowledge of MASLD in mouse models and humans, focusing on pathophysiology, histological phenotypes, and the role of preclinical imaging as a non-invasive translational screening tool. Methods: A literature search was conducted in PubMed and Web of Science to identify English-language publications from January 2020 to March 2026 on murine models and imaging techniques for MASLD, using pertinent keywords. Attention was given to highlighting similarities and differences between human and murine approaches. Results: MASLD arises from complex interactions between genetics, sedentary lifestyles, and imbalanced diets. While mouse models have been refined to capture the multifactorial interplay driving disease progression and are still essential for drug development, no single model fully mirrors the human condition. Histological assessment remains an essential tool for MASLD staging, in both humans and mouse models. However, imaging is increasingly emerging as an important complementary technique to non-invasively investigate MASLD. Conclusions: Mouse models are essential to address specific mechanistic and therapeutic questions, but understanding of their limitations and strengths is crucial for translational research. Integrating phenotype-driven approaches in both humans and mice, combining traditional histology, quantitative imaging, and metabolic profiling, as well as longitudinal, combined, and humanized preclinical models, will enhance translational alignment and accelerate the development of therapies for MASLD. Full article

Alterations in gastrointestinal function (digestion, absorption, motility, secretion, and elimination) play important roles in the pathophysiology of many gastrointestinal disorders. Food also strongly influences gastrointestinal health and disease. Some foods act as antigens that trigger an enteric immune response, while others can serve as substrates with direct or indirect biological effects. Food can also be metabolized by gut microbes into bioactive molecules that alter physiology. This review discusses the current research evidence and the clinical use of “food as medicine” through dietary therapies for the management of various gastrointestinal conditions, including disorders of gut–brain interaction, eosinophilic esophagitis, celiac disease, inflammatory bowel disease, gastroparesis, and short bowel syndrome with intestinal failure. Full article

Self-limited focal epilepsies in childhood (SELFEs), formerly referred to as “benign epilepsies in childhood”, constitute a heterogeneous group of epileptic conditions with onset predominantly in the neonatal, infantile, and childhood periods. A defining feature of these syndromes is that seizures arise without underlying structural, metabolic, or other demonstrable cerebral pathology, and the overall clinical trajectory is expected to be favorable, with seizures resolving spontaneously over time. Current nosological frameworks divide SELFEs into two broad categories according to age at onset: (a) neonatal and infantile forms, encompassing self-limited familial and non-familial neonatal, neonatal-infantile, and infantile epilepsies, genetic epilepsy with febrile seizures plus (GEFS+), and myoclonic epilepsy of infancy (MEI); and (b) childhood-onset forms, including self-limited epilepsy with centrotemporal spikes (SeLECTS), self-limited epilepsy with autonomic seizures (SeLEAS), childhood occipital visual epilepsy (COVE), and photosensitive occipital lobe epilepsy (POLE). Despite their historically “benign” label, there is no general agreement to include GEFS + and MEI among the group of SELFEs as both these conditions have been not classified as focal epilepsy in general. Accumulating evidence shows that a subset of affected children subsequently develop additional seizure types, cognitive deterioration, and behavioral or neuropsychiatric difficulties—outcomes that the word “benign” does not adequately communicate. Advances in molecular genetics have identified pathogenic variants affecting ion channels, synaptic transmission, and neuronal excitability, reshaping current understanding of disease mechanisms and phenotypic variability across these syndromes. This review highlights clinically relevant challenges in the diagnosis and management of SELFEs, critically examines emerging genotype–phenotype correlations, and provides evidence-based recommendations for antiseizure medication initiation and withdrawal tailored to individual syndrome characteristics and risk profiles. Full article

Background: Early identification of metabolic health risk is important for preventive intervention, but routine laboratory testing is not always available in everyday health-management environments. Artificial intelligence models can estimate risk from accessible variables, but purely data-driven models may provide limited clinical interpretability. Objective: This study presents the Advanced Hybrid Inference Model (AIM), a clinically interpretable screening support framework that combines biomarker estimation, Random Forest-based risk prediction, and rule-based clinical interpretation. Methods: AIM was intentionally implemented as a three-stage, Random Forest-centered pipeline: (1) Selected anthropometric and demographic variables were used to estimate clinically relevant metabolic biomarkers when direct measurements were unavailable. (2) A Random Forest model generated metabolic risk estimates from measured or estimated biomarkers and clinical variables. (3) Rule-based interpretation mapped the model outputs and biomarker thresholds to clinically meaningful risk-support messages. Results: Experimental validation was conducted using clinically collected datasets under class-imbalanced conditions. The results indicate that the proposed framework showed exploratory potential for identifying high-risk patterns. These findings suggest that the AIM framework may be useful as a screening-oriented approach. Conclusions: AIM should be interpreted as an exploratory clinical screening support framework that prioritizes interpretability, structured rule-based reasoning, and risk prioritization rather than a diagnostic classifier or universally superior prediction model. Full article

The renin–angiotensin system (RAS) regulates inflammation, tissue homeostasis, and barrier integrity in lung and colon epithelial cells. Beyond classical pathways, non-canonical components including angiotensin-converting enzyme 2 (ACE2), epidermal growth factor receptor (EGFR), insulin-like growth factor 2 receptor (IGF2R) and aminopeptidase N (ANPEP) are implicated in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and bacterial sepsis due to their roles in tissue repair and signaling. Despite their similar inflammatory and coagulopathic features, their impact on RAS-associated non-immune gene expression in epithelial tissues remains unclear. This study investigates the regulation of these targets in lung (BEAS-2B) and colon (CRL-1831) cells following exposure to recombinant SARS-CoV-2 spike protein N-terminal domain fragment (S1-NTD) and Pseudomonas aeruginosa-derived lipopolysaccharide (LPS). Cells were treated with 100 ng/mL of S1-NTD or LPS for 12–72 h. Viability was assessed via XTT assays, and molecular changes were analyzed through qRT-PCR and Western blotting. Both stimuli induced a time and dose-dependent decrease in metabolic activity. ACE2 was significantly downregulated in lung cells, while transient upregulation occurred in colon cells at 24 h. EGFR expression increased in colon cells following LPS exposure but decreased in lung cells after S1-NTD treatment. Both IGF2R and ANPEP were upregulated by S1-NTD in lung cells at 72 h, whereas colon cells showed earlier upregulation at 24–48 h. Our findings reveal that viral and bacterial stimuli elicit distinct, tissue-specific regulatory patterns in RAS-associated pathways. These alterations may contribute to epithelial barrier dysfunction and inflammation, highlighting these proteins as potential targets for managing secondary bacterial infections and inflammatory lung–gut complications in COVID-19. Full article

Background: Metabolic syndrome (MS), characterized by a constellation of interrelated cardiometabolic abnormalities, markedly amplifies cardiovascular risk. Despite the high prevalence of atherosclerotic cardiovascular disease (ASCVD) in the Middle East, evidence regarding the burden and determinants of MS in this high-risk population remains limited. This study aimed to estimate the prevalence of MS and identify its independent predictors among Middle Eastern patients with established ASCVD. Methods: This comprehensive analysis integrated data from two complementary sources: a prospective cohort derived from the Jordan SMuRF-less Study, which enrolled adults (≥18 years) with confirmed ASCVD across nine centers in Jordan, and a pooled retrospective dataset from six regional cardiovascular registries. Standardized case report forms were used to collect demographic, clinical, and laboratory data. Participants were stratified according to the number of standard modifiable risk factors (SMuRFs) into three categories (0, 1–2, and 3–4 SMuRFs). Multivariable logistic regression analysis was conducted to determine independent predictors of MS. Results: Among 1016 patients with ASCVD, MS was present in 42.7% of the cohort. The prevalence of MS demonstrated a significant graded increase with higher SMuRF burden, rising from 2.2% in patients without SMuRFs to 28.3% in those with one to two SMuRFs and 62.2% in those with three to four SMuRFs (p < 0.001). Patients with MS were significantly older and exhibited higher body mass index and triglyceride levels, lower high-density lipoprotein cholesterol, and a greater prevalence of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and heart failure (all p < 0.001). Independent predictors of MS included advanced age, diabetes mellitus, hypertension, chronic kidney disease, heart failure, elevated body mass index, and increased triglyceride levels. In contrast, higher HDL cholesterol and smoking were inversely associated with MS. Conclusions: MS is highly prevalent among Middle Eastern patients with ASCVD and is strongly associated with cumulative SMuRF burden in a graded manner. These findings highlight the urgent need for targeted, region-specific strategies focusing on early identification and comprehensive management of cardiometabolic risk in this vulnerable population. Full article

Frailty is a geriatric syndrome involving inflammation, oxidative stress, mitochondrial dysfunction, and metabolic disturbances. Metabolomics can systematically elucidate metabolic pathways and identify actionable biomarkers. This study systematically reviews the progress and evolutionary trends of metabolomics applications in frailty research from 2006 to 2025. Based on 1924 publications retrieved from the Web of Science Core Collection, systematic analyses were performed using CiteSpace, VOSviewer, SCImago Graphica, and the R package “bibliometrix”, focusing on pathway-level research hotspots and collaboration networks. The United States and China are the leading contributors. Research hotspots have shifted from macro-level biomarkers such as inflammation and protein–energy wasting to specific metabolic pathways including amino acid metabolism, energy metabolism, lipid metabolism, and tryptophan degradation. Key metabolites include sphingomyelin, butyrate, and trimethylamine-N-oxide. Emerging frontiers focus on the association between gut microbiota-derived metabolites and frailty phenotypes, as well as intervention strategies targeting these metabolites. This study provides the first systematic overview of global research progress in metabolomics and frailty, establishes a reproducible evaluation framework integrating physiology, nutrition, geriatrics, and computational biology, and identifies butyrate, trimethylamine-N-oxide, and tryptophan metabolites as potential metabolic targets for early identification and intervention. Full article

Carpal tunnel syndrome (CTS) is the most common compressive mononeuropathy. In patients with type 2 diabetes mellitus (T2DM), chronic hyperglycemia, microangiopathy, and systemic inflammation increase the vulnerability of peripheral nerves to compression. This study aimed to assess the relationship between CTS severity and clinical, metabolic, inflammatory, and electrophysiological parameters in patients with T2DM. A cross-sectional study was conducted from June 2023 to June 2024, involving patients diagnosed with T2DM. Electrophysiological assessment of the upper and lower limbs was performed using a four-channel electromyography apparatus. Clinical and anthropometric data and laboratory parameters were obtained, as well as the results of nerve conduction studies (NCS). One hundred and twenty-three patients with T2DM were included in the study. The prevalence of moderate-to-severe forms of CTS was 43.9%, and bilateral involvement was present in 21.95% of patients. Patients with moderate-to-severe CTS had significantly higher hemoglobin A1c (HbA1c) (p = 0.004), glycemia (p < 0.001), and Triglyceride–Glucose Index (p = 0.018) compared with those without CTS/with mild forms. The number of monocytes was significantly higher in the group with moderate-to-severe forms (p = 0.012), suggesting a chronic inflammatory state. In the logistic regression analysis, hemoglobin HbA1c emerged as an independent predictor of CTS severity, with each 1% increase associated with approximately a 60% higher risk of moderate/severe CTS. NCS analysis showed significant correlations between median nerve parameters and those of the lower-limb peripheral nerves, particularly the tibial and sural nerves, suggesting an association with generalized diabetic peripheral neuropathy. Professional activity was significantly associated with moderate-to-severe CTS (OR = 3.5). CTS is a common complication in patients with T2DM and is associated with worse glycemic control, insulin resistance, systemic inflammation, and peripheral neuropathic damage. Full article

Obesity is a major global health burden that is linked to type 2 diabetes, cardiovascular disease, and metabolic syndrome. Chitosan oligosaccharides (COS) are bioactive compounds that are derived from the depolymerization of the chitosan in crustacean shells and are promising candidates for natural anti-adipogenesis effects. However, there is incomplete understanding of the molecular mechanisms by which structurally defined low-molecular-weight COS modulates adipogenic transcription networks and global transcriptional reprogramming. MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight) mass spectrometry and ¹³C NMR spectroscopy indicated a predominance of dimeric species (DP2) at m/z 344.79, which represents a lower molecular weight fraction and is proposed to improve the membrane permeability and intracellular bioavailability of COS. In a 3T3-L1 preadipocyte model, COS treatment at concentrations of 320–1280 µg/mL dose-dependently reduced intracellular lipid accumulation, triglyceride content, and adipocyte maturation while enhancing lipolysis and insulin-mediated glucose uptake. Western blot analysis indicated dose-dependent downregulation of PPARγ and C/EBPα. Transcriptomic RNA-seq analysis indicated large-scale transcriptional reprogramming with the altered expression of genes involved in PPAR signaling, PI3K-Akt, AMPK, insulin signaling, and fatty acid metabolism pathways among differentially expressed genes. These findings demonstrate that COS suppresses adipogenesis through the coordinated modulation of adipogenic transcription factors and multiple metabolic signaling pathways. The results support its potential as a promising natural compound but warrant preclinical investigation in the context of obesity and metabolic disorders. Full article