Search Results (662)

Elevated concentrations of FGF23 are commonly observed in patients with impaired kidney function. It has been hypothesized that acute kidney injury (AKI), in contrast to chronic kidney disease (CKD), may be associated with increased FGF23 cleavage, resulting in a decreased ratio of intact to C-terminal FGF23 (iFGF23:cFGF23). However, data on the diagnostic utility of this ratio in differentiating AKI from CKD remain limited. A single-center cohort study involving 173 patients admitted to the Nephrology Department with abnormal serum creatinine levels between March 2018 and July 2021 was conducted. Blood samples were collected within 24 h of admission to measure FGF23 concentrations using both intact and C-terminal ELISAs. The iFGF23:cFGF23 ratio was calculated and analyzed across diagnostic groups. Generalized estimating equations with doubly robust adjustment were used to account for the relevant clinical and biochemical covariates. In unadjusted analyses, patients with AKI had significantly higher cFGF23 concentrations (p = 0.021) and a lower iFGF23:cFGF23 ratio (p = 0.017) compared to patients with stable CKD. No significant difference in iFGF23 levels was observed. However, after multivariable adjustment for age, serum creatinine, markers of mineral metabolism (calcium, phosphate, and parathormone) and inflammation (CRP), the observed differences were no longer statistically significant (p > 0.5 for all), and the interaction terms revealed no consistent modifiers of the exposure effect. The ROC analysis demonstrated modest discriminatory ability of the iFGF23:cFGF23 ratio, with an AUC of 0.60. After robust adjustment for key confounders, the iFGF23:cFGF23 ratio does not serve as a reliable independent marker for differentiating AKI from CKD. These results were supported by the ROC analysis, reflecting limited clinical utility for this ratio as a standalone biomarker. Our findings suggest that the observed differences in FGF23 metabolism are primarily driven by underlying disturbances in mineral metabolism and inflammation rather than the acute or chronic nature of the kidney injury itself. Full article

In this study, a sea buckthorn–wolfberry compound coffee (SWCC) solid beverage was formulated and evaluated based on sensory scores, dispersibility, and water solubility. The optimal formulation consisted of 9% sea buckthorn powder, 16% wolfberry powder, 65% coffee powder, 8% sugar, 1.25% microcrystalline cellulose, 0.5% sodium bicarbonate, and 0.25% tricalcium phosphate. The SWCC contained 18.75 ± 0.43 mg RE/g total flavonoids and 4.60 ± 0.04 mg GAE/g total phenols, demonstrating superior in vitro antioxidant activity compared to the raw sea buckthorn or wolfberry powders, with a 90.21 ± 0.15% DPPH radical scavenging rate, 90.56 ± 0.35% ABTS radical scavenging rate, and 6.64 ± 0.03 mg Trolox/g ferric-reducing power. In vivo experiments showed that specific doses (1.25–5.00 g/kg·BW/day) of SWCC exhibited significant physical fatigue-relieving and antioxidant effects, significantly extending loaded swimming time, reducing BLA accumulation, increasing LG reserves, enhancing SOD activity, and lowering MDA levels in serum. Overall, our findings offer both theoretical and practical insights for utilizing medicinal and edible resources in functional food development, meeting the growing demand for healthy and diverse food options, and contributing significantly to the advancement of public nutrition and the healthy food industry. Full article

Congenital portosystemic shunts (CPSSs) are often associated with life-threatening systemic complications, which may be detected by identifying hypergalactosemia in newborn screening (NBS). However, diagnosing CPSS at an early stage is not easy. The purpose of this study was to predict CPSS early using screening values and general blood tests. The medical records of 153 patients with hypergalactosemia who underwent NBS in Saitama Prefecture between 1 December 1997 and 31 October 2023 were retrospectively analyzed. We provided the final diagnosis of the analyzed patients. Of the 153 patients, 44 (29%) were in the CPSS group and 83 (54%) were in the transient galactosemia group. Using the initial screening items and the six blood test items, we attempted to extract a CPSS group from the transient galactosemia group. Finally, a model for CPSS prediction was established. From multiple logistic regression analysis, filtered blood galactose-1 phosphate/galactose, serum total bile acid, and ammonia were adopted as explanatory variables for the prediction model. If the cut-off value for predicted disease probability value (P) was >0.357, CPSS was identified with 86.4% sensitivity (95%CI 72.6–94.8%) and 81.9% specificity (95%CI 72.0–89.5%). This predictive model might allow prediction of CPSS and early intervention. Full article

Background/Objectives: Blunt cardiac injury (BCI) is a severe medical condition that may arise as a result of various traumas, including motor vehicle accidents and falls. The main objective of this study was to explore the role and underlying mechanisms of the TRPV4 gene in BCI. Elucidating the function of TRPV4 in BCI may reveal potential novel therapeutic targets for the treatment of this condition. Methods: Rats in each group, including the SD control group (SDCON), the SD blunt-trauma group (SDBT), the TRPV4 gene-knockout control group (KOCON), and the TRPV4 gene-knockout blunt-trauma group (KOBT), were all freely dropped from a fixed height with a weight of 200 g and struck in the left chest with a certain energy, causing BCI. After the experiment, the levels of serum IL-6 and IL-1β were detected to evaluate the inflammatory response. The myocardial tissue structure was observed by HE staining. In addition, cardiac transcriptome analysis was conducted to identify differentially expressed genes, and metabolomics studies were carried out using UHPLC-Q-TOF/MS technology to analyze metabolites. The results of transcriptomics and metabolomics were verified by qRT-PCR and Western blot analysis. Results: Compared with the SDCON group, the levels of serum IL-6 and IL-1β in the SDBT group were significantly increased (p < 0.001), while the levels of serum IL-6 and IL-1β in the KOBT group were significantly decreased (p < 0.001), indicating that the deletion of the TRPV4 gene alleviated the inflammation induced by BCI. HE staining showed that myocardial tissue injury was severe in the SDBT group, while myocardial tissue structure abnormalities were mild in the KOBT group. Transcriptome analysis revealed that there were 1045 upregulated genes and 643 downregulated genes in the KOBT group. These genes were enriched in pathways related to inflammation, apoptosis, and tissue repair, such as p53, apoptosis, AMPK, PPAR, and other signaling pathways. Metabolomics studies have found that TRPV4 regulates nucleotide metabolism, amino-acid metabolism, biotin metabolism, arginine and proline metabolism, pentose phosphate pathway, fructose and mannose metabolism, etc., in myocardial tissue. The combined analysis of metabolic and transcriptional data reveals that tryptophan metabolism and the protein digestion and absorption pathway may be the key mechanisms. The qRT-PCR results corroborated the expression of key genes identified in the transcriptome sequencing, while Western blot analysis validated the protein expression levels of pivotal regulators within the p53 and AMPK signaling pathways. Conclusions: Overall, the deletion of the TRPV4 gene effectively alleviates cardiac injury by reducing inflammation and tissue damage. These findings suggest that TRPV4 may become a new therapeutic target for BCI, providing new insights for future therapeutic strategies. Full article

This study aimed to investigate the effects of adding 360 mg/kg niacinamide (NAM) to diets on nutrient metabolism, providing insights into how dietary NAM supplementation enhances nitrogen utilization and growth performance in pigs. Forty growing–finishing pigs were randomly assigned to one of four experimental diets as follows: basal diet + 30 mg/kg NAM (CON), basal diet + 360 mg/kg NAM (CON + NAM), low-protein diet + 30 mg/kg NAM (LP), and low-protein diet + 360 mg/kg NAM (LP + NAM). Results showed that supplementation of both the CON and LP diets with 360 mg/kg NAM resulted in decreased urea nitrogen concentrations and carbamyl phosphate synthetase-I activity (p < 0.05). The pyruvate dehydrogenase activity in the serum and liver, as well as the activity of pyruvate dehydrogenase, citrate synthase, and glutamate dehydrogenase 1 in the ileum mucosa, was increased by supplementing the LP diet with 360 mg/kg NAM (p < 0.05). The LP diet with 360 mg/kg NAM increased the villi length to crypt depth, mRNA expression of glucose transporters 1 and 2 and alanine-serine-cysteine transporter 1, and mRNA expression of mechanistic target of the rapamycin 1 in the ileum (p < 0.05). Additionally, 360 mg/kg NAM supplementation in the LP diet reduced ileal Lactobacillus abundance (LDA > 4) and increased ileal microbial nucleotide and purine metabolism (p < 0.05). Our findings suggest that addition of 360 mg/kg NAM to the LP diet reduced urea production in the liver, enhanced glucose and amino acid absorption and transport in the ileum, and improved glucose metabolism. Full article

Background/Objectives: The development of hypophosphatemia has been associated with intravenous iron products, with the rate of hypophosphatemia found to be higher with ferric carboxymaltose. This consensus statement provides clinical guidance on the risk of hypophosphatemia development with ferric carboxymaltose and the approaches for management. To develop consensus recommendations regarding the clinical implications of hypophosphatemia after the administration of ferric carboxymaltose, the assessment of patient risk profile, and recommended approaches for risk reduction. Methods: Consensus statements were developed from an in-person meeting of specialists with expertise in iron pathophysiology and iron therapy and further supplemented with literature review. The multidisciplinary expert panel comprised global iron specialists spanning anesthesiology, cardiology, gastroenterology, obstetrics/gynecology, hematology, nephrology, and iron molecular biology. Structured discussions were held in an in-person meeting to gather expert opinion on the evidence base regarding intravenous iron and hypophosphatemia. Consolidated summary opinions underwent further iterations of panel review to form consensus recommendation statements. Results: The expert panel developed the following consensus statements: (1) Routine serum phosphate level measurement is not recommended for low-risk patients before or after treatment with ferric carboxymaltose, as most cases of hypophosphatemia that occur following the administration of ferric carboxymaltose are asymptomatic and transient; (2) patients receiving ferric carboxymaltose should be assessed for the degree of risk for developing symptomatic or severe hypophosphatemia prior to administration; (3) monitoring serum phosphate is recommended for patients at an increased risk for developing low serum phosphate or who require repeated courses of ferric carboxymaltose treatment at higher doses; (4) prophylactic oral phosphorus after ferric carboxymaltose is unlikely to effectively elevate phosphate and is not recommended for routine clinical practice; and (5) hypophosphatemic osteomalacia is rare and the risk of development after the administration of ferric carboxymaltose, in particular single infusion, is low. Conclusions: Hypophosphatemia following ferric carboxymaltose is predominantly asymptomatic and transient. Individuals at higher risk for developing hypophosphatemia with ferric carboxymaltose treatment include those who receive multiple infusions, higher cumulative doses, or long-term iron treatment or who have underlying clinical risk factors. These consensus statements provide structured guidance on the risk of hypophosphatemia with ferric carboxymaltose and the approaches to clinical management. Full article

Hypomagnesemia is the most common electrolyte disorder in kidney transplant recipients (KTR), yet its causes remain unclear. Few studies have explored its underlying factors. This study aimed to assess its prevalence and identify risk factors in KTR. We conducted a retrospective cross-sectional study in 489 outpatient KTR. Demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify factors associated with hypomagnesemia (≤1.7 mg/dL). Hypomagnesemia was present in 50.7% of patients. Multivariate analysis identified tacrolimus [OR 2.91 (1.62–5.22)], thiazides [OR 2.23 (1.21–4.08)], cinacalcet [OR 2.31 (1.29–4.13)], serum phosphate < 3.7 mg/dL [1.99 (1.29–3.05)], serum calcium ≤ 10 mg/dL [1.99 (1.29–3.05)] and diabetes [1.94 (1.22–3.08)] as risk factors. Protective factors included SGLT2 inhibitors (SGLT2i) [OR 0.17 (0.10–0.27)] and mTOR inhibitors (mTORi) [OR 0.62 (0.38–0.98)]. Among hypomagnesemic patients, those receiving Mg²⁺ supplements had lower Mg²⁺ levels [1.54 (0.15) vs. 1.59 (0.13) mg/dL, p = 0.005] and higher fractional Mg²⁺ excretion [8.28 (4.48)% vs. 7.36 (4.19)%, p = 0.05]. Hypomagnesemia is highly prevalent in KTR. Tacrolimus, thiazides, and cinacalcet are key risk factors and, in some patients, risks and benefits of continuing these medications should be carefully weighed. In refractory cases, SGLT2i or mTORi may offer benefit. Full article

Background/Objectives: Carbohydrate antigen 19-9 (CA19-9) is a clinically established biomarker primarily used for monitoring disease progression and recurrence in pancreatic and gastrointestinal cancers. Accurate and continuous quantification of CA19-9 in patient samples is critical for effective clinical management. This study aimed to develop dual-emitting molecularly imprinted nanopolymers (dual@nanoMIPs) for ratiometric and reliable detection of CA19-9 in serum. Methods: Dual-emitting nanoMIPs were synthesized via a one-step molecular imprinting process, incorporating both blue-emitting carbon dots (b-CDs) as internal reference fluorophores and yellow-emitting quantum dots (y-QDs) as responsive probes. The CA19-9 template was embedded into the polymer matrix to create specific recognition sites. Fluorescence measurements were carried out under 365 nm excitation in 1% human serum diluted in phosphate-buffered saline (PBS). Results: The dual@nanoMIPs exhibited a ratiometric fluorescence response upon CA19-9 binding, characterized by the emission quenching of the y-QDs at 575 nm, while the b-CDs emission remained stable at 467 nm. The fluorescence shift observed in the RGB coordinates from yellow to green in the concentration range of CA19-9 tested, improved quantification accuracy by compensating for matrix effects in serum. A linear detection range was achieved from 4.98 × 10⁻³ to 8.39 × 10² U mL⁻¹ in serum samples, with high specificity and reproducibility. Conclusions: The dual@nanoMIPs developed in this work enable a stable, sensitive, and specific detection of CA19-9 in minimally processed serum, offering a promising tool for longitudinal monitoring of cancer patients. Its ratiometric fluorescence design enhances reliability, supporting clinical decision-making in the follow-up of pancreatic cancer. Full article

Zinc is an essential trace element involved in diverse physiological processes in humans. Zinc deficiency is common in patients with chronic kidney disease (CKD), including those undergoing hemodialysis. This narrative review synthesizes both experimental and clinical findings on zinc status in CKD patients. Literature was primarily retrieved from PubMed using the keywords “zinc” AND (“CKD” OR “hemodialysis”) AND at least one of the following: “cardiovascular disease (CVD)”, “vascular calcification”, “anemia”, “blood pressure”, OR “infection”. In vitro, studies have shown that zinc suppressed phosphate-induced vascular calcification while zinc deficiency directly promoted calcification. Clinically, serum zinc levels were positively correlated with calcification propensity in patients with CKD. In vivo zinc deficiency has been implicated in elevated blood pressure, Moreover, zinc supplementation enhanced erythropoiesis and improved responsiveness to erythropoiesis-stimulating agents in both animal models and humans. We recently reported that low serum zinc levels are associated with increased mortality in hemodialysis patients with hypoalbuminemia. Previous randomized controlled trials (RCTs) suggest a daily dose of approximately 45 mg of zinc for 2 months mitigates inflammation, oxidative stress, and malnutrition in patients undergoing hemodialysis. Emerging evidence suggests that vascular calcification, hypertension, and renal anemia are newly recognized features of zinc deficiency and are established risk factors for CKD progression, CVD, and mortality. However, the impact of zinc supplementation on these clinical outcomes remains inconclusive. Further RCTs are required to establish zinc supplementation as an effective therapeutic strategy for improving various outcomes in patients with CKD including hemodialysis. Full article

Human cytomegalovirus (CMV) is the leading cause of congenital infections, often leading to mental retardation and neurological disorders. It is a major public health priority to develop a vaccine for preventing and controlling human CMV infection. In this report, we generated an oral Salmonella-based vaccine to express the M33 protein of murine cytomegalovirus (MCMV) and investigated the anti-MCMV immune responses induced in mice immunized with this vaccine. Compared to those administered with phosphate-buffered saline (PBS) or a control vaccine without M33 expression, mice immunized with the vaccine expressing the M33 protein exhibited a remarkable induction of antiviral serum IgG and mucosal IgA humoral responses and a significant elicitation of antiviral T cell responses. Successful inhibition of viral growth in lungs, spleens, livers, and salivary glands was also found in the vaccinated animals compared to the PBS-treated animals or those immunized with the control vaccine without M33 expression. Furthermore, substantial protection against MCMV challenge was observed in mice immunized with the vaccine. Thus, Salmonella-based vaccine expressing MCMV M33 can induce anti-MCMV effective immune responses and protection. Our study implies that attenuated Salmonella expressing human CMV antigens, including its homologue to M33, may represent promising oral anti-CMV vaccine candidates. Full article

Osteogenesis imperfecta (OI) is a rare bone dysplasia that occurs with a frequency of 1/15,000–20,000 live births. It is characterized by increased susceptibility of bone fractures, skeletal deformities, low stature, and low bone mass. It results in impaired production of type I collagen. About 90% of people with OI have heterozygous mutations in the COL1A1 and COL1A2 genes. Fibroblast growth factor 23 (FGF23) is a protein involved in the regulation of phosphate and 1,25-dihydroxyvitamin D₃ metabolism on a negative feedback basis. FGF23 is secreted by osteocytes in response to increased serum calcitriol and phosphorus. The purpose of this study was to evaluate the concentration of FGF23 among children with osteogenesis imperfecta and the differences in reference values in a healthy population of children and adolescents. Then, this study sought to evaluate how the course of osteogenesis imperfecta, including type of disease, number of bone fractures, and bone mineral density, are related to FGF23 concentration. The study included 47 children aged 3 to 17 years with a diagnosis of osteogenesis imperfecta, confirmed by genetic tests. The patients were hospitalized at the Department from August 2019 to September 2020 and were treated with intravenous infusions of sodium pamidronate. The course of the disease was analyzed, including the number of bone fractures, clinical symptoms, and anthropometric parameters, and bone densitometry was performed by dual X-ray absorptiometry (DXA) in Total Body Less Head (TBLH) and Spine options with Z-score evaluation. FGF23 concentration was determined by the ELISA method. The study was prospective in nature. Results: The mean level of FGF23 in the study group of patients was 645.09 pg/mL and was within the reference values for the developmental age population. There was no significant correlation between FGF23 concentration and anthropometric measurements: body weight (p = 0.267), height (p = 0.429), gender (p = 0.291), or pubertal stage (p = 0.223) in the study group of patients. FGF23 levels were not related to the number of fractures (p = 0.749), the number of sodium pamidronate cycles administered (p = 0.580), bone mineral density parameters (Z-score), the form of osteogenesis imperfecta (p = 0.156), or the genetic test result (p = 0.573). FGF23 levels decrease with age (r = −0.32, p = 0.030) and BMI (r = −0.34, p = 0.020). The level of FGF23 in patients with osteogenesis imperfecta is lower among older children and those having a higher BMI. This index cannot be a diagnostic tool in this group of patients, for no differences were found between the concentrations in patients with osteogenesis imperfecta and the developmental age population. Full article

Although cancer is often considered a genetic disease, genotoxic damage to nuclear DNA caused by carcinogens is not always sufficient to stimulate cancer cell growth, suggesting that other etiological factors are involved. Indeed, many carcinogens are also nephrotoxic and can impair kidney function. In turn, impaired renal function can dysregulate serum inorganic phosphate, leading to hyperphosphatemia and excess phosphate storage in tissues, which causes phosphate toxicity. Moreover, phosphate toxicity can contribute to cancer cell growth by activating cell signaling pathways, overexpressing sodium phosphate cotransporters, and stimulating excessive RNA biogenesis and protein synthesis. The present narrative review proposes a general underlying mechanism by which phosphate toxicity mediates the association of toxin nephropathy with carcinogenesis. This proposed pathway could explain why any factor that impairs renal function, including an overload of nontoxic substances, may indirectly contribute to excess phosphate sequestration in the tumor microenvironment which stimulates cancer cellular growth. Importantly, chemotherapy agents are often nephrotoxic, and carcinogenicity associated with such nephrotoxins could explain the occurrence of second tumors in treated cancer patients. More research is needed to investigate the mediating role of phosphate toxicity in the association of toxin nephropathy with carcinogenesis. Full article

Background: The increasing prevalence of processed foods has significantly elevated dietary phosphorus intake globally, posing a risk to skeletal health. Elevated serum phosphate promotes parathyroid hormone (PTH) release, leading to bone resorption and decreased bone formation. Objective: This study investigated the influence of chronically elevated phosphorus intake on bone structure in rats with normal renal function, focusing on the Receptor Activator of Nuclear factor Kappa-B (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) pathway and its related components, leucine rich repeat containing G protein-coupled receptor 4 (LGR4), and R-spondins (RSPOs). Methods: Rats were fed a high-phosphorus diet, followed by assessment of the bone microstructure and of the expression of key signalling molecules. Results: Elevated phosphorus intake induced significant bone deterioration, particularly in the trabecular bone compartment, associated with alterations in the RANK/RANKL/OPG pathway and in the LGR4 and RSPO1 and RSPO4 signalling components in bone. Moreover, we also observed changes in RANKL, RSPO1 and RSPO4 serum levels in the rats that had received a high-phosphorus diet. Conclusions: These findings highlight the detrimental impact of excessive dietary phosphorus on skeletal health, even without renal impairment, and suggest that components of this pathway, particularly RSPO1 and RSPO4, could serve as potential biomarkers of bone deterioration. The widespread consumption of phosphorus-rich processed foods underscores the importance of nutritional education to mitigate these skeletal risks in industrialized populations. Full article

Background: Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by recurrent sinopulmonary infections due to motile cilia defects. The disease is genetically heterogeneous, with abnormalities in structural ciliary proteins. Zinc finger MYND-type containing 10 (ZMYND10) is essential for the assembly of outer dynein arms (ODA), with chaperones like Glucose-regulated protein 78 (GRP78) facilitating protein folding. This study investigates ZMYND10 and Dynein axonemal heavy chain 5 (DNAH5) mutations in individuals with PCD. Methods: Eight individuals aged 14–22 with clinical PCD symptoms and confirmed DNAH5 mutations were included. We analyzed the correlation between DNAH5 abnormalities and preassembly/chaperone proteins using immunofluorescence labeling. Nasal swabs were double-labeled (DNAH5–β-tubulin, β-tubulin–ZMYND10, β-tubulin–GRP78) and examined via fluorescence microscopy. Serum metabolomics and proteomics were also assessed. Results: The corrected total cell fluorescence (CTCF) levels of DNAH5, ZMYND10, and GRP78 were significantly different between PCD individuals and controls. Metabolomic analysis showed reduced valine, leucine, and isoleucine biosynthesis, with increased malate and triacylglycerol biosynthesis, malate-aspartate and glycerol phosphate shuttles, and arginine/proline metabolism, suggesting mitochondrial and ER stress. Conclusions: The altered expression of DNAH5, ZMYND10, and GRP78, along with metabolic shifts, points to a complex link between ciliary dysfunction and cellular stress in PCD. Further studies are needed to clarify the underlying mechanisms. Full article

It is now widely recognized that maintaining magnesium (Mg) homeostasis is critical for health, especially in the context of chronic kidney disease (CKD). Patients with CKD commonly develop hyperphosphatemia and secondary hyperparathyroidism, which are controlled by therapies targeting intestinal phosphate absorption and circulating calcium levels or by modulating parathyroid calcium sensing. Notably, Mg supplementation may provide dual benefits by promoting bone formation and maintaining normal mineralization with slightly elevated serum levels. Importantly, low Mg levels are associated with mortality risk in CKD, highlighting the importance of maintaining adequate serum Mg levels in these patients. Particularly, kidney transplant (KT) patients have lower circulating Mg levels, likely due to interactions with immunosuppressive treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown survival benefits in CKD and increased serum Mg levels, suggesting that Mg regulation may contribute to these outcomes. Overall, Mg plays a key role in CKD-associated mineral and bone disorders (CKD-MBD). Thus, understanding the mechanisms underlying the alteration of Mg homeostasis in CKD could improve clinical outcomes. This review summarizes the basic and clinical studies demonstrating (1) the key actions of Mg in CKD-MBD, including secondary hyperparathyroidism and bone abnormalities; (2) the distinctive profile of KT patients for Mg homeostasis; and (3) the interaction between commonly used drugs, such as SGLT2 inhibitors or immunosuppressive treatments, and Mg metabolism, providing a broad understanding of both the key role of Mg in the context of CKD and the treatments that should be considered to manage Mg levels in CKD patients. Full article