Gut microbiota and associated metabolites: key players in high-fat diet-induced chronic diseases

Excessive intake of dietary fats is strongly associated with an increased risk of various chronic diseases, such as obesity, diabetes, hepatic metabolic disorders, cardiovascular disease, chronic intestinal inflammation, and certain cancers. A significant portion of the adverse effects of high-fat diet on disease risk is mediated through modifications in the gut microbiota. Specifically, high-fat diets are linked to reduced microbial diversity, an overgrowth of gram-negative bacteria, an elevated Firmicutes-to-Bacteroidetes ratio, and alterations at various taxonomic levels. These microbial alterations influence the intestinal metabolism of small molecules, which subsequently increases intestinal permeability, exacerbates inflammatory responses, disrupts metabolic functions, and impairs signal transduction pathways in the host. Consequently, diet-induced changes in the gut microbiota play a crucial role in the initiation and progression of chronic diseases. This review explores the relationship between high-fat diets and gut microbiota, highlighting their roles and underlying mechanisms in the development of chronic metabolic diseases. Additionally, we propose probiotic interventions may serve as a promising adjunctive therapy to counteract the negative effects of high-fat diet-induced alterations in gut microbiota composition.

Sedentary lifestyle and physical inactivity: A mutual interplay with early and overt frailty

AIMS

In recent years medical science and research are increasingly directed towards a holistic approach that considers health as global well-being rather than solely as the absence of disease. In this framework, lifestyle interventions and, in particular, physical exercise, are of crucial importance in prevention and treatment. Therefore, the purpose of this study is to describe this mutual interplay between physical behaviours, sarcopenia, and frailty, as well as to illustrate the role of structured exercise training in aging and disease.

DATA SYNTHESIS

Physical activity and exercise training are determinants of lifelong global wellness and healthy aging. On the contrary, sedentary behaviour and physical inactivity are strictly linked to frailty and pre-frailty, both in adults and the elderly, with or without chronic diseases. On the other hand, the presence of pathological conditions is associated with a more inactive and sedentary behaviour. The co-presence of these factors is characterized by a mutual causal exchange in which they are imbricated in a continuous mechanistic interplay that involves inflammation, sarcopenia, osteopenia, functional impairment and many other pathophysiological aspects that rapidly can lead to a status of frailty.

CONCLUSION

A sedentary lifestyle and physical inactivity critically affect alterations in body composition and loss in functional capacity, typically linked to aging and accelerated by chronic diseases. However, physical activity and exercise can counteract the onset of pre-frailty and frailty by conferring beneficial effects on the individual's overall well-being.

The impact of two different aerobic exercise intensities on cardiometabolic parameters in type 2 diabetic patients: A randomized trial

BACKGROUND

Regular exercise significantly reduces cardiovascular risk and helps prevent primary and secondary cardiac events. However, the mechanisms through which exercise affects cardiovascular health remain unclear. This study investigates the acute effects of high-intensity interval training (HIIT) versus moderate-intensity continuous exercise (MOD) on endothelial function and glycemic control in patients with type 2 diabetes (T2D).

OBJECTIVES

The study aimed to compare the acute effects of a single session of HIIT and MOD on endothelial function, hemodynamic parameters, and blood glucose levels in T2D patients.

DESIGN

This was a randomized controlled trial (RCT).

SETTING

Conducted at the Laboratory of Cardiopulmonary Rehabilitation.

PARTICIPANTS

Fifty-seven sedentary patients with type 2 diabetes (39 women and 18 men) participated in the study.

METHODS

Participants were randomly assigned to either HIIT (10 sprints of 30 s at 85-100% of maximum heart rate, with 1-min active pauses) or MOD (continuous exercise at 60-70% of maximum heart rate for 30 min). Brachial artery flow-mediated dilation (%FMD) and blood glucose levels were measured before and immediately after the sessions.

RESULTS

HIIT significantly increased %FMD (9.3 ± 5.3% vs 20.05 ± 9.3%, p < 0.01) and reduced glucose levels (189 [106-335] mg/dL vs 149 [70-448] mg/dL, p < 0.01). Although MOD also showed positive responses, HIIT yielded more pronounced improvements in endothelial function.

CONCLUSION

HIIT is more effective for cardiovascular protection than MOD, although both exercises improve glycemic control in T2D patients. Higher %FMD is associated with better physical capacity and heart rate recovery, indicating a favorable prognosis.

The mechanism of perilla oil in regulating lipid metabolism

Emerging science supports the role of lipid metabolism disorders in the occurrence and development of chronic diseases. Dietary intervention has been shown to be an effective strategy for regulating lipid metabolism. Recent studies showed that perilla is rich in various effective ingredients, including fatty acids, flavonoids, and phenolic acids. These ingredients exhibit a myriad of benefits, notably enhancing intestinal health and helping to manage metabolic diseases. Perilla oil stands out as a promising agent for regulating lipid metabolism, underscoring its potential for various health applications. This review introduces the active ingredients in perilla and provides a systematic overview of the mechanism by which perilla oil regulates lipid metabolism to expand its application value. Further research should focus on exploring the dose effect and absorption efficiency of perilla oil in clinical applications.

Topical insulin treatment efficacy in rat corneal epithelial wound healing model and comparison of efficacy with topical hyaluronate treatment

This study aimed to examine the effect of topical insulin on healing of the corneal epithelium in a rat corneal epithelial defect model, comparing it to artificial tears and non-treated controls. 28 adult male Sprague Dawley rats were divided into 4 groups in this study. A 2 mm diameter epithelial defect was created at the central cornea of one eye under sedation. Group A had untreated epithelial defects, Group B received 0.15 % sodium hyaluronate qid, and Group C received topical 1IU/mL insulin qid. The last group was healthy controls. Biomicroscopic examinations were performed at the 4th hour, 12th hour, 1st day, 2nd day, and 3rd day0. The defect size of epithelium was photographed during each examination using fluorescein staining. The area of the defect was calculated using the ImageJ software to determine the percentage of defect closure. On the 10th day, corneal tissues were excised for histopathological examination, after sacrification. Topical insulin and sodium hyaluronate treatment groups showed faster healing rate of corneal epithelial defect closure biomicroscopically compared to the untreated group. However, there was no statistically significant difference in the rate of epithelial defect closure between topical insulin and sodium hyaluronate groups. Histopathologically, topical insulin group showed superior epithelial remodeling at the fine structural level. Although no biomicroscopic difference was observed in corneal epithelial healing with topical insulin treatment compared to sodium hyaluronate, it has been demonstrated to be more effective histopathologically.

The role of the hypothalamus in the development of cancer cachexia

Cachexia is a complex multiorgan syndrome associated with various chronic diseases, characterized by anorexia and increased tissue wasting in the context of chronic inflammation. A specific form of this syndrome, known as cancer cachexia (CC), occurs alongside different types of tumors. The pathogenesis of CC is multifactorial. Inflammatory mediators and hormones released by both tumor and host cells have a relevant role in driving the peripheral catabolic process through several direct mechanisms. Accumulating evidence indicates that the central nervous system (CNS) plays an integral role in the pathogenesis of CC. The hypothalamus has emerged as a critical brain region that senses and amplifies peripheral stimuli, generating inappropriate neuronal signaling and leading to the dysregulation of energy homeostasis under cachexia conditions. Circulating cytokines may act in concert with hormones and neurotransmitters and perturb critical hypothalamic neurocircuits shifting their activity towards the anorexigenic pathway and increase of energy expenditure. This review discusses the mechanisms mediating the hypothalamic homeostatic imbalance in the context of anorexia and cachexia associated with cancer.

Unsaturated fatty acids enhance mitochondrial function and PGC1-α expression in brown adipose tissue of obese mice on a low-carbohydrate diet

Brown adipose tissue (BAT) exhibits greater resilience against inflammation compared to white adipose tissue. However, chronic consumption of a high-fat diet can render brown adipocytes vulnerable to proinflammatory conditions, leading to a decline in their thermogenic capacity and subsequent dysfunction. The analysis of the effects of type fatty acids intake must be important in the context of the dietary pattern and obesity. This study aims to investigate the impact of a low-carbohydrate/high-fat diet, enriched with different types of fatty acids, on mitochondrial activity on brown adipose tissue in obese mice. Male mice were allocated into different dietary groups: a control diet (CTL), and a high-fat diet (HFD) for a duration of 10 weeks to induce obesity. Subsequently, the HFD group was subdivided into the following categories for an additional 6 weeks: HFD with a low carbohydrate content enriched with saturated fatty acids; HFD with a low carbohydrate content enriched with fish oil; HFD with a low carbohydrate content enriched with soybean oil; and HFD with a low carbohydrate content enriched with olive oil. The findings indicated that in comparison to a low-carbohydrate diet rich in saturated fats, diets rich in unsaturated fatty acids-particularly omega-6 (n-6) and omega-9 (n-9)-resulted in elevated expression of UCP1, a marker of BAT activity. Moreover, there was an increase in the expression of PGC1-α, a protein involved in mitochondrial biogenesis, and enhanced functionality of the oxidative phosphorylation system within BAT mitochondria. These results suggest that n-6 and n-9 fatty acids may confer greater benefits to BAT functionality than saturated fats within the context of a low-carbohydrate diet. Therefore, this study revealed some molecular components that mediate BAT mitochondria function influenced by different fatty acids in a low carbohydrate diet, making it an important therapeutic target in obesity.

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: a scoping review

BACKGROUND

The COVID-19 pandemic disrupted care for non-communicable diseases globally. This study synthesizes evidence on disruptions to primary care, focusing on hypertension and diabetes care and mitigation approaches taken during the pandemic in Latin America and the Caribbean (LAC).

METHODS

We conducted a scoping review, searching nine electronic databases for studies from January 2020 to December 2022 on COVID-19-related primary care disruptions and interventions, including studies on hospital-based interventions given their relevance to the pandemic response in LAC. We adapted the Primary Health Care Performance Initiative framework to develop our search strategy and synthesize data. For studies reporting interventions, we included studies conducted outside of LAC.

RESULTS

Of 33,510 references screened, 388 studies were included (259 reported disruptions in LAC, 61 interventions in LAC, 63 interventions outside LAC, and five interventions from countries within and outside LAC), with three-quarters presenting data from Brazil, Argentina, Mexico, and Peru; few studies focused on rural areas. Additionally, the few studies that adequately quantified care disruptions reported a reduction in hypertension and diabetes control during the pandemic (e.g., hypertension control rate decreased from 68 to 55% in Mexico). Frequently reported causes of disruption included burnout and mental health challenges among healthcare workers (with disproportionate effects by type of worker), reduced medication supplies, and reduced frequency of clinic visits by patients (e.g., due to financial constraints). The most reported interventions included remote care strategies (e.g., smartphone applications, virtual meeting platforms) and mental health programs for healthcare workers. Remote care strategies were deemed feasible for care delivery, triaging, and clinical support for non-physicians. Patients were generally satisfied with telemedicine, whereas providers had mixed perceptions. Robust evidence on the effectiveness of remote care strategies for diabetes and hypertension care was unavailable in LAC.

CONCLUSION

Hypertension and diabetes control appeared to worsen in LAC during the pandemic. Major reported causes of care disruptions were workforce issues, reduced medication supply, and changes in patient perceptions of seeking and receiving primary healthcare. Remote care strategies were feasible for various purposes and were well received by patients. However, the lack of data on intervention effectiveness underscores the importance of strengthening research capacity to generate robust evidence during future pandemics. Developing resilient healthcare systems able to provide care for hypertension and diabetes during future pandemics will depend on investment in the healthcare workforce, medical supply chain, health data and research infrastructure, and technology readiness.

Barriers and facilitators of the implementation of mammography screening in the Brazilian public health system: scoping review

BACKGROUND

There are high incidence and mortality rates of breast cancer in Brazil. Brazilian's social and economic disparities, along with complexities of its health system pose challenges to the appropriate implementation of mammography screening as a public policy for the population. In 2015, the Ministry of Health updated the recommendations for the early detection of breast cancer, which had, until then, been based on specialists' consensus, maintaining biennial screening mammography for women aged 50-69 years. However, the screening coverage did not exceed 25% of the expected number of exams for the Brazilian population who use the public health system. The objective of this study was to analyze barriers and facilitators (determinants) of opportunistic mammography screening in the Brazilian public health system.

METHODS

We conducted a scoping review to examine the extent to which guidelines have been implemented from 2015 to 2025, excluding those that (1) did not include the population aged 50 to 69 years, (2) did not discuss mammographic screening in the Brazilian public health system, (3) included populations with cancer or at high risk of cancer. Results were coded into the domains of the Consolidated Framework for Implementation Research (CFIR).

RESULTS

In the 85 articles selected, we coded 74 determinants, 50 referring to barriers and 24 to facilitators. The barriers were related to the outer setting 18(24.3%), inner setting 11(14.9%), characteristics of individuals 9(12.2%), process 6(8.1%), and intervention characteristics 6(8.1%). The facilitators were related to the outer setting 14(18.9%), inner setting 5(6.8%), intervention characteristics 3(4.1%) and individual characteristics 2(2.7%).

CONCLUSION

Using CFIR helps understand the multiple interrelated factors that affect the implementation of opportunistic mammographic screening in the Brazilian public health system. Our results can provide initial data for further studies that aim to improve and organize the implementation of mammography screening in Brazil.

Transcriptomic and Epigenomic Signatures of Liver Metabolism and Insulin Sensitivity in Aging Mice

Age-related declines in insulin sensitivity and glucose metabolism contribute to metabolic disease. Despite the liver's central role in glucose homeostasis, a comprehensive phenotypic characterization and concurrent molecular analysis of insulin resistance and metabolic dysfunction in the aging liver is lacking. We characterized hepatic insulin resistance and mitochondrial metabolic defects through metabolic cage, hyperinsulinemic-euglycemic clamp, and tracer studies paired with transcriptomic and DNA methylation analyses in young and aged male mice. Aged mice exhibited benchmark measures of whole body and liver insulin resistance. Aged mice showed lower pyruvate dehydrogenase flux, decreased fatty acid oxidation and citrate synthase fluxes, and increased pyruvate carboxylase flux under insulin-stimulated conditions. Molecular analysis revealed age-related changes in metabolic genes Pck1, Socs3, Tbc1d4, and Enpp1. Unsupervised network analysis identified an intercorrelated phenotype module (ME-Glucose), RNA module, and DNA methylation module. The DNA methylation module was enriched for lipid metabolism pathways and TCF-1 binding, while the RNA module was enriched for MZF-1 binding and regulation by miR-155-5p. Protein-protein interaction network analysis revealed interactions between module genes and canonical metabolic pathways, highlighting genes including Ets1, Ppp1r3b, and Enpp3. This study reveals novel genes underlying age-related hepatic insulin resistance as potential targets for metabolic interventions to promote healthy aging.

Prediction of metachronous liver metastasis in mid-low rectal cancer using quantitative perirectal fat content from high-resolution MRI

PURPOSE

To investigate the relationship between perirectal fat content and metachronous liver metastasis (MLM) in patients with Mid-low rectal cancer (MLRC).

MATERIALS AND METHODS

A retrospective analysis was conducted on 254 patients who underwent curative surgery for MLRC between December 2016 and December 2021. Preoperative MRI measurements of the rectal mesenteric fat area (MFA), rectal posterior mesorectal thickness (PMT), and rectal mesenteric fascia envelopment volume (MFEV) were performed, along with collection of relevant clinical, pathological, and imaging data. Patients were categorized into the MLM group (Group A), other recurrence or metastasis group (Group B), and no recurrence and metastasis group (Group C). Analyze the differences between Group A and the other groups, and independent risk factors for MLM were explored. Kaplan-Meier analysis and log-rank test were used to validate independent predictive biomarkers for MLM.

RESULTS

Patients with MLM from MLRC had later pathological and imaging T stages and lower perirectal fat content (all P < 0.05). Compared to patients with other types of recurrent metastasis, male gender, poorly differentiated tumors, and advanced tumor N stage were more likely to develop MLM (all P < 0.05). In Cox univariate and multivariate regression analysis, smaller rectal PMT (hazard ratio (HR) 0.361 [0.154-0.846], P = 0.019) and MFEV (HR 0.983 [0.968-0.998], P = 0.022) were independently associated with MLM in MLRC (HR 0.361;0.983). Kaplan-Meier analysis showed that patients with rectal PMT <1.43 cm and rectal MFEV <137.46 cm3 had a significantly higher risk of MLM compared to patients with rectal PMT ≥1.43 cm and rectal MFEV ≥137.46 cm3 (all P < 0.05).

CONCLUSION

Rectal PMT and rectal MFEV can serve as novel parameters for predicting MLM in patients with MLRC.

Chronic IL-21 drives neuroinflammation and promotes lipid accumulation in microglia

Neuroinflammation is a key contributor to the onset and progression of neurodegenerative diseases, driven by factors such as viral infections, autoimmune disorders, and peripheral inflammation. However, the mechanisms linking peripheral inflammation or viral infections to neuroinflammation remain poorly understood, limiting the development of effective therapies. Proinflammatory cytokines are implicated in these processes but their effects on brain cells, including microglia, remain insufficiently characterized. Here, we demonstrate that IL-21, a proinflammatory cytokine elevated in autoimmune disorders, chronic viral infections, and Alzheimer's disease, activates microglia and promotes lipid accumulation within these cells. Young, healthy mice injected with IL-21 to mimic chronic exposure exhibited increased proinflammatory cytokine levels and microglial activation in the brain. Notably, microglia in these mice displayed enhanced lipid accumulation, accompanied by upregulation of lipid uptake receptors such as CD36 and TREM-2. These findings were corroborated using the human microglial cell line HMC-3, where IL-21 exposure similarly induced lipid accumulation and increased expression of CD36 and ApoE. Mechanistic investigations revealed that IL-21 upregulates HIF-1α, a transcription factor critical for lipid metabolism and lipid droplet formation. Additionally, we observed elevated IL-21 levels in the circulation of elderly individuals compared to younger counterparts, with IL-21 increases associated with CMV seropositivity. Aged mouse brains mirrored the microglial lipid accumulation and activation patterns seen in IL-21-injected mice. In summary, we identify a novel IL-21-driven mechanism involving lipid accumulation in microglia that contributes to neuroinflammation.

High fat diet induces differential age- and gender-dependent changes in neuronal function in Drosophila linked to redox stress

The prevalence of neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, is steadily increasing, thus posing significant challenges to global healthcare systems. Emerging evidence suggests that dietary habits, particularly consumption of high-fat diets, may play a pivotal role in the development and progression of neurodegenerative disorders. Moreover, several studies have shed light on the intricate communication between the gut and the brain, linking gut health with neuroinflammation and its involvement in neurodegenerative processes. This study aims to assess the effects of a high-fat dietary intake on various aspects of neuronal function during aging in a gender specific manner to help understand the potential contributions of diet to neuronal function. To investigate the effects of a high-fat diet, Drosophila melanogaster was used and exposed to a standard normal food diet (NF) and a high-fat diet (HF). Adults were grouped at 10 and 45 days of age in male and female flies reared under the same conditions starting the HF diet at 5 days of age with data showing differential gender- and HF diet-induced phenotypes. Malondialdehyde (MDA) levels were higher in males at 10 and 45 days (p < 0.05), caspase-3 expression increased at 45 days (p < 0.01) implicating apoptosis induction and a reduced climbing activity at 10 and 45 days was apparent in females only (p < 0.01). Adult lifespan under both dietary conditions was unchanged when reared at 18°C but odour-associated learning ability was reduced in larvae reared in a HF diet throughout their development (p < 0.05). This is the first study to characterise effects of a HF diet on neuronal phenotypes in an age- and gender-specific manner in a Drosophila model. Our findings suggest a HF diet induces differential effects of neuronal dysfunction with age and sex-specific outcomes, characterised by enhanced oxidative stress and cell death impacting on behaviour.

Granulosa cell RNA-Seq insights into senescence and sphingolipid metabolism disorder in PCOS: aspirin as a potential therapeutic drug

BACKGROUND

Polycystic ovary syndrome (PCOS) is a pivotal cause of anovulatory infertility and the pathogenesis remains elusive. Cellular senescence and sphingolipid metabolism disorder are closely intertwined, and both have been demonstrated present within the granulosa cells of PCOS, while research on the combined impact of senescence and sphingolipids on PCOS-related anovulation is scarce.

METHODS

Here, we leveraged four datasets of PCOS and executed differential gene expression analysis, engaged in WGCNA, and harnessed machine learning algorithms-including RF, SVM-RFE, and LASSO-to deeply explore the key genes that interact with senescence and sphingolipid metabolism in granulosa cells of PCOS. These key genes were subjected to further analysis to construct a diagnostic model, forecast immune cell infiltration, and identify potential agents. Additionally, within the testosterone-stimulated granulosa cells, we validated the expression of key genes, confirmed senescence and sphingolipids dysregulation, and evaluated the therapeutic efficacy of the candidate agent.

RESULTS

Our research pinpointed a set of genes (LYN, PLCG2, STAT5B, MMP9, and IL6R) that showed promise as biomarkers for PCOS-related anovulation and the diagnostic nomogram was developed. These biomarkers were linked to various immune cell types infiltration. In testosterone-stimulated granulosa cells, we observed increased expression of these biomarkers, accompanied by signs of senescence and changes in sphingolipids. Importantly, the potential agent aspirin displayed the ability to ameliorate these two processes.

CONCLUSION

This study highlighted the important value of genes associated with senescence and sphingolipids dysregulation in PCOS. Aspirin targeting senescence could be a promising therapeutic drug for addressing anovulation associated with PCOS.

Subcutaneous adipose tissue [18F]FDG uptake and CT-derived body composition variables for predicting survival outcomes in patients with locally advanced gastric cancer

PURPOSE

This study aimed to investigate the impact of glucose metabolism in subcutaneous adipose tissue (SAT) and skeletal muscle (SM) variables on overall survival (OS) in patients with locally advanced gastric cancer.

METHODS

A retrospective study was conducted on 110 patients with advanced gastric cancer who underwent baseline [18F]FDG PET/CT. Demographic, clinical, and survival data were collected. Mean standardized uptake value (SUVmean) of SAT as well as skeletal muscle, and body composition measurement, including SAT area, SAT radiodensity, SM area, and SM radiodensity, were assessed on PET/CT. SM area was normalized for patient stature, resulting in the skeletal muscle index (SMI). Patients were stratified into subgroups with high and low SAT uptake based on the optimum cut-off value of the SAT SUVmean. The univariate, multivariate regression analysis, Kaplan-Meier survival analysis, and Spearman's correlation analysis were employed to evaluate the associations among metabolic activity and CT-derived body composition variables as well as OS.

RESULTS

Out of 110 patients with an average age of 62.65 ± 13.25 years, 58 (52.73%) patients died during follow-up. Cox regression analysis identified TNM stage, SAT SUVmean, and SMI as independent prognostic factors for OS (all p < 0.05). Notably, patients with elevated SAT uptake exhibited significantly poorer long-term survival compared to those with low SAT uptake (p < 0.001). Correlation analyses revealed a moderate positive association between SAT SUVmean and SAT radiodensity (p < 0.001, r = 0.47), whereas a significant inverse correlation was observed between SAT SUVmean and SAT area (p < 0.001, r = -0.465). Additionally, stratification by combined SAT SUVmean and SMI profiles showed that patients with low SAT uptake and high SMI exhibited a better prognosis than those with high SAT uptake and/or low SMI (p = 0.004 and p < 0.001).

CONCLUSION

Increased [18F]FDG uptake in SAT was correlated with higher SAT radiodensity as well as lower SAT area, and shortened survival in patients with advanced gastric cancer, underscoring its potential as a biomarker for adverse outcomes.

Relationship between dietary inflammatory index and chronic diseases in older U.S. Adults: NHANES 1999-2018

BACKGROUND

Chronic diseases pose a significant public health challenge, especially among the aging population. Understanding the potential impact of an inflammatory diet on the prevalence of chronic diseases is crucial for effective health interventions.

OBJECTIVE

This study assesses the relationship between the Dietary Inflammatory Index (DII) and chronic diseases in older adults.

METHODS

Data from the National Health and Nutrition Examination Surveys (NHANES) were utilized, with the DII calculated from 28 food parameters obtained through 24-hour dietary recalls and food records. Five major chronic diseases, including cardiovascular disease, hypertension, diabetes, COPD, and cancer, were used in the analysis. Logistic multivariable regression was used to determine odds ratios for chronic diseases across DII quartiles and with one unit increment in DII.

RESULTS

16,512 adults aged over 60 years were included in the study, with DII scores ranging from - 5.28 to 5.48. In the fourth DII quartile, individuals with one or more chronic diseases were more prevalent than those without. Compared to the first quartile, individuals in the fourth quartile had 28% higher odds of having CVD, 17% higher odds of having diabetes, and 19% higher odds of having hypertension, after adjusting for age, sex, smoking status, drinking status, BMI, ethnicity, poverty, marital status, education, annual family income, and citizenship. Similarly, one unit increase in DII was significantly associated with higher odds of CVD (OR [95%CI] = 1.05[1.02,1.09]) and hypertension (OR [95%CI] = 1.03 [1.00,1.06]). In Model 2, one unit increase in DII was positively associated with the number of chronic diseases (β[95%CI], 0.02[0.01, 0.03], p = 0.003).

CONCLUSION

Higher DII scores were associated with increased odds of cardiovascular disease, diabetes, and hypertension in older adults. Following an anti-inflammatory diet may be beneficial for preventing and treating chronic diseases in an older population.

Fractional CO2 laser alone versus combined with topical timolol or insulin for acne Scar treatment: a randomized controlled clinical trial

INTRODUCTION

Acne vulgaris is a common disease involving adolescents predominantly, which can lead to scar formation. This study aimed to compare the efficacy of fractional CO2 laser therapy, alone or combined with topical Timolol or insulin, for acne scar treatment, which has not been yet rigorously investigated.

METHOD

In this Randomized Controlled Trial (RCT) conducted in 2024, we enrolled 30 subjects and randomly assigned them to groups A and B. Both groups received bilateral fractional CO2 laser therapy; one group received unilateral topical 0.5% Timolol Maleate, while the other received unilateral topical regular insulin. Scar severity was assessed using the Scale for Acne Scar Severity (SCAR-S), Acne Scar Assessment Scale (ASAS), and Goodman and Baron Quantitative Global Scarring Grading System (GBAQGS) before and after the therapy. Additionally, patients' quality of life was evaluated using the Dermatologic Life Quality Index (DLQI) questionnaire at the designated time points. Statistical analyses were conducted using the IBM ™ SPSS Statistics application (version 26.0).

RESULTS

The subjects consisted of 20 females and 10 males of Persian ethnicity, with a mean age of 32.20 years. Despite significant improvements in acne scar severity, and quality of life observed following fractional CO2 laser therapy alone and in combination with topical Timolol or insulin application, no significant differences existed between these treatment approaches. No adverse effect was seen during the study.

CONCLUSION

Fractional CO2 laser alone or its combination with topical Timolol or insulin mitigated acne scar severity and enhanced patients' quality of life, despite the absence of significant differences.

Association of low skeletal muscle mass and radiodensity with clinical outcomes in patients undergoing robotic radical gastric cancer surgery: a population-based retrospective cohort study

BACKGROUND

Sarcopenia (defined as low skeletal muscle index - SMI) and myosteatosis (defined as low skeletal muscle radiodensity - SMD) associate with poor outcomes in gastric cancer, but their impact after robotic surgery is unknown.

METHODS

This retrospective cohort study analyzed 381 gastric cancer patients undergoing robotic surgery from December 2019 to October 2022. Sarcopenia and myosteatosis were assessed on preoperative CT scans. Outcomes were postoperative complications, mortality, survival, and recurrence. Multivariable regression and propensity score matching examined associations.

RESULTS

The mean age at diagnosis was 58.5 ± 10.8 years, and 69.3% (262/381) were male. Low SMI or Low SMD independently associated with more complications (odds ratio[OR] = 3.36, 95%CI: 2.08-5.43; OR = 2.49,95%CI: 1.48-4.19, respectively), unplanned ICU admission (OR = 1.51, 95%CI: 1.22-8.44; OR = 2.00; 95%CI: 1.23-8.89, respectively) or 30-day mortality (OR = 5.89, 95%CI: 1.80-14.23; OR = 7.34; 95%CI: 2.43-18.67, respectively). Concurrent sarcopenia and myosteatosis heightened risks of complications (OR = 7.29, 95%CI: 1.62-42.30), severe complications (OR = 6.67, 95%CI: 2.22-12.68), 30-day mortality (OR = 9.55, 95%CI: 2.67-33.89), and reduced survival (hazard ratio[HR] = 3.09, 95%CI: 1.77-8.60).

CONCLUSIONS

Sarcopenia and myosteatosis independently and additively associate with increased postoperative complications, mortality, and worse prognosis after robotic gastric cancer surgery. Identifying sarcopenia and myosteatosis preoperatively could inform risk assessments and guide management to improve surgical outcomes.

68Ga-labeled prostate specific membrane antigen HBED-CC PET/MRI for staging and evaluating the clinicopathological characteristics in newly diagnosed prostate cancer

OBJECTIVE

The purpose of this study was to investigate the role of 68Ga-labeled prostate specific membrane antigen HBED-CC (68Ga-PSMA-11) PET/MRI in primary staging and to evaluate the relationship between PSMA-derived parameters and clinicopathological characteristics in newly diagnosed prostate cancer (PCa).

MATERIALS AND METHODS

This study reports the findings from 72 patients newly diagnosed with primary PCa, all of whom underwent 68Ga-PSMA-11 PET/MRI scans. Calculated the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 68Ga-PSMA-11 PET/MRI for T, N, M staging, respectively. The maximum standardized uptake value (SUVmax), PSMA-tumor volume (PSMA-TVp), and total lesion-PSMA (TL-PSMAp) of primary lesion, PSMA-TV of total lesions (PSMA-TVt), and TL-PSMA of total lesions (TL-PSMAt) were measured, and Spearman correlation analysis was performed to assess their correlation with baseline prostate-specific antigen (PSA). Non-parametric Mann-Whitney U test was conducted to assess the difference of PSMA-derived parameters among clinicopathological characteristics of PCa. Receiver operating characteristic (ROC) curve was used to evaluate the performance of PSMA-derived parameters in diagnosing the clinicopathological characteristics of PCa.

RESULTS

The overall accuracy of 68Ga-PSMA-11 PET/MRI in detecting T staging of PCa was 80.7%. Diagnostic accuracy for T2a, T2b, T2c, T3a, and T3b were 94.2%, 92.3%, 90.4%, 90.4%, and 94.2%, respectively. Diagnostic accuracy for N and M staging were 96.1% and 97.2% based on patients-level, respectively. There were significant correlation between the SUVmax, PSMA-TVp, TL-PSMAp, PSMA-TVt, TL-PSMAt and baseline PSA values. Significant differences were observed in SUVmax, PSMA-TVp, TL-PSMAp, PSMA-TVt, and TL-PSMAt between T3 and T2 staging. Statistical differences were observed in SUVmax, TL-PSMAp, PSMA-TVt, and TL-PSMAt between Gleason Score (GS) > 7 and GS ≤ 7, as well as positive and negative regional lymph node metastasis. TL-PSMAt show the highest value in assessing clinicopathological characteristics.

CONCLUSIONS

68Ga-PSMA-11 PET/MRI can provide accurate TNM staging for PCa, particularly in local staging. TL-PSMAt accurately evaluate overall tumor burden and aids in diagnosing clinicopathological characteristics in mid-to-late-stage patients, outperforming SUVmax.

Targeting CD38 immunometabolic checkpoint improves metabolic fitness and cognition in a mouse model of Alzheimer's disease

Protective immunity, essential for brain maintenance and repair, may be compromised in Alzheimer's disease (AD). Here, using high-dimensional single-cell mass cytometry, we find a unique immunometabolic signature in circulating CD4+ T cells preceding symptom onset in individuals with familial AD, featured by the elevation of CD38 expression. Using female 5xFAD mice, a mouse model of AD, we show that treatment with an antibody directed to CD38 leads to restored metabolic fitness, improved cognitive performance, and attenuated local neuroinflammation. Comprehensive profiling across distinct immunological niches in 5xFAD mice, reveals a high level of disease-associated CD4+ T cells that produce IL-17A in the dural meninges, previously linked to cognitive decline. Targeting CD38 leads to abrogation of meningeal TH17 immunity and cortical IL-1β, breaking the negative feedback loop between these two compartments. Taken together, the present findings suggest CD38 as an immunometabolic checkpoint that could be adopted as a pre-symptomatic biomarker for early diagnosis of AD, and might also be therapeutically targeted alone or in combination with other immunotherapies for disease modification.

Vagal Splenic-Dependent Effects Influence Glucose Homeostasis, Insulin Secretion, and Histopathology of the Endocrine Pancreas in Hypothalamic Obese Male Rats: Vagus Nerve and Spleen Interactions Affect the Endocrine Pancreas

Vagus nerve (VN) and spleen dysfunctions are often associated with obesity (Ob). Aim: We evaluated the effects of VN and spleen ablation on adiposity, metabolism, and insulin secretion in hypothalamic obese male rats. Methods: Ob was induced by neonatal subcutaneous injection of monosodium glutamate (4 g/kg). At 60 days of life, Ob animals were randomly distributed into four groups (n = 16 rats/group): sham operation (SHAM), vagotomy (VAG), splenectomy (SPL), and VAG + SPL. Body weight and food intake were monitored for 8 weeks postsurgery. Intraperitoneal glucose tolerance test (ipGTT) and intraperitoneal pyruvate tolerance test (ipPTT) were performed at 148 days of life, and VN activity was recorded at 150 days. After euthanasia (150 days), adiposity, plasma biochemical parameters, glucose-induced insulin secretion (GIIS), and cholinergic and adrenergic islet responsiveness were evaluated. The pancreas was submitted for histopathological analysis, and the protein content of OXPHOS and IL-10 was evaluated in isolated pancreatic islets. Results: Decreased VN activity was confirmed in the Ob-VAG groups, associated with lower visceral adiposity, triglycerides, and plasma insulin, together with improved insulin sensibility and pyruvate tolerance, compared to Ob-SHAM rats. Spleen absence reduced VN activity and cholinergic insulinotropic responses, with deleterious effects on the endocrine pancreas. Furthermore, Ob-VAG + SPL rats presented greater reductions in GIIS and more severe endocrine pancreas histopathology, compared to the Ob-SHAM group, without altered islet size or number or protein content of OXPHOS or IL-10. Conclusion: Vagal and splenic interactions contribute to glucose homeostasis control in hypothalamic obese rats, modulating insulin secretion and pancreas histology.

Helminth-induced immune modulation in colorectal cancer: exploring therapeutic applications

Colorectal cancer is one of the most lethal tumors, posing a financial and healthcare burden. This study investigates how helminths and pre-existing diseases such as colitis, obesity, diabetes, and gut microbiota issues influence colon cancer development and prognosis. The immune system's protective immunosuppressive response to helminth invasion minimizes inflammation-induced cell damage and DNA mutations, lowering the risk of colorectal cancer precursor lesions. Helminth infection-mediated immunosuppression can hasten colorectal cancer growth and metastasis, which is detrimental to patient outcomes. Some helminth derivatives can activate immune cells to attack cancer cells, making them potentially useful as colorectal cancer vaccines or therapies. This review also covers gene editing approaches. We discovered that using CRISPR/Cas9 to inhibit live helminths modulates miRNA, which limits tumor growth. We propose more multicenter studies into helminth therapy's long-term effects and immune regulation pathways. We hope to treat colorectal cancer patients with helminth therapy and conventional cancer treatments in an integrative setting.

Okra-supplemented diet prevents hypothalamic inflammation in early overfeeding-programmed obese rats

BACKGROUND

Early overnutrition programs long-term metabolic dysfunctions. Owing to their benefits, functional foods have been used to treat metabolic diseases. We aimed to test the hypothesis that a diet supplemented with okra (Abelmoschus esculentus L.) mitigates energy metabolism impairment and glucose dyshomeostasis in early overfeeding-programmed rat offspring.

METHODS

At postnatal Day 3, the litters were adjusted to 3 (small litter, SL) or 8 (normal litter, NL) pups. During lactation, milk collection and milk intake were performed. At 22 days-old, the pups were weaned and fed a standard diet (NL-SD and SL-SD groups) or an okra-supplemented diet (1.5 % A. esculentus; NL-AE and SL-AE groups). Body weight and food and water intake were measured every two days. Intraperitoneal glucose tolerance and intracerebroventricular insulin (10-3 mmol/L) tests were performed, and then the offspring were euthanized. Blood, hypothalamus, and visceral fat pads were collected and lean body mass was measured.

RESULTS

Milk from SL mothers had higher triglyceride and energy contents (P < 0.05), and milk consumption by SL offspring was greater than that by NL rats. SL-SD rats were obese, hyperphagic, hypertriglyceridemic, hyperglycemic and glucose intolerant (P < 0.05) and presented central insulin resistance and increased levels of hypothalamic proinflammatory [tumor necrosis factor alpha (TNF-α), 43.5 %; interleukin 6 (IL-6), 78.5 %; and interleukin 1 beta (IL-1β), 50.1 %, P < 0.05] cytokines. On the other hand, the consumption of an okra-supplemented diet prevented all metabolic impairments.

CONCLUSION

In summary, dietary supplementation with okra prevents obesity and glucose deregulation in early-overfeeding rats, which is associated with improved hypothalamic inflammation and insulin resistance.

Physical activity in Alzheimer's disease prevention: Sex differences and the roles of BDNF and irisin

Alzheimer's disease (AD) disproportionately affects women, with postmenopausal hormonal changes contributing to elevated risk. Physical exercise is a promising, non-pharmacological strategy to mitigate cognitive decline and AD progression. Brain-derived neurotrophic factor (BDNF) and irisin are key molecular mediators of exercise-induced brain health and protection against AD pathology by promoting synaptic plasticity, neurogenesis, and reducing amyloidosis, tau pathology, and neuroinflammation in sex-specific mechanisms. This review explores sex and gender influences on exercise outcomes and their interaction with FNDC5/irisin and BDNF signaling pathways in the context of AD prevention. We highlight emerging evidence on the interplay between exercise, sex, and neuroprotective pathways, emphasizing the need for sex-sensitive research designs to advance precision approaches for AD prevention.

A multi-omics microbiome signature is associated with the benefits of gastric bypass surgery and is differentiated from diet induced weight loss through 2 years of follow-up

Roux-en-Y gastric bypass (GBP) surgery is an effective treatment for reducing body weight and correcting metabolic dysfunction in individuals with severe obesity. Herein, we characterize the differences between very low energy diet (VLED) and GBP induced weight loss by multi-omic analyses of microbiome and host features in a non-randomized, controlled, single-center study. Eighty-eight participants with severe obesity were recruited into two arms - GBP versus VLED with matching weight loss for 6 weeks and 2-years of follow-up. A dramatic shift in the distribution of gut microbial taxa and their functional capacity was seen in the GBP group at Week 2 after surgery and was sustained through 2 years. Multi-omic analyses were performed after 6 weeks of matching weight loss between the GBP and VLED groups, which pointed to microbiome derived metabolites such as indoxyl sulphate as characterizing the GBP group. We also identified an inverse association between Streptococcus parasanguinis (an oral commensal) and plasma levels of tryptophan and tyrosine. These data have important implications, as they reveal a significant robust restructuring of the microbiome away from a baseline dysbiotic state in the GBP group. Furthermore, multi-omics modelling points to potentially novel mechanistic insights at the intersection of the microbiome and host.

Tanycytes in the nexus of hypothalamic inflammation, appetite control, and obesity

Hypothalamic inflammation has been identified as a critical factor driving the development of obesity and associated metabolic disorders. This inflammation-related disruption of energy balance relies on alterations in metabolic cues sensing and hypothalamic cellular functions, together leading to overeating and weight gain. Within the hypothalamic cellular networks controlling energy balance, recent studies have highlighted the significance of glial dysfunction in these processes, suggesting that these cells could provide new avenues for weight loss therapies. Glia rapidly activates following the consumption of a high-fat diet, even after a very short exposure, and contributes to the disruption of the entire system through inflammatory crosstalk. This review explores recent progress in understanding the molecular interactions between glial cells and neurons in hypothalamic inflammation related to obesity, diabetes, and associated complications. Notably, it highlights specialized ependymal cells called tanycytes, whose role is still underestimated in hypothalamic inflammation, and examines the potential for targeting this cell type as a treatment strategy for metabolic disorders.

A Novel Serum Inflammation Risk-Index (SIRI-RT)-Driven Nomogram for Predicting Secondary Malignancy Outcomes Post-Radiotherapy

Radiation is often used as the primary treatment for a range of cancers. Nonetheless, its ability to trigger secondary tumors has emerged as a significant issue. Therefore, gaining insight into and predicting radiation-induced secondary cancers is essential for enhancing the long-term prognosis of cancer survivors.

BACKGROUND AND OBJECTIVES

Previous studies have identified several factors; however, research on the use of serum-based inflammatory markers as prognostic tools for predicting radiation-induced secondary malignancies is limited. Investigating the potential of serum-based inflammation prognostic scores could provide a minimally invasive and affordable method for the early prediction of secondary malignancies.

METHODS

We retrospectively analyzed a patient cohort with radiation-induced secondary malignancy from the electronic database MIMIC-IV to investigate whether a serum-based inflammatory marker score can serve as a predictive tool.

RESULTS

This study seeks not only to assess the efficacy of the risk score, but also to develop a clinical utility tool nomogram for predicting the occurrence of radiation-induced secondary cancers. A RISM of 4.28% was observed in a cohort from the MIMIC-IV database using SIRI-RT as a risk index, with the Charlson comorbidity index, chemotherapy, and creatinine levels as significant confounding risk factors.

CONCLUSIONS

Our study suggests that elevated serum-based inflammation prognostic scores and the nomogram developed herein can be used to predict a greater likelihood of developing secondary malignancies following radiation therapy.

Integrator loss leads to dsRNA formation that triggers the integrated stress response

Integrator (INT) is a metazoan-specific complex that targets promoter-proximally paused RNA polymerase II (RNAPII) for termination, preventing immature RNAPII from entering gene bodies and functionally attenuating transcription of stress-responsive genes. Mutations in INT subunits are associated with many human diseases, including cancer, ciliopathies, and neurodevelopmental disorders, but how reduced INT activity contributes to disease is unknown. Here, we demonstrate that the loss of INT-mediated termination in human cells triggers the integrated stress response (ISR). INT depletion causes upregulation of short genes such as the ISR transcription factor activating transcription factor 3 (ATF3). Further, immature RNAPII that escapes into genes upon INT depletion is prone to premature termination, generating incomplete pre-mRNAs with retained introns. Retroelements within retained introns form double-stranded RNA (dsRNA) that is recognized by protein kinase R (PKR), which drives ATF4 activation and prolonged ISR. Critically, patient cells with INT mutations exhibit dsRNA accumulation and ISR activation, thereby implicating chronic ISR in diseases caused by INT deficiency.

SARCOPENIA AND GASTROINTESTINAL CANCER: NUTRITIONAL APPROACH FOCUSING ON CURCUMIN SUPPLEMENTATION

BACKGROUND

Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass. When associated with cancer, it correlates with poorer clinical outcomes. Cancers of the gastrointestinal tract, prevalent globally and in Brazil, are associated with a greater nutritional risk. Early detection and intervention for nutritional risks are critical in this population. Recent studies on turmeric/curcumin have demonstrated beneficial effects in cancer patients. Specifically, curcumin have shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia. This review aims to elucidate sarcopenia and sarcopenia secondary to cancer, emphasizing nutritional management and the role of curcumin supplementation. Effective cancer management, whether with or without sarcopenia, demands comprehensive public health strategies and multimodal interventions within healthcare institutions. Nutrition is pivotal across the cancer care journey, encompassing screening, guidance, and provision of nutrients that support maintaining or recovering body composition. Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management. Nevertheless, further clinical studies are warranted to substantiate these findings.

BACKGROUND

• Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass.

BACKGROUND

• Sarcopenia when associated with cancer, it correlates with poorer clinical outcomes.

BACKGROUND

• Curcumin has shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia.

BACKGROUND

• Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management.

Phycochemistry and pharmacological significance of filamentous cyanobacterium Spirulina sp

The cyanobacterium, Spirulina sp. is a photosynthetic blue-green alga with essential nutrients, vitamins nucleic acids, proteins, carbohydrates, fatty acids and pigments carotenes; and phycocyanins are the significant components having immunomodulatory, anti-inflammatory properties, which are used in food and cosmetics industries. Spirulina sp. can play an important role in human and animal nutrition for potential health benefits due to their phycochemical and pharmaceutical significance. This study highlights antibacterial, antifungal, antiviral, antioxidant, nephroprotective, cardioprotective, anticancer, neuroprotective, anti-aging, anti-inflammatory, and immunomodulatory properties. It highlights anti-anemic, antidiabetic, probiotic, anti-malarial, anti-obesity and weight loss, anti-genotoxicity, anti-thrombic, radioprotective, and detoxifying effects of Spirulina sp. Pharmaceutical studies indicate it may improve heart health and add to the treatment of diabetes, obesity and weight loss. It can play a major role in protecting the environment by recycling wastewater and providing food for humans and animals. Spirulina sp. can supply ingredients for aquaculture and agricultural feeds, pigments, antioxidants, and essential omega-3 oils, among other human health and wellness products. The amino acid of Spirulina is among the greatest qualititavely of any plant, even higher than that of soybean. Furthermore, cyanobacterium Spirulina sp. could be a future antimicrobial drug agent.

Role of metabolic dysfunction and inflammation along the liver-brain axis in animal models with obesity-induced neurodegeneration

The interaction between metabolic dysfunction and inflammation is central to the development of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. Obesity-related conditions like type 2 diabetes and non-alcoholic fatty liver disease exacerbate this relationship. Peripheral lipid accumulation, particularly in the liver, initiates a cascade of inflammatory processes that extend to the brain, influencing critical metabolic regulatory regions. Ceramide and palmitate, key lipid components, along with lipid transporters lipocalin-2 and apolipoprotein E, contribute to neuroinflammation by disrupting blood-brain barrier integrity and promoting gliosis. Peripheral insulin resistance further exacerbates brain insulin resistance and neuroinflammation. Preclinical interventions targeting peripheral lipid metabolism and insulin signaling pathways have shown promise in reducing neuroinflammation in animal models. However, translating these findings to clinical practice requires further investigation into human subjects. In conclusion, metabolic dysfunction, peripheral inflammation, and insulin resistance are integral to neuroinflammation and neurodegeneration. Understanding these complex mechanisms holds potential for identifying novel therapeutic targets and improving outcomes for neurodegenerative diseases.

Low muscle mass as a poor prognostic factor in patients with advanced melanoma

BACKGROUND & AIMS

Low muscle mass is associated with poor immune checkpoint inhibitor (ICI) efficacy in patients with melanoma; however, whether this is true in all populations remains to be explored. The current study aimed to investigate the effect of low muscle mass on overall survival (OS) and progression-free survival (PFS) of patients with advanced melanoma treated with ICI.

METHODS

muscle index (SMI) at the third lumbar spine was calculated from computed tomography (CT) images, and SMI values < 42 cm2/m2 for men and <38 cm2/m2 for women diagnosed low muscle mass. The association of low muscle mass, OS, and PFS with ICI treatment in patients was investigated.

RESULTS

Seventy-six patients with advanced melanoma were assessed retrospectively at our institution; 32 were in the low muscle mass group, while 44 were in the normal muscle mass group. The median OS in patients with and without low muscle mass was 7.1 and 26.6 months (hazard ratio [HR] 3.12, 95 % confidence interval [Cl], 1.65-5.89; p < 0.001) and median PFS was 2.1 and 14.8 months, respectively (HR, 3.10; 95 % Cl 1.74-5.54, p < 0.001). Multivariate analysis showed significantly poor differences in OS (HR, 2.46; 95 % CI, 1.20-5.03; p = 0.01) and significant differences in PFS independently in the low muscle mass group (HR, 3.10; 95 % CI, 1.74-5.54; p < 0.001).

CONCLUSIONS

Low muscle mass may be a poor prognostic factor for patients with advanced melanoma treated with ICI.

Colon cancer biology and treatment in the era of precision oncology: A primer for Radiologists

In the era of precision oncology, systemic therapies for colon cancer are becoming increasingly biomarker-led, with implications for patients in the neoadjuvant, adjuvant and metastatic settings. As the landscape for colon cancer treatment evolves and becomes more complex, it is important that all members of the multidisciplinary team keep abreast of developments to ensure the most effective care is delivered to patients. As core members of the colorectal multidisciplinary team, Radiologists play a central role throughout the patient journey. This review serves as an educational summary of current and emerging treatment pathways in colon cancer, standards for biomarker testing, mechanisms of action for key drugs, important treatment-related complications, relevant tumour biology that underpins patterns of disease and treatment response, and the specific implications systemic therapies have for cancer imaging and Radiologists. We also highlight the increasing role for radiology in patient stratification and the importance of imaging biomarkers. It is crucial that Radiologists understand the current landscape of colon cancer treatment and emerging strategies on the horizon in clinical trials. Only through engagement across the wider multidisciplinary team will we deliver true personalised medicine for patients with colon cancer.

Insulin resistance in Alzheimer's disease: signalling mechanisms and therapeutics strategies

BACKGROUND

Alzheimer's disease (AD), one of the most common neurodegenerative disorders, is characterised by hallmark abnormalities such as amyloid-β plaques and neurofibrillary tangles (NFTs). Emerging evidence suggests that faulty insulin signalling contributes to these pathological features, impairing critical cellular and metabolic processes.

OBJECTIVE

This review aims to elucidate the role of insulin signalling in the central nervous system (CNS) under normal and pathological conditions and to explore therapeutic approaches targeting insulin pathways in AD and other neurodegenerative diseases.

METHODS

We reviewed studies highlighting the involvement of insulin-signalling pathways in neuronal health, with a particular focus on the key components-IRS, PI3K, Akt, and GSK-3β-predominantly expressed in cortical and hippocampal regions.

RESULTS

Insulin, an essential growth factor, regulates numerous cellular functions, including glucose metabolism, mitochondrial activity, oxidative stress response, autophagy, synaptic plasticity, and cognitive processes. Altered phosphorylation of signalling molecules in insulin pathways contributes to oxidative stress, inflammation, and the formation of AD hallmarks. Indirect modulators such as NF-κB and caspases further exacerbate neuronal damage, linking impaired insulin signalling to neurodegeneration.

CONCLUSION

Insulin signalling plays a crucial role in maintaining neuronal health and mitigating neurodegenerative processes. Targeting insulin pathways and associated molecules offers promising therapeutic avenues for AD and other neurodegenerative disorders.

Inequality by Skin Color in Breast Cancer Screening in Brazil: a Differences-in-Differences Analysis of the COVID-19 Pandemic

Breast cancer is the second most common cancer type and the first in mortality among Brazilian women. Mammograms are one of the main early diagnosis strategies. National breast cancer screening coverage is still low. Brazil's low screening coverage is due to high mammography access inequality. Skin color defines healthcare access differences. Our article explores the natural event of the COVID-19 pandemic to analyze differences in screening rates between two racial groups of women through the application of the differences in differences (DiD) estimator. The results indicate that BBI women (Black, Brown, and Indigenous Brazilian) have lower screening rates than WY women (White and Yellow) and that the pandemic reduced the difference between these two groups due to the lower number of mammograms performed by WY women. It is believed that the information channel can explain much of this result. The BA population, wealthier and more educated, may have had additional information about COVID-19 and its consequences, as well as an increased likelihood of working remotely and practicing social distance. Structural racism causes many social indicators to be correlated with inequality of access to mammography and negatively impacts health conditions for BBI women. Public policies are necessary for equal access to breast cancer screening for the most vulnerable women.

Zinc, copper, copper-to-zinc ratio, and other biometals in blood serum and tumor tissue of patients with colorectal cancer

The objective of the present study was to assess serum and cancerous tissue biometal levels in colorectal cancer (CRC) patients, and its relation to disease severity. A total of 90 CRC patients and 97 controls were involved in the present study. The level of biometals in blood serum and colon tissues (only in CRC cases) was evaluated by inductively-coupled plasma mass-spectrometry. CRC patients are characterized by lower serum Ca, Fe, Se, and Zn, as well as higher serum Co, Cu, Mg, V, and Cu/Zn ratio compared to healthy controls. The lowest serum Zn levels and the highest Cu concentration and Cu/Zn ratio were observed in patients with the largest tumor size. Regression analysis demonstrated that tumor size is a significant negative predictor of serum Se levels, being positively associated with serum Cu/Zn values. The degree of metastasis to regional lymph nodes was inversely associated with circulating Ca, Co, Mg, Zn, and Mn levels. Serum Mg and Mn levels were positively associated with the stage of the disease and tumor location, respectively. Cancerous tissue Ca and Mo levels were lower, while Mg content was higher compared to healthy adjacent tissues. In cancerous tissues a constant but non-significant trend to elevation of tissue Zn content with increasing tumor size was observed. In addition, serum Cu, Zn, and Cu/Zn values positively correlated with the respective tumor values. These findings demonstrate that altered biometal metabolism is associated with CRC, while systemic Cu/Zn ratio may be indicative of Cu and Zn imbalance in cancerous tissue.

Diet Quality Scores and Central Precocious Puberty Risk in Chinese Girls: A Case-Control Study

OBJECTIVE

Diet is an important factor influencing central precocious puberty (CPP). This study aimed to investigate the relationship among diet quality, pro-inflammatory diets, and CPP in Chinese girls.

DESIGN, PATIENTS AND MEASUREMENTS

This case-control study enroled 112 Chinese girls with CPP and 131 healthy controls. Children's dietary intake was assessed using a validated food frequency questionnaire, anthropometric and sociodemographic data were collected and serum interleukin-6 levels were measured. We calculated the Children's Dietary Inflammatory Index (C-DII), Chinese Children's Dietary Index (CCDI), Dietary Approaches to Stop Hypertension (DASH) score, and the adjusted Dietary Approaches to Stop Hypertension (aDASH) score. The association between diet and the risk of CPP was analysed using logistic regression models.

RESULTS

After adjustment, higher C-DII scores were associated with an increased risk of CPP (P for trend = 0.034), and aDASH scores were significantly negatively associated with the risk of CPP (P for trend = 0.048). Serum IL-6 levels were significantly higher in the case group than in the control group and were positively correlated with the risk of CPP (P for trend = 0.006).

CONCLUSIONS

High-quality dietary patterns and an anti-inflammatory diet may contribute to the prevention of CPP in Chinese girls.

Clinical and immunohistochemical effects of OncoTherad (MRB-CFI-1) nanoimmunotherapy on SERBP1, HABP4, CD44 and Ki-67 in BCG-unresponsive non-muscle invasive bladder cancer

Non-muscle-invasive bladder cancer (NMIBC) is a malignancy with a high recurrence and progression rate, particularly in patients who fail to respond to standard Bacillus Calmette-Guérin (BCG) therapy. OncoTherad (MRB-CFI-1) nanoimmunotherapy has emerged as a promising therapeutic option, with potential to modulate immune responses and inhibit tumor progression. This study evaluated the clinical efficacy of OncoTherad (MRB-CFI-1) nanoimmunotherapy in patients with BCG-unresponsive NMIBC and investigated correlations between therapeutic outcomes and histopathological and molecular findings. In this retrospective cross-sectional study, 20 patients with BCG-unresponsive NMIBC were treated with OncoTherad (MRB-CFI-1) across two clinical centers. Bladder tissue samples were collected before and after treatment, and immunohistochemical analyses were performed to assess the expression of SERBP1, HABP4, CD44, and Ki-67. Primary endpoints included pathological complete response (pCR), recurrence-free survival (RFS), and duration of response (DoR), which were analyzed in relation to immunohistochemical biomarker findings. Our results demonstrated that high Ki-67 proliferative index and elevated immunoreactivity for CD44 and SERBP1 were associated with shorter RFS. Treatment with OncoTherad (MRB-CFI-1) significantly reduced (p < 0.05) the immunoreactivity of SERBP1 and CD44, which was accompanied by a marked decrease in Ki-67 proliferative index, indicating effective suppression of tumor activity. Conversely, a significant increase (p < 0.05) in HABP4 immunoreactivity was observed, suggesting a protective role against NMIBC recurrence and progression. A pCR was achieved in 65 % of patients, with a median RFS of 21.1 months and a median DoR of 15.7 months, underscoring the clinical efficacy of OncoTherad (MRB-CFI-1). These findings suggest that OncoTherad (MRB-CFI-1) nanoimmunotherapy offers a novel and effective treatment strategy for patients with BCG-unresponsive NMIBC, providing a promising alternative to radical cystectomy and significantly improving patient outcomes.

Notch1 Signalling Is Downregulated by Aerobic Exercise, Leading to Improvement of Hepatic Metabolism in Obese Mice

BACKGROUND AND AIMS

Notch1 protein plays a significant role in hepatic metabolism, as evidenced by its correlation with insulin resistance in the livers of obese individuals, making it an intriguing research target. Therefore, this study aims to investigate the impact of aerobic exercise on Notch1 pathways in the hepatic tissue of obese mice and its role in controlling hepatic metabolism.

METHODS

Therefore, we conducted a cross-sectional study utilising liver biopsies from lean and obese humans, as well as an intervention study involving mice subjected to a high-fat diet. The obese-trained mice group underwent a treadmill-running protocol for 4 weeks.

RESULTS

Our findings revealed that obese individuals exhibited increased NOTCH1 mRNA levels compared to lean subjects. The detrimental effects of Notch1 signalling were confirmed by Notch1-overexpressed HepG2 cell lines. Obese mice with higher hepatic Notch1 signalling demonstrated a reduction in this pathway when subjected to a 4-week treadmill running. Another benefit noticed in this trained group was the amelioration of insulin resistance, as well as a reduction in pyruvate intolerance and gluconeogenic enzymes. Additionally, we observed that these protective findings were accompanied by a decrease in mTORC1 pathway activity and lipid accumulation in the liver. Pharmacological inhibition of Notch1 in obese mice led to an increase in mitochondrial respiration in the liver.

CONCLUSIONS

We conclude that Notch1 signalling may be a potentially useful therapeutic target in obesity, while aerobic exercise training suppresses the Notch1 pathway in the liver, contributing to the regulation of hepatic glucose and lipid metabolism in obese mice.

The prognostic impact of body composition assessed by computed tomography in adult patients with newly diagnosed acute lymphoblastic leukemia

BACKGROUND

Body composition has emerged as a significant determinant of cancer patient outcomes, with computed tomography (CT) assessment at the L3 level offering a reliable evaluation method. While muscle mass and adiposity have been linked to poorer outcomes in hematological malignancies, their impact remains unstudied in adults with acute lymphoblastic leukemia (ALL).

METHODS

This retrospective single-center study enrolled adults newly diagnosed with ALL. Skeletal muscle, visceral, and subcutaneous fat areas were quantified. Low muscle mass was defined as a skeletal muscle index (SMI) less than 55 cm2/m2 in men, and less than 39 cm2/m2 in women, and receiver operating characteristic curves determined cutoff points for SMI, subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI) correlated with mortality.

RESULTS

Ninety patients were included. Low muscle mass was associated with mortality in patients treated with a pediatric inspired regimen (PIR) (HR 4.92, 95 % CI [1.38-17.57], p = 0.014) and lower median SMI was observed in patients who died during induction (p = 0.016). High visceral adiposity (HR 1.89, 95 % CI [1-3.57], p = 0.049) and high subcutaneous adiposity (HR 1.99, 95 % CI [1-3.96], p = 0.05) were also associated with mortality in the whole population. Furthermore, a higher VATI was observed in patients who developed an infectious episode during induction (p = 0.03), and a higher VATI was observed in patients who were treated with a PIR who had measurable residual disease positivity after induction chemotherapy (p = 0.044).

CONCLUSION

CT-assessed muscle mass, and adiposity bear prognostic significance in newly diagnosed ALL patients.

The effect of Helicobacter pylori-derived extracellular vesicles on glucose metabolism and induction of insulin resistance in HepG2 cells

Helicobacter pylori infection has been associated with the development of insulin resistance (IR). This study aimed to examine the effect of H. pylori-derived extracellular vesicles (EVs) on IR induction. EVs were derived from two H. pylori strains, and characterised by transmission electron microscopy and dynamic light scattering. Different concentrations of insulin were added to HepG2 cells to induce IR model. HepG2 cells were exposed to various concentrations of H. pylori-derived EVs to assess IR development. The gene expression of IRS1, AKT2, GLUT2, IL-6, SOCS3, c-Jun and miR-140 was examined using RT-qPCR. Glucose uptake analysis revealed insulin at 5 × 10 -7 mol/l and EVs at 50 µg/ml induced IR model in HepG2 cells. H. pylori-derived EVs downregulated the expression level of IRS1, AKT2, and GLUT2, and upregulated IL-6, SOCS3, c-Jun, and miR-140 expression in HepG2 cells. In conclusion, our findings propose a novel mechanism by which H. pylori-derived EVs could potentially induce IR.

Alleviative effect of probiotics and prebiotics on dry eye in type 2 diabetic mice through the gut-eye axis

Diabetes Mellitus (DM) is a metabolic disease that manifests as a state of "chronic low-grade inflammation". Patients with DM have a disorder of intestinal flora. There is a discernible correlation between this disorder of intestinal flora and the onset and progression of eye diseases, which offers novel insights into treating eye diseases through the modulation of intestinal flora. Here, we demonstrated that a high-fat diet and streptozotocin injection-induced intestinal microbiota dysbiosis can lead to dry eye-like manifestations in T2DM mice. Probiotic and prebiotic treatments not only alleviated intestinal inflammation and barrier disruption, but also mitigated damage to the lacrimal barrier and suppressed immune cell infiltration and inflammatory responses. Additional mechanism investigation found that probiotics and prebiotics inhibited the TLR4/NF-κB signaling pathway and its downstream pro-inflammatory products both in the lacrimal gland and colon. 16S RNA sequencing identified a reduction in the bacterial genera Akkermansia and Lactobacillus in the fecal samples of DM mice. By contrast, treatment with probiotics and prebiotics led to a reshaping of the intestinal microbial community and a reduction in bile acid metabolites, such as taurocholic acid and deoxycholic acid. Our current study demonstrates that probiotic and prebiotic treatments can ameliorate dry eye-like symptoms and associated pathological changes in T2DM mice. Moreover, we proved that a high-fat diet and STZ-induced microbiota dysbiosis were involved in diabetic dry eye through the gut-eye axis.

Sarcopenia in gynaecological cancers

Gynaecological cancers (GCs) comprise a group of cancers that originate in the female reproductive organs. Each GC is unique, with different signs and symptoms, risk factors and therapeutic strategies. Worldwide, the majority of GCs are still associated with high mortality rates, especially ovarian, due to difficulty in early detection. Despite numerous studies on the underlying pathophysiology, research in the field of GCs poses unique scientific and technological challenges. These challenges require a concerted multi- and inter-disciplinary effort by the clinical, scientific and research communities to accelerate the advancement of prognostic, diagnostic, and therapeutic approaches. Sarcopenia is a multifactorial disease which leads to the systemic loss of skeletal muscle mass and function. It can be caused by malignancies, as well as due to malnutrition, physical inactivity, ageing and neuromuscular, inflammatory, and/or endocrine diseases. Anorexia and systemic inflammation can shift the metabolic balance of patients with cancer cachexia towards catabolism of skeletal muscle, and hence sarcopenia. Therefore, sarcopenia is considered as an indicator of poor general health status, as well as the possible indicator of advanced cancer. There is a growing body of evidence showing the prognostic significance of sarcopenia in various cancers, including GCs. This review will outline the clinical importance of sarcopenia in patients with GCs.

Incretin-based therapeutics for the treatment of neurodegenerative diseases

Neurodegenerative diseases (NDDs) represent a heterogeneous group of disorders characterized by progressive neuronal loss, which results in significant deficits in memory, cognition, motor skills, and sensory functions. As the prevalence of NDDs rises, there is an urgent unmet need for effective therapies. Current drug development approaches primarily target single pathological features of the disease, which could explain the limited efficacy observed in late-stage clinical trials. Originally developed for the treatment of obesity and diabetes, incretin-based therapies, particularly long-acting GLP-1 receptor (GLP-1R) agonists and GLP-1R-gastric inhibitory polypeptide receptor (GIPR) dual agonists, are emerging as promising treatments for NDDs. Despite limited conclusive preclinical evidence, their pleiotropic ability to reduce neuroinflammation, enhance neuronal energy metabolism and promote synaptic plasticity positions them as potential disease-modifying NDD interventions. In anticipation of results from larger clinical trials, continued advances in next-generation incretin mimetics offer the potential for improved brain access and enhanced neuroprotection, paving the way for incretin-based therapies as a future cornerstone in the management of NDDs.

Drug-Induced Thrombotic Microangiopathy Arising During the Treatment of Anal Carcinoma After the Use of Mitomycin C

Anal cancer is a rare disease where malignant cells originate in the tissues of the anal canal. This form of cancer is classically treated with a combination of radiation therapy and a chemotherapy regimen that includes mitomycin C. This case illustrates an unusual presentation of thrombotic microangiopathy associated with mitomycin C. A 57-year-old woman with a history of anal carcinoma treated with capecitabine/mitomycin C and radiation was sent to the emergency department by her oncologist for an incidental finding of worsening kidney function noted on a complete metabolic panel done prior to getting radiographic imaging. The patient was admitted to the hospital for suspected acute kidney injury from suspected ureteral obstruction and stent occlusion; however, despite reversal of the stents, renal function did not improve. Renal biopsy confirmed thrombotic microangiopathy and diagnosis of drug-induced thrombotic microangiopathy. This case discusses a side effect of thrombotic microangiopathy from mitomycin C and successful treatment with eculizumab.

The Effects of Concurrent Training Versus Aerobic or Resistance Training Alone on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Introduction and Aim: The beneficial effects of aerobic training (AT) on preventing excess fat mass, and of resistance training (RT) on skeletal muscle adaptation, are well established. However, the effects of concurrent training (CT) compared to AT or RT alone on body composition in middle-aged and older adults are less understood, and therefore, the focus of this meta-analysis. Methods: Three databases, including PubMed, Web of Science, and Scopus, were searched from inception to March 2024. Randomized trials were included if they compared CT versus either AT or RT, and included body composition measures such as fat mass, body fat percentage, waist circumference, visceral fat mass, lean body mass (LBM), muscle mass/volume, or muscle or muscle fiber cross-sectional area (CSA), in middle-aged (50 to <65 years) and older adults (≥65 years). Weighted mean differences (WMD) or standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. Results: A total of 53 studies involving 2873 participants were included. Overall, CT increased body weight and LBM significantly more, trending toward significantly larger increases in muscle mass and CSA, compared with AT alone. However, there were no significant differences between CT and RT alone, for body weight, BMI, body fat percentage, fat mass, waist circumference, or visceral fat mass. Conclusions: CT is as effective as AT for decreasing body fat measures and as effective as RT for increasing muscle mass in middle-aged and older adults, and it should be recommended accordingly.

Muscle Radiodensity Reduction in COVID-19 Survivors Is Independent of NLR Levels During Acute Infection Phase

COVID-19 survivors often experience late symptoms, possibly secondary to an exacerbated inflammatory response. This study aimed to investigate whether inflammatory levels, assessed by the neutrophil-to-lymphocyte ratio (NLR) during hospitalization in the acute phase of SARS-CoV-2 infection, affect the skeletal muscle phenotype and adipose tissue of COVID-19 survivors during outpatient follow-up after discharge. This retrospective, single-center study included COVID-19 survivors hospitalized from March 2020 to April 2021, who attended outpatient follow-ups 3 to 9 months after discharge. Patients were divided into two groups based on inflammatory levels during hospitalization: (1) low NLR (≤4.2) and (2) high NLR (>4.2). The skeletal muscle phenotype and adipose tissue were assessed using computed tomography. The study included 60 patients: 20 low NLR and 40 high NLR. The high NLR group was unexpectedly younger, but had longer hospital stays and required more intensive care. We observed a reduction in skeletal muscle radiodensity and an increase in skeletal muscle fat in both groups. However, we observed no differences in subcutaneous and visceral adipose tissue between hospitalization and follow-up. We conclude that COVID-19 survivors show reduced skeletal muscle radiodensity and increased skeletal muscle fat infiltration post-hospitalization, regardless of NLR levels during acute infection. In addition, age and intramuscular fat infiltration during hospitalization are associated with reducing skeletal muscle radiodensity. This highlights the need for targeted rehabilitation to address long-term muscle effects and recovery.

Predictive value of serum calcium ion level in patients with colorectal cancer: A retrospective cohort study

BACKGROUND

Serum calcium ion (Ca2+) is an economical and readily available indicator as a routine screening test for hospitalized patients. There are no studies related to serum Ca2+ level and digestive tract malignancy.

AIM

To evaluate the effectiveness of serum Ca2+ level in predicting the prognosis of patients with colorectal cancer (CRC).

METHODS

We retrospectively collected the data of 280 patients diagnosed with CRC who underwent radical surgery at the Affiliated Cancer Hospital of Xinjiang Medical University. By analyzing the clinicopathological features, differences between serum Ca2+ concentrations on the first day after surgery were determined. We used the receiver operating characteristic curve to assess the predictive ability of serum Ca2+ for survival. Survival analyses were performed using the Kaplan-Meier method, and multivariate Cox proportional risk regression was used to determine association between calibration serum Ca2+ levels and CRC survival outcomes.

RESULTS

By receiver operating characteristic curve analysis, the ideal threshold value for Ca2+ the first postoperative day and delta serum calcium (δCa2+) value were 1.975 and 0.245, respectively. Overall survival (OS) and progression-free survival (PFS) were better in both the high Ca2+ group and high δCa2+ group on the first postoperative day. The variables identified through univariate analysis were incorporated into multivariate analysis and showed that tumor differentiation (P = 0.047), T stage (P = 0.019), N stage (P < 0.001), nerve vascular invasion (P = 0.037), carcinoembryonic antigen (P = 0.039), baseline serum Ca2+ level (P = 0.011), and serum Ca2+ level on the first day (P = 0.006) were independent predictors of prognosis for patients undergoing feasible radical CRC surgery. Using the findings from the multifactorial analysis, we developed a nomogram and the calibration showed a good predictive ability.

CONCLUSION

Low serum Ca2+ level on the first postoperative day is an independent risk factor for OS and PFS in CRC.

Kumquat Fruit Administration Counteracts Dysmetabolism-Related Neurodegeneration and the Associated Brain Insulin Resistance in the High-Fat Diet-Fed Mice

Metabolic disorders and brain insulin resistance (IR) are major risk factors for the development of neurodegenerative conditions. Kumquat fruit (KF) administration has demonstrated significant anti-dysmetabolic effects, improving peripheral IR in murine models of metabolic syndrome. Along these lines, this study evaluated the neuroprotective effects of KF supplementation in a model of dysmetabolism-induced neuronal damage and its ability to counteract the disruption of brain insulin signalling. To this end, biochemical and histological analysis assessed neuroapoptosis, disruption of brain insulin signalling and neuroinflammation in a model of high-fat diet (HFD)-induced neuronal damage. Our findings demonstrate, for the first time, that KF supplementation significantly counteracts HFD-induced neuroapoptosis downregulating pro-apoptotic genes (FAS-L, BIM and P27) and upregulating the anti-apoptotic ones (BDNF and BCL-2). Coherently, KF positively influenced the expression of selected genes related to Alzheimer's Disease. Relevantly, these effects were associated to KF ability to restore brain insulin signalling by increasing insulin receptor expression, reducing IRS-1 serine phosphorylation, enhancing both AKT activation and GSK-3β inactivation. Accordingly, KF suppressed HFD-neuroinflammation, counteracting the overexpression of NF-κB and its downstream enzymatic products, iNOS and COX-2. Collectively, these findings demonstrate the neuroprotective benefits of KF administration, supporting its potential as a dietary intervention for dysmetabolic-related neurodegenerative disorders.

Diet induced insulin resistance is due to induction of PTEN expression

Insulin resistance is a condition associated with obesity, type 2 diabetes(T2D), hyperinsulinemia, hyperglycemia and defined by reduced sensitivity to insulin signaling. Molecular causes and early signaling events underlying insulin resistance are not well understood. Here we show that insulin activation of PI3K/AKT/mTOR signaling in insulin target tissues, causes mTORC1 induction of PTEN translation, a negative regulator of PI3K signaling. We hypothesized that insulin resistance is due to insulin dependent induction of PTEN that prevents further increases in PI3K signaling. In a diet induced animal model of obesity and insulin resistance, we show that PTEN levels are increased in fat, muscle, and liver. Hyperinsulinemia and PTEN induction are followed by hyperglycemia, severe glucose intolerance, and hepatic steatosis. In response to chronic hyperinsulinemia, PTEN remains increased, while AKT activity is induced transiently before settling down to a PTEN-high and AKT-low state in the tissues, predicted by computational modeling of the PTEN-AKT feedback loop. Treatment with PTEN and mTORC1 inhibitors prevent and reverse the effect of PTEN induction, rescue insulin resistance and increase PI3K/AKT signaling. Thus, we show that PTEN induction by increased insulin levels elevates feedback inhibition of the pathway causing insulin resistance, its associated phenotypes, and is a potential therapeutic target.