Corticosteroids: Mechanisms of Action in Health and Disease

Therapeutic potential of (1 → 4)-linked glucuronoglucan from an edible brown mussel Perna indica: A promising candidate for anti-inflammatory and antidyslipidemic nutraceuticals

The brown mussel, Perna indica (Kuriakose & Nair, 1976), family Mytilidae, is harvested along the southwest coast of India for its rich nutritional composition and therapeutic potential. This study highlights the role of PIP-1, a (1 → 4)-linked glucuronoglucan derived from Perna indica composed of repeating pyranose units of β-d-glucose (Glcp) and α-D-glucuronic acid (GlcAp), in alleviating chronic diseases. PIP-1 demonstrated potent anti-inflammatory activity by attenuating 5-lipoxygenase (5-LOX) and cyclooxygenases (COXs) (IC₅₀ ≤ 1.5 mg/mL), with preferential COX-2 selectivity and reduced nitric oxide levels (IC₅₀ 2.9 μg/mL) in lipopolysaccharide-induced macrophages. In vivo models demonstrated that PIP-1, at higher dose, significantly reduced acute paw edema (91 % within 5 h) induced by carrageenan and chronic paw edema (77 % within day 10) induced by formalin. PIP-1 exhibited a potent antihypercholesterolemic effect by inhibiting 3-hydroxy-3-methylglutaryl-CoA reductase (IC₅₀ 0.86 mg/mL) and significantly reduced triglyceride levels by 8-54 % in Caco-2 cells. In vivo studies showed that PIP-1 reduced total cholesterol by 68 % and triglycerides by 25 % in dyslipidemic rats after 48 h of acute study. In chronic studies, reductions of 19 % in total cholesterol and 46 % in triglycerides were observed after 45 days. The therapeutic potential of PIP-1 largely stems from its electronegative groups, which increase its total polar surface area, thereby facilitating receptor interactions through Van der Waals forces and modulating key metabolic pathways. Given its notable anti-inflammatory and antidyslipidemic effects, PIP-1 presents a promising source for developing nutraceutical products designed to alleviate chronic ailments.

Glucocorticoids as emerging pollutants in surface water: A systematic review on their global occurrence and distribution

Glucocorticoids (GCs) are synthetic drugs widely used for treating several diseases with inflammatory pathophysiology. In general, 1-20% of the concentration of GCs initially administered is eliminated unchanged in the urine while still in its active form, and therefore, fractions of GCs are constantly released in effluents. Currently, water treatment plants do not have sufficiently effective technologies to remove these substances completely, favoring the presence of these emerging pollutants in the effluents of wastewater treatment plants. In this context, we conduct a systematic review to identify studies that found GCs in surface water. The general data of the included studies, the GCs found and their concentration, the water body where the GCs were found, and the place and date of sampling were summarized. GCs have already been found in the surface water of 24 countries, mainly China, Malaysia, and the United States. Countries with the highest concentrations of GCs found in surface water were Mexico, India, and Brazil. Betamethasone, budesonide, corticosterone, cortisol, cortisone, dexamethasone, fludrocortisone, fluticasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, and triamcinolone were reported at concentrations ranging from 0.00098 to 24760 ng/L, including in water for human consumption. Revised data showed that the real presence of these substances worldwide is still underestimated, requiring further studies to determine their real distribution. Furthermore, we believe that some strategies can be adopted to mitigate surface water contamination by GCs, such as the intensification of public programs about educational activities related to the rational use of medicines, and the urgent need to improve and expand the water treatment methods.

Steroid-Induced Ocular Hypertension in Children: A Review on Risk Factors

PURPOSE

Steroid-induced ocular hypertension is poorly understood in children, despite its frequent occurrence. Significant knowledge voids exist in steroid responsiveness, especially in the pediatric population. Therefore, highlighting the most critical risk factors in pediatric patients can help ophthalmologists identify who is at increased risk of developing a high steroid response.

METHODS

A manual search was conducted in PubMed and Google Scholar in search of relevant articles on the steroid-induced glaucoma subtopic.

RESULTS

Key risk factors for high steroid response include glaucoma family history, previous glaucoma diagnosis, young age, steroid type, administration route, and diseases such as vernal keratoconjunctivitis (VKC) and uveitis. Clinically, it presents similarly to primary glaucoma, except for steroid usage history. Steroid cessation or reduction can normalize intraocular pressure (IOP) levels; however, in some cases, pressure-lowering drugs are necessary for treatment.

CONCLUSION

Topical ocular steroids are frequently used by pediatricians and ophthalmologists alike. Understanding the importance of risk factors allows for a timely diagnosis of steroid response and adequate treatment before glaucomatous vision loss can occur.

Perforated peptic ulcers in children: a systematic review

BACKGROUND

Perforated peptic ulcers (PPU) represent a significant complication of peptic ulcers, associated with high mortality. As no systematic review of the literature on PPU in children currently exists, this study aims to summarize findings from studies focusing on its risk factors, etiology, treatment modalities, and outcomes.

METHODS

A systematic review was conducted following the PRISMA guidelines. A literature search was performed on 24 November 2024, using four electronic databases: Web of Science, Scopus, PubMed, and ScienceDirect. The inclusion criteria were studies published in English, focusing on perforated peptic ulcers in paediatric patients. The exclusion criteria were: studies published in languages other than English; publication formats such as conference abstracts, personal communications, and single case reports; studies focusing on non-perforated peptic ulcers; studies involving participants > 18 years; and studies reporting ulcer perforations outside the stomach or duodenum.

RESULTS

Out of 1963 records identified, 12 studies met the inclusion criteria and were included in the review. A total of 239 children with perforated peptic ulcers were analyzed, with a median age of 11 years (range 3.2-16.5 years). The results indicate that ulcer perforations were more prevalent in males (74.8%). Furthermore, duodenal perforations (73%) were more common than gastric perforations (27%). The most commonly reported symptoms were abdominal pain (n = 175, 73.2%), vomiting (n = 82, 34.3%), peritoneal signs (n = 79, 33%), and fever (n = 38, 15.9%). Subdiaphragmatic free air was detected in 141 patients (58.9%). Of the total number of patients, 207 (86.6%) were treated surgically, while 32 (13.4%) received conservative treatment. Regarding the surgical approach, most patients underwent open surgery (n = 143, 69%) compared to laparoscopic repair (n = 64, 31%). Among the surgical procedures, 114 involved simple sutures, with or without an omental patch. Postoperative complications were reported in 30 children (14.5%). Reoperation was required in 4 patients (1.9%), and mortality was recorded in 9 patients (3.8%).

CONCLUSIONS

PPU was more prevalent in males and predominantly located in the duodenum. Ulcer suturing, with or without an omental patch, was the most commonly utilized treatment modality, demonstrating a relatively low complication rate. Further studies are needed to provide more comprehensive and unbiased evidence on PPU in children.

Biocatalytic Synthesis of Corticosteroid Derivatives by Toad-Derived Steroid C21-Hydroxylase

CsCYP21A, a steroid 21-hydroxylase from Bufo bufo gargarizans, exhibits unprecedented sequential oxidations. Optimizing Pichia pastoris biotransformation conditions enhanced C21-hydroxylation selectivity, converting 14 substrates to 21-hydroxylated products, with 10 conversions of >80% and 4 yields of >80%. Hydrocortisone production reached 1.5 g L-1 day-1 with 100 g/L wet biomass. CsCYP21A's versatility enables integration into the synthesis of over 10 steroidal drugs, offering a sustainable biocatalytic platform for green pharmaceutical manufacturing.

Stress regulatory hormones and cancer: the contribution of epinephrine and cancer therapeutic value of beta blockers

The word "cancer" evokes myriad emotions, ranging from fear and despair to hope and determination. Cancer is aptly defined as a complex and multifaceted group of diseases that has unapologetically led to the loss of countless lives and affected innumerable families across the globe. The battle with cancer is not only a physical battle, but also an emotional, as well as a psychological skirmish for patients and for their loved ones. Cancer has been a part of our history, stories, and lives for centuries and has challenged the ingenuity of health and medical science, and the resilience of the human spirit. From the early days of surgery and radiation therapy to cutting-edge developments in chemotherapeutic agents, immunotherapy, and targeted treatments, the medical field continues to make significant headway in the fight against cancer. However, even after all these advancements, cancer is still among the leading cause of death globally. This urges us to understand the central hallmarks of neoplastic cells to identify novel molecular targets for the development of promising therapeutic approaches. Growing research suggests that stress mediators, including epinephrine, play a critical role in the development and progression of cancer by inducing neoplastic features through activating adrenergic receptors, particularly β-adrenoreceptors. Further, our experimental data has also shown that epinephrine mediates the growth of T-cell lymphoma by inducing proliferation, glycolysis, and apoptosis evasion via altering the expression levels of key regulators of these vital cellular processes. The beauty of receptor-based therapy lies in its precision and higher therapeutic value. Interestingly, the enhanced expression of β-adrenergic receptors (ADRBs), namely ADRB2 (β2-adrenoreceptor) and ADRB3 (β3-adrenoreceptor) has been noted in many cancers, such as breast, colon, gastric, pancreatic, and prostate and has been reported to play a pivotal role in facilitating cancer growth mainly by promoting proliferation, evasion of apoptosis, angiogenesis, invasion and metastasis, and chemoresistance. The present review article is an attempt to summarize the available findings which indicate a distinct relationship between stress hormones and cancer, with a special emphasis on epinephrine, considered as a key stress regulatory molecule. This article also discusses the possibility of using beta-blockers for cancer therapy.

Current and emerging therapies for autoimmune encephalitis

INTRODUCTION

Autoimmune encephalitis (AIE) is an inflammatory neurological disorder often associated with autoantibodies targeting neural or glial antigens. Patients with AIE are often treated with immunotherapy, but multiple questions remain about the optimal treatment strategy for common AIE subtypes.

AREAS COVERED

The authors conducted a literature search of PubMed articles and Google Scholar articles using keywords 'autoimmune encephalitis,' 'anti-NMDA receptor encephalitis, 'LG1 encephalitis' from 2005 to 2024. This review briefly outlines the proposed pathophysiology of AIE with autoantibodies toward cell surface vs intracellular antigens. Next, the authors discuss treatments commonly used for AIE, and provide guidance on side effects and monitoring, and the evidence for treatment approaches for anti-NMDAr and LGI1 encephalitis is reviewed. In the final section, an overview of ongoing clinical trials and future therapies for AIE is provided.

EXPERT OPINION

Patients with AIE benefit from treatment with immunotherapy, but the evidence supporting specific treatment strategies is limited to observational studies. Successful clinical trials for AIE will provide new therapy options for patients, and the next generation of therapies may provide more targeted approaches to treating the condition.

Reprogramming human macrophages in symptomatic carotid stenosis: Stabilization of atherosclerotic carotid plaques

BACKGROUND AND AIMS

Inflammation is a precursor to atherosclerotic plaque destabilisation, leading to ischaemic events like stroke. Since macrophage phenotypes can be influenced by their microenvironment, we aimed to stabilise plaques and reduce the risk of recurrent ischaemic events using clinically relevant anti-inflammatory agents.

METHODS

Thirteen carotid plaques from stroke/Transient Ischaemic Attack (TIA) patients undergoing carotid endarterectomy were analysed using immunofluorescence stain to identify macrophage markers (CD68, CD86, MRC1). An in vitro model of human blood-derived macrophages was used to evaluate the effects of statins and glucocorticoids on macrophage-specific markers using RT-qPCR, Western Blot, and immunofluorescence staining. The physiological effects of dexamethasone on macrophages and human carotid plaques were further studied ex vivo.

RESULTS

The macrophage population (CD68+) in the carotid plaques was dominated by "double-positive" (CD86+MRC1+) macrophages (67.8 %), followed by "M1-like" (CD86+MRC1-) (16.5 %), "M2-like" (CD86-MRC1+) (8.7 %) and "double-negative" (CD86-MRC1-) (7.0 %) macrophages. M1-like macrophages were more prevalent in unstable plaque sections than stable ones (p = 0.0022). Exposure to dexamethasone increased macrophage MRC1 gene expression in vitro and ex vivo. It also reduced the expression of the Oxidised Low-Density Lipoprotein Receptor 1 (OLR1) gene and protein, leading to reduced oxLDL uptake in foam cell assays.

CONCLUSIONS

Clinically relevant concentrations of glucocorticoids may shift human macrophages to a less inflammatory state, thus reducing their ability for oxidised LDL uptake. In contrast, this anti-inflammatory mechanism was not observed in response to statins. These findings suggest that glucocorticoids could help prevent ischemic events in patients with advanced atherosclerosis.

Contributors to organ damage in childhood lupus: corticosteroid use and disease activity

OBJECTIVES

Awareness of paediatric-specific predictors of damage in childhood lupus is needed to inform mitigation measures. The objective of this study was to ascertain how clinical and demographic variables correlate with damage accrual and identify predictors of damage.

METHODS

This analysis included UK JSLE Cohort Study participants. Univariable and multivariable Prentice-Williams-Peterson models investigated how demographic and clinical factors influenced the hazards of new damage. Analyses were performed across the entire cohort, in patients with minimal disease activity marked by a time-adjusted average SLEDAI-2K score (AMS) of ≤2, in patients with low activity (AMS of ≤4), patients with moderate-to-high activity (AMS of >4) and patients with no CS use.

RESULTS

Within the entire cohort (n = 430), factors associated with damage included: any methylprednisolone [hazard ratio, HR 2.20 (CI 1.33-3.62)], time-adjusted mean Physician's Global Assessment (PGA) [HR 2.87 (CI 1.48-5.56)] and AMS score [HR 1.13 (CI 1.03-1.24), all P < 0.05]. Within the low activity subgroup, any methylprednisolone [HR 2.61 (CI 1.04-6.53)] and time-adjusted mean PGA [HR 3.41 (CI 1.52-7.76)] were associated with damage (both P < 0.05). Within the moderate-to-high activity subgroup, any methylprednisolone [HR 2.29 (CI 1.31-4.00)], time-adjusted mean PGA [HR 2.66, (CI 1.20-5.87)] and AMS score [HR 1.15 (CI 1.03-1.29)] were predictive of damage (all P < 0.05). Baseline organ damage was predictive of subsequent damage accrual in the minimal disease activity subgroup [HR 1.33 (CI 1.78-8.08)] and the no CSs subgroup [HR 3.64 (CI 1.83-7.24), both P < 0.005].

CONCLUSION

Disease activity levels (AMS/PGA) and proxy indicators (methylprednisolone exposure, baseline damage) were found to be key predictors of damage accrual. This highlights the importance of practical strategies, such as treat-to-target, for reducing disease activity and long-term treatment toxicity.

Neurocognitive risks of asthma during childhood

The impact of chronic medical conditions on the developing brain has gained recent attention, but the neurocognitive risks associated with asthma, which has high prevalence in childhood, are still largely unknown. Recent findings have underscored that children with asthma may be at higher risk for developing cognitive difficulties. In this review, we examine the pathophysiology of asthma and its associations with brain and cognitive development based on rodent models and relatively scant research in humans. We also examine risk factors that may exacerbate asthma symptoms and neurocognitive outcomes, and we discuss why children may be particularly vulnerable to asthma-related neurocognitive consequences. We conclude by providing a framework for future research.

Pharmacology and macrophage modulation of HPGDS inhibitor PK007 demonstrate reduced disease severity in DMD-affected muscles of the mdx mouse model

BACKGROUND

Duchenne Muscular Dystrophy (DMD) is an X-linked disease characterised by chronic inflammation, progressive muscle damage, and muscle loss. Typically, initial symptoms affect lower limb muscles, including the gastrocnemius (GA), tibialis anterior (TA), and extensor digitorum longus (EDL). During the acute phase of DMD, particularly in boys aged 2-8 years, muscle damage resulting in necrosis (myonecrosis) involves a complex immune-inflammatory response. Prostaglandin D2 (PGD2) is recognised for enhancing pro-inflammatory chemokine and interleukin signalling and recruiting infiltrating immune cells such as pro-inflammatory macrophages, exacerbating myonecrosis.

METHODS

To reduce levels of PGD2, a novel hematopoietic prostaglandin D2 synthase (HPGDS) inhibitor, PK007, was characterised (i) for potency and pharmacokinetic profiles and then tested in the mdx mouse model of DMD during the acute early onset of disease progression. Juvenile mdx and wild type (WT) C57Bl/10Scsn mice were orally treated with PK007 and control vehicle solution for 10 days, from postnatal day 18 to 28. This builds upon a previous study with PK007 with (ii) additional analyses of disease progression assessed for muscle grip strength, metabolic and locomotor activity, myonecrosis in a wide range of muscles (3 from hindlimb, diaphragm, heart, and tongue), macrophage infiltration and pro-inflammatory cytokines (TNF-α, IL-1β and iNOS).

RESULTS

PK007 exhibited high potency (17.23 ± 12 nM), a long half-life (3.0 ± 0.3 h), and good oral bioavailability (81%). Treatment with PK007 decreased serum PGD2 levels (33.36%) in mdx mice compared to control (vehicle-treated) mdx mice. In mdx mice (compared with controls), PK007 enhanced grip strength (69.05% increase) and improved locomotor activity (69.05% increase). Histological analysis revealed a significant reduction in the total myonecrotic area in PK007-treated GA (49.75%), TA (73.87%), EDL (60.31%), diaphragm (48.02%), and tongue (37.93%) muscles of mdx mice (compared with controls). Additionally, PK007 decreased macrophage cell area by 55.56% in GA and 47.83% in EDL muscles. Further expression of pro-inflammatory cytokines and enzymes such as TNF-α, IL-1β and iNOS were significantly reduced in PK007 treated mice. These results demonstrate that PK007 significantly reduces the inflammatory response, protects muscles from necrosis and increases strength in juvenile mdx mice.

CONCLUSION

This study lays a strong foundation for progressing the use of HPDGS inhibitors such as PK007, which specifically inhibit PGD2 and reduce inflammation, as a viable therapeutic approach for DMD. This approach protects dystrophic muscles from necrosis and reduces the severity of this debilitating disease, improving outcomes and quality of life.

Pediatric blepharokeratoconjunctivitis: review of epidemiology, pathophysiology, and current treatments

PURPOSE OF REVIEW

This review aims to provide a comprehensive overview of the epidemiology and clinical features of pediatric blepharokeratoconjunctivitis (BKC), with a focus on elucidating the underlying pathophysiology and evaluating new therapeutic strategies.

RECENT FINDINGS

Ongoing research continues to refine the management of pediatric BKC. Recent evidence suggests that disease remission can be achieved in approximately 95% of cases through an integrated approach involving topical or systemic antibiotics, corticosteroids, topical immunosuppressants, and lid hygiene. Notably, a significant advancement in the treatment of Demodex blepharitis is the FDA approval of 0.25% lotilaner ophthalmic solution, which has demonstrated safety and efficacy with twice-daily application over six weeks.

SUMMARY

Pediatric blepharokeratoconjunctivitis is a chronic inflammatory condition affecting the eyelids, conjunctiva, and cornea. It is underdiagnosed and associated with significant vision-threatening complications. While there is no established consensus on the most effective therapeutic strategy, management currently includes lid hygiene, topical/systemic antibiotics, corticosteroids, immunosuppressants, lubricants, and dietary supplements. Challenges arise from its chronicity, recurrence, and lack of standardized treatment protocols. This underscores the importance of early diagnosis, education, and continued research on treatment methods to prevent severe outcomes.

An isotope dilution-liquid chromatography-tandem mass spectrometry-based candidate reference measurement procedure for the quantification of cortisone in human serum and plasma

OBJECTIVES

Cortisone is an inert precursor/metabolite of the potent steroid hormone cortisol. Measurement of serum cortisone levels and the cortisol-cortisone ratio can be useful for the diagnosis of dysfunction in the regulation of cortisol levels (i.e., severe and subtle apparent mineralocorticoid excess, low-renin primary aldosteronism). Therefore, an isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC MS/MS)-based candidate reference measurement procedure (RMP) to quantify cortisone in human serum/plasma was developed and validated.

METHODS

Quantitative nuclear magnetic resonance (qNMR) was utilized to assign absolute content (g/g) and SI-traceability to reference materials used as primary calibrators. A supported liquid extraction sample preparation protocol as well as a two-dimensional heart-cut LC approach for LC-MS/MS analysis were employed to mitigate matrix effects and prevent co-elution of interferences. Selectivity was determined by analyzing a matrix sample containing the analyte, the internal standard and six potential interferents. A post-column infusion experiment and a comparison of standard line slopes were performed to evaluate matrix effects. An extensive protocol over five days was applied to determine precision, accuracy and trueness. Measurement uncertainty (MU) was evaluated in compliance with current guidelines.

RESULTS

This RMP is suitable for analyzing cortisone within the 0.0800-120 ng/mL (0.222-333 nmol/L) range, demonstrating selectivity, sensitivity and matrix independence. Intermediate precision was ≤3.4 %, repeatability was ≤2.9 % across all concentration levels and relative mean bias ranged from -3.7 to 2.8 % across all tested matrices and concentrations. Expanded MU (k=2) for target value assignment (n=6) ranged from 2.1 to 5.5 %, irrespective of concentration or sample type.

CONCLUSIONS

This RMP allows for accurate and reproducible determination of cortisone in human serum and plasma. Implementation of this method supports routine assay standardization and patient sample measurement with confirmed traceability.

Immune Dysregulation in Depression and Anxiety: A Review of the Immune Response in Disease and Treatment

Rates of depression and anxiety have increased significantly in recent decades, with many patients experiencing treatment-resistant symptoms. Beyond psychiatric manifestations, these conditions are associated with heightened risks of suicide, cardiovascular disease, chronic pain, and fatigue. Emerging research suggests that neuroinflammation, immune dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction contribute to their pathophysiology, often interacting bidirectionally with stress. While current first-line treatments primarily target neurotransmitter imbalances, many patients do not achieve symptom resolution, highlighting the need for novel approaches. This review explores the role of immune dysfunction, cytokine activity, and neurotransmitter interactions in depression and anxiety. Additionally, we examine how existing pharmacological and non-pharmacological interventions influence inflammation and immune responses. Understanding these mechanisms may pave the way for more integrative treatment strategies that combine immune modulation with traditional psychiatric therapies.

Risk of hepatocellular carcinoma and cirrhosis decompensation in a large retrospective cohort of cirrhotic patients with autoimmune hepatitis

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that can lead to cirrhosis in up to 30% of patients. Cirrhotic patients are at risk of high morbidity and mortality due to cirrhosis decompensation and hepatocellular carcinoma (HCC). This retrospective study assessed the rates of decompensated cirrhosis and HCC in patients with AIH-related cirrhosis. A total of 774 AIH patients were included, with 40% developing cirrhosis. Over a median follow-up of 8.2 years (IQR 2.9-12.3), the annual incidence of decompensated cirrhosis was 4.25%, with a mean time of 8.2 years from cirrhosis diagnosis to decompensation. Nineteen cirrhotic patients (6.2%) developed HCC, with a yearly incidence rate of 0.63%. Most HCC cases occurred within the first years of cirrhosis diagnosis. The rate of decompensated cirrhosis in AIH patients was lower than in other cirrhotic liver diseases, suggesting AIH may follow a different clinical course. The annual incidence of HCC was also significantly lower than the threshold for HCC surveillance. This indicates the need to reassess current surveillance guidelines, particularly in the late years following a cirrhosis diagnosis.

The transcription factor HHEX maintains glucocorticoid levels and protects adrenals from androgen-induced lipid depletion

Glucocorticoid-producing cells of the adrenal cortex (i.e. zona fasciculata, zF) constitute the critical effectors of the hypothalamic-pituitary-adrenal axis, mediating the mammalian stress response. With glucocorticoids being essential for life, it is not surprising that zF dysfunction perturbs multiple organs that participate in optimizing cardiometabolic fitness. The zF forms a dynamic and heterogenous cell population endowed with the capacity to remodel through the engagement of both proliferative and differentiation programs that enable the adrenal to adapt and respond to diverse stressors. However, the mechanisms that sustain such differential responsiveness remain poorly understood. In this study, we resolved the transcriptome of the steroidogenic lineage by scRNA-seq using Sf1-Cre; Rosa mT/mG reporter mice. We identified HHEX, a homeodomain protein, as the most enriched transcription factor in glucocorticoid-producing cells. We developed new genetic mouse models to demonstrate that HHEX deletion causes glucocorticoid insufficiency in male animals. Molecularly, we demonstrated that HHEX is an androgen receptor (AR) target gene, shaping the sexual dimorphism of the adrenal gland by repressing the female transcriptional program at puberty, while also maintaining zF cholesterol ester content by protecting lipid droplets from androgen-induced-lipophagy. Moreover, our study revealed that, in both sexes, HHEX is crucial for maintaining the identity of the innermost adrenocortical cell subpopulation. Specifically, loss of HHEX impairs the expression of Abcb1b (P-glycoprotein/MDR1), an efflux pump regulating steroid export and cellular levels of xenobiotics. Together, these data demonstrate that HHEX serves as a multi-functional regulator of post-natal adrenal maturation that is potentiated by androgens.

The Role of Pain Medications in Modulating Peripheral Nerve Injury Recovery

Peripheral nerve injuries (PNIs) are common, costly, and cause significant pain. Effective management of PNIs involves tailoring medications to the injury type as well as understanding the pharmacokinetics/pharmacodynamics to support nerve regeneration and reduce pain. Opioids act on opioid receptors to significantly reduce pain for many patients, but there are significant addiction risks and side effects. In addition, opioids may exacerbate pain sensitivity and affect nerve regeneration. Non-steroidal anti-inflammatory drugs or acetaminophen act on cyclooxygenase enzymes and are commonly used for nerve pain, with 34.7% of people using them for neuropathic pain. While effective for mild pain, they are often combined with opioids, gamma-aminobutyric acid (GABA) analogs, lidocaine, or corticosteroids for more severe pain. Corticosteroids, mimicking adrenal hormones like cortisol, treat PNI-related inflammation and pain. Their pharmacokinetics are complex, often requiring local injections in order to minimize systemic risks while effectively treating PNIs. Lidocaine, a common local anesthetic, blocks ion channels in the central nervous system (CNS) and peripheral nerves, providing strong analgesic and anti-inflammatory effects. If used improperly, lidocaine can cause neuronal toxicity instead of anesthetic effect. GABA acts as an inhibitory neurotransmitter in the CNS and its drug analogs like pregabalin and gabapentin can alleviate neuropathic pain by binding to voltage-gated Ca2+ channels, inhibiting neurotransmitter release. These pain medications are commonly prescribed for PNIs despite a limited guidance on their effects on nerve regeneration. This review will discuss these drug's mechanisms of action, pharmacokinetics/pharmacodynamics, and their clinical application to highlight their effect on the PNI recovery.

The impact of hypercortisolism beyond metabolic syndrome on left ventricular performance: a myocardial work analysis

BACKGROUND AND AIMS

Endogenous Cushing's syndrome (CS) is characterized by an unfavorable cardiovascular (CV) and metabolic risk profile, but the potential adverse effects of hypercortisolism on myocardial function are not well known. Myocardial Work analysis is a new echocardiographic method that utilizes left ventricular pressure-strain loops to quantify cardiac performance independent of afterload.

METHODS AND RESULTS

In a cross-sectional analysis, we compared four groups: patients with overt endogenous CS (n = 31, mean age 47 ± 12 years, 71% women), patients with endogenous CS in long-term remission after medical cure (CS-LTR; n = 49, 53 ± 12 years, 78% women), healthy subjects (n = 439; 49 ± 11 years, 57% women), and individuals with metabolic syndrome (n = 305, 59 ± 10 years, 37% women). Both CS patient groups exhibited a CV risk pattern and metabolic profile worse than healthy subjects but better than individuals with metabolic syndrome. Analyses adjusted for sex and age revealed higher Wasted Work both in overt CS (median; quartiles: 105 mmHg%; 74, 147) and CS-LTR (97 mmHg%; 69, 158), respectively, when compared to healthy individuals (75 mmHg%; 54, 109, p < 0.01) or individuals with metabolic syndrome (95 mmHg%, 65, 136, p < 0.05), resulting in compromised Work Efficiency (p < 0.05).

CONCLUSION

Left ventricular performance is compromised in overt CS beyond alterations found in individuals with metabolic syndrome sharing equal CV risk factors and remains so despite biochemical remission during the LTR period. Myocardial Work analysis is suited to detect the subtle yet clinically relevant differences between different phenotypes of myocardial involvement.

Infant development at 14 months in the context of maternal objective and subjective birth experience and infant hair glucocorticoids

BACKGROUND

Evidence suggests maternal birth experience impacts infant health. Alterations of the infant's hypothalamus-pituitary-adrenal (HPA) axis are discussed as one possible underlying mechanism. This study aimed to investigate both objective and subjective birth experience as potential predictors of offspring's hair glucocorticoid concentrations (GCs) and infant development, respectively. Further, we examined the role of hair GCs for prospective infant development in different domains.

METHODS

n = 263 mothers participating in the prospective cohort study DREAMHAIR completed questionnaires about their objective and subjective birth experience approximately eight weeks after birth. Additionally, hair samples from n = 286 infants were taken around ten days (neonatal hair GCs) and eight weeks after birth (infant hair GCs) and long-term integrated hair cortisol and cortisone levels were measured in scalp-near 2-cm segments. Infant development (communication, gross motor, fine motor, problem-solving, personal-social) was assessed 14 months after birth using the Ages and Stages Questionnaire - 3 (ASQ-3).

RESULTS

No significant associations were found between objective or subjective birth experience and most domains of infant development, except that a more negative objective birth experience predicted poorer fine motor skills. Additionally, a more negative objective birth experience was linked to lower infant hair cortisone levels and a higher cortisol/cortisone ratio, while a more negative subjective experience was associated with higher neonatal hair cortisol. Lower neonatal hair cortisone showed a link to poorer personal-social development. However, after correction for multiple testing, only the associations between a more negative objective birth experience and lower hair cortisone and a higher cortisol/cortisone ratio at eight weeks remained significant.

CONCLUSIONS

Objective aspects of the birth experience may have a more enduring impact on infant hair GCs than maternal subjective perceptions, particularly with higher birth complications being linked to lower infant cortisone and a higher infant cortisol/cortisone ratio. Given that this ratio may indicate reduced enzymatic activity in converting cortisol to its inactive form, results suggest that birth complications could affect the infant's glucocorticoid metabolism. No robust associations were found between birth experiences or hair GCs and infant development. Further research in more diverse, at-risk populations is needed to clarify these complex relationships.

Immunomodulatory Effects of Copper Bis-Glycinate In Vitro

Copper functions as a cofactor and antioxidants in a large number of enzymes that are important for cellular respiration and the nervous system. In the last century scholars have explored copper's relationship with the immune system, with copper deficiency drastically upsetting the overall function of the immune system, as seen in symptoms such as increased susceptibility to pathogens, decreased proliferation of lymphocytes, and impaired function of both cytotoxic T lymphocytes and helper T cells. Among copper's various forms, copper bis-glycinate (Cbg) has been used as an official EU-approved oral supplement to promote health. In this study, we observed the influence of Cbg on human epithelial cells (HCE-T cells) to determine its cytotoxicity, anti-reactive oxygen (ROS), and wound healing capabilities. We also evaluated Cbg's anti-inflammatory immune cells like primary human mononuclear cells (PBMCs), monocytic THP-1, and Jurkat cells in the context of anti-inflammation. At all the investigated concentrations of Cbg (0.05-100 μg/mL), ther was no considerable impact detected on the epithelial cells. However, the proliferation rate of stimulated PBMCs was affected progressively (3-50 μg/mL). In CD4+ helper T cells, interleukin (IL)-17 and IL-2 cytokine levels were decreased in a dose-dependent manner, while interferon (IFN)-γ and IL-2 levels were slightly decreased with no noticeable changes between each treated concentration. Furthermore, stimulated monocytic THP-1 cells treated with Cbg reduced IL-6 and significantly reduced tumor necrosis factor (TNF)-α cytokines secretion. Lastly, stimulated Jurkat intracellular Ca2+ influx was significantly inhibited in a dose-dependent manner. Taken together, this study demonstrated that copper possesses modulatory effects on immune cells but not on epithelial cells, but further studies are needed to underline this hypothesis.

Depletion of Fkbp5 Protects Against the Rapid Decline in Ovarian Reserve Induced by Prenatal Stress in Female Offspring of Wild-Type Mice

Prenatal stress (PNS) impairs offspring ovarian development by exerting negative long-term effects on postnatal ovarian function and folliculogenesis. FKBP51 is a stress-responsive protein that inhibits glucocorticoid and progesterone receptors. We hypothesize that FKBP51 contributes to impaired ovarian development and folliculogenesis induced by PNS. Timed-pregnant Fkbp5+/+ (wild-type) and Fkbp5-/- (knockout) mice were randomly assigned to either the undisturbed (nonstress) or PNS group, with exposure to maternal restraint stress from embryonic days 8 to 18. Ovaries from the offspring were harvested and stained, and follicles were counted according to their stages. Ovarian expressions of FKBP51 were evaluated by immunohistochemistry and Fkbp5 and steroidogenic enzymes were evaluated by qPCR. Compared to controls, Fkbp5+/+ PNS offspring had increased peripubertal primordial follicle atresia and fewer total follicles in the adult and middle-aged groups. In adult Fkbp5+/+ offspring, PNS elevated FKBP51 levels in granulosa cells of primary to tertiary follicles. Our results suggest that PNS administration increased FKBP51 levels, depleted the ovarian reserve, and dysregulated ovarian steroid synthesis. However, these PNS effects were tolerated in Fkbp5-/- mice, supporting the conclusion that FKBP51 contributes to reduced ovarian reserve induced by PNS.

Development of Anti-Inflammatory Agents Utilizing DC-SIGN Mediated IL-10 Secretion in Autoimmune and Immune-Mediated Disorders: Bridging Veterinary and Human Health

DC-SIGN (dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin) is a C-type lectin receptor expressed on dendritic cells and M2 macrophages, playing a key role in immune regulation and pathogen recognition. Its ability to mediate anti-inflammatory effects by interacting with specific ligands triggers pathways that suppress pro-inflammatory responses and promote tissue repair, making it a potential therapeutic target for inflammatory and autoimmune diseases. DC-SIGN homologs in various animal species share structural similarities and perform comparable immune functions, offering valuable insights into its broader application across species. By recognizing carbohydrate ligands on pathogens, DC-SIGN facilitates immune modulation, which can be harnessed for developing therapies aimed at controlling inflammation. In veterinary medicine, autoimmune and inflammatory diseases, such as rheumatoid arthritis and inflammatory bowel disease, represent significant challenges, and the anti-inflammatory properties of DC-SIGN could provide new therapeutic options to improve disease management and enhance animal health. Future investigations should focus on the structural and functional analysis of DC-SIGN homologs in various species, as well as the development of preclinical models to translate these findings into clinical interventions bridging veterinary and human health.

Hormone circuit explains why most HPA drugs fail for mood disorders and predicts the few that work

Elevated cortisol in chronic stress and mood disorders causes morbidity including metabolic and cardiovascular diseases. There is therefore interest in developing drugs that lower cortisol by targeting its endocrine pathway, the hypothalamic-pituitary-adrenal (HPA) axis. However, several promising HPA-modulating drugs have failed to reduce long-term cortisol in mood disorders, despite effectiveness in other hypercortisolism conditions such as Cushing's syndrome. The reasons for these failures remain unclear. Here, we use a mathematical model of the HPA axis to demonstrate that the pituitary and adrenal glands compensate for drug effects by adjusting their functional mass, a feedback mechanism absent in Cushing tumors. Our systematic in silico analysis identifies two interventions targeting corticotropin-releasing hormone (CRH) as effective for lowering long-term cortisol. Other targets either fail due to gland mass compensation or harm other aspects of the HPA axis. We propose CRH-neutralizing antibodies and CRH-synthesis inhibitors as potential targets for reducing long-term cortisol in mood disorders and chronic stress. More generally, this study indicates that understanding the slow compensatory mechanisms in endocrine axes can be crucial to prioritize drug targets.

Understanding the molecular bridges between the drugs and immune cell

The interactions of drugs with the host's immune cells determine the drug's efficacy and adverse effects in patients. Nonsteroidal Anti-Inflammatory Drugs (NSAID), such as corticosteroids, NSAIDs, and immunosuppressants, affect the immune cells and alter the immune response. Molecularly, drugs can interact with immune cells via cell surface receptors, changing the antigen presentation by modifying the co-stimulatory molecules and interacting with the signaling pathways of T cells, B cells, Natural killer (NK) cells, mast cells, basophils, and macrophages. Immunotoxicity, resulting from drug-induced changes in redox status, generation of Reactive Oxygen Species (ROS)/Reactive Nitrogen Species (RNS), and alterations in antioxidant enzymes within immune cells, leads to immunodeficiency. This, in turn, causes allergic reactions, autoimmune diseases, and cytokine release syndrome (CRS). The treatment options should include the evaluation of immune status and utilization of the concept of pharmacogenomics to minimize the chances of immunotoxicity. Many strategies in redox, like targeting the redox pathway or using redox-active agents, are available for the modulation of the immune system and developing drugs. Case studies highlight significant drug-immune cell interactions and patient outcomes, underscoring the importance of understanding these complexities. The future direction focuses on the drugs to deliver antiviral therapy, new approaches to immunomodulation, and modern technologies for increasing antidote effects with reduced toxicity. In conclusion, in-depth knowledge of the interaction between drugs and immune cells is critical to protect the patient from the adverse effects of the drug and improve therapeutic outcomes of the treatment process. This review focuses on the multifaceted interactions of drugs and their consequences at the cellular levels of immune cells.

A review of sarcoidosis etiology, diagnosis and treatment

Sarcoidosis is an inflammatory disease characterized by the formation of granulomas in various organs, leading to inflammation and potential organ dysfunction. Symptoms often start with general signs like fatigue, fever, and weight loss, but vary depending on the affected organ. Diagnosis is challenging due to its diverse clinical presentation and lack of a definitive test, while treatment is complicated by the disease's variable course, requiring a personalized approach. This review explores the role of genetic and environmental factors in sarcoidosis etiology, examines current challenges in diagnosis and treatment, and discusses how understanding etiology informs patient management and future treatment strategies.

Energy metabolism in health and diseases

Energy metabolism is indispensable for sustaining physiological functions in living organisms and assumes a pivotal role across physiological and pathological conditions. This review provides an extensive overview of advancements in energy metabolism research, elucidating critical pathways such as glycolysis, oxidative phosphorylation, fatty acid metabolism, and amino acid metabolism, along with their intricate regulatory mechanisms. The homeostatic balance of these processes is crucial; however, in pathological states such as neurodegenerative diseases, autoimmune disorders, and cancer, extensive metabolic reprogramming occurs, resulting in impaired glucose metabolism and mitochondrial dysfunction, which accelerate disease progression. Recent investigations into key regulatory pathways, including mechanistic target of rapamycin, sirtuins, and adenosine monophosphate-activated protein kinase, have considerably deepened our understanding of metabolic dysregulation and opened new avenues for therapeutic innovation. Emerging technologies, such as fluorescent probes, nano-biomaterials, and metabolomic analyses, promise substantial improvements in diagnostic precision. This review critically examines recent advancements and ongoing challenges in metabolism research, emphasizing its potential for precision diagnostics and personalized therapeutic interventions. Future studies should prioritize unraveling the regulatory mechanisms of energy metabolism and the dynamics of intercellular energy interactions. Integrating cutting-edge gene-editing technologies and multi-omics approaches, the development of multi-target pharmaceuticals in synergy with existing therapies such as immunotherapy and dietary interventions could enhance therapeutic efficacy. Personalized metabolic analysis is indispensable for crafting tailored treatment protocols, ultimately providing more accurate medical solutions for patients. This review aims to deepen the understanding and improve the application of energy metabolism to drive innovative diagnostic and therapeutic strategies.

Sensitive and selective silver nanoparticle-based fluorescence sensor for corticosteroid determination in pharmaceutical formulations

Glucocorticoids play a crucial role in metabolic processes and have potent anti-inflammatory and immunosuppressive properties. Hence, developing a facile, sensitive, selective, and green approach to determine corticosteroids is essential. In this study, silver nanoparticles (Ag-NPs) were synthesized via the chemical reduction of silver nitrate using sodium borohydride in distilled water without using non-environmentally friendly organic stabilizers. The synthesized Ag-NPs exhibited high stability, as evidenced by a zeta potential measuring - 36.8 mV. Also, the average particle size was determined to be 8 ± 2 nm. These Ag-NPs were then employed as a nano fluorescence probe to establish a fluorometric assay for determining prednisolone sodium phosphate (PDN) and dexamethasone sodium phosphate (DXZ). Reduction in fluorescence intensity of Ag-NPs observed at 484 nm following excitation at 242 nm exhibited quantitative quenching upon the incremental addition of the investigated drugs, with limits of detection of 0.178 µg/mL and 0.145 µg/mL for PDN and DXZ, respectively. The quenching mechanisms were examined and explained using the Stern-Volmer and Inner Filter Effect methods. The method's selectivity was also assessed by testing other corticosteroids. The proposed method is suitable for drug testing in pharmaceutical products and quality control labs. It follows ICH guidelines and has been confirmed to be safe and eco-friendly.

Nanotechnological approaches to improve corticosteroids ocular therapy

The administration of corticosteroids is the first-line treatment of the clinical conditions with ocular inflammation. Nonetheless, ocular physiological mechanisms, anatomical barriers and corticosteroid properties prevent it from reaching the target site. Thus, frequent topical administered doses or ocular injections are required, leading to a higher risk of adverse events and poor patient compliance. Designing novel drug delivery systems based on nanotechnological tools is a useful approach to overcome disadvantages associated with the ocular delivery of corticosteroids. Nanoparticle-based drug delivery systems represent an alternative to the current dosage forms for the ocular administration of corticosteroids, since due to their particle size and the properties of their materials, they can increase their solubility, improve ocular permeability, control their release and increase bioavailability after their ocular administration. In this way, lipid and polymer-based nanoparticles have been the main strategies developed, giving rise to novel patent applications to protect these innovative drug delivery systems as a product, its preparation or administration method. Additionally, it should be noted that at least 10 clinical trials are being carried out to evaluate the ocular application of different pharmaceutical formulations based on corticosteroid-loaded nanoparticles. Through a comprehensive and extensive analysis, this review highlights the impact of nanotechnology applications in ocular inflammation therapy with corticosteroids.

The Mechanisms and Safety of Corticosteroid Injections in Orthopaedic Surgery

» Corticosteroid injections (CSIs), including intra-articular, perineural, and those involving tendon sheaths or bursae, offer potential relief from osteoarthritic and inflammatory musculoskeletal pain, including gout attacks, as well as tarsal tunnel syndrome, plantar fasciitis, and interdigital neuromas.» CSI for musculoskeletal pain is commonly used as a nonoperative management option for both diagnostic and therapeutic purposes, offering pain relief, typically lasting from days to months.» CSIs are often performed prior to surgery as part of the nonoperative management of many conditions, with multiple CSIs within the year of surgery increasing postoperative infection risk in some major joints.» Despite the potential benefits of CSI, there are risks, including a potential increase in the risk of surgical site infection secondary to bacterial contamination and the immunomodulating effect of corticosteroids when given in the perioperative period.» To date, a multitude of studies across orthopaedic subspecialties has reported on perioperative infection risk associated with CSIs. However, heterogeneity in study design and patient populations has made standardized recommendations challenging. It is, therefore, difficult to elucidate, with a high level of evidence, the most appropriate perioperative timeline for CSI administration for which infection risk is nonsignificant.

Salivary steroids in acute central serous chorioretinopathy

PURPOSE

To analyze levels of salivary steroids, including 17-OH-progesterone (17-OHP), androstenedione, dehydroepiandrosterone, cortisol, cortisone, progesterone, testosterone, and estradiol, in patients with acute central serous chorioretinopathy (CSCR) patients.

METHODS

Acute CSCR patients and healthy individuals were included in this observational case-control study. Levels of salivary steroids were determined by high-performance liquid chromatography with tandem mass spectrometry detection. Clinical characteristics of CSCR patients were assessed based on multimodal imaging.

RESULTS

Seventeen CSCR patients (40.1 ± 4.6 years) and fourteen age-matched healthy controls (40.6 ± 3.8 years) were included. Mean central retinal thickness and subfoveal choroidal thickness in affected eye of CSCR patients were 436.2 ± 131.1 µm and 464.6 ± 132.6 µm, respectively. Mean best-corrected visual acuity was 0.09 ± 0.11 LogMAR. Mean symptoms duration before saliva collection was 0.9 ± 0.6 months. 17-OHP was decreased compared to the normal limits established in healthy controls in 10 out of 17 patients (59%), androstenedione in 15 out of 17 patients (88%), dehydroepiandrosterone in 10 out of 17 patients (59%), cortisol in 6 out of 17 patients (35%), cortisone in 12 out of 17 patients (83%), progesterone in 9 out of 17 patients (53%), testosterone in 10 out of 17 patients (59%), and estradiol in 5 out of 17 patients (29%). In total, among CSCR patients lower level in saliva was found for all studied hormones (p < 0.05), except progesterone and estradiol.

CONCLUSION

Salivary steroids are decreased in acute CSCR male patients compared with age-matched controls. This may indicate inhibition of steroidogenesis caused by chronic stress and personal reactivity preceding manifestation of CSCR.

Sleep deprivation-induced shifts in gut microbiota: Implications for neurological disorders

Sleep deprivation is a prevalent issue in contemporary society, with significant ramifications for both physical and mental well-being. Emerging scientific evidence illuminates its intricate interplay with the gut-brain axis, a vital determinant of neurological function. Disruptions in sleep patterns disturb the delicate equilibrium of the gut microbiota, resulting in dysbiosis characterized by alterations in microbial composition and function. This dysbiosis contributes to the exacerbation of neurological disorders such as depression, anxiety, and cognitive decline through multifaceted mechanisms, including heightened neuroinflammation, disturbances in neurotransmitter signalling, and compromised integrity of the gut barrier. In response to these challenges, there is a burgeoning interest in therapeutic interventions aimed at restoring gut microbial balance and alleviating neurological symptoms precipitated by sleep deprivation. Probiotics, dietary modifications, and behavioural strategies represent promising avenues for modulating the gut microbiota and mitigating the adverse effects of sleep disturbances on neurological health. Moreover, the advent of personalized interventions guided by advanced omics technologies holds considerable potential for tailoring treatments to individualized needs and optimizing therapeutic outcomes. Interdisciplinary collaboration and concerted research efforts are imperative for elucidating the underlying mechanisms linking sleep, gut microbiota, and neurological function. Longitudinal studies, translational research endeavours, and advancements in technology are pivotal for unravelling the complex interplay between these intricate systems.

Early psilocybin intervention alleviates behavioral despair and cognitive impairment in stressed Wistar rats

Chronic stress exerts profound effects on mental health, contributing to disorders such as depression, anxiety, and cognitive impairment. This study examines the potential of psilocybin to alleviate behavioral despair and cognitive deficits in a rodent model of chronic stress, focusing on the interplay between the Hypothalamic-Pituitary-Adrenal (HPA) axis and the Endocannabinoid System (ECS). Twenty-two male Wistar rats were divided into control and stress groups. Animals within the stress group were exposed to predator odor and chronic social instability to induce chronic stress, and were either sham treated, or given psilocybin. Behavioral assessments were conducted using the Open Field Test, Sucrose Preference Test, Novel Object Recognition, Elevated Plus Maze, and Forced Swimming Test to evaluate locomotion, anhedonia, memory, anxiety, and behavioral despair, respectively. Blood and brain samples were analyzed for biochemical markers. Results indicated that psilocybin significantly reduced stress-induced behavioral despair and cognitive impairments, likely through ECS-mediated downregulation of the HPA axis. These findings suggest that early intervention with psilocybin has sustained beneficial effects on stress-related behavioral and cognitive disturbances, underscoring its potential as a novel therapeutic approach for stress-related mental health disorders.

The Potential Anti-psoriatic Effects of Andrographolide: A Comparative Study to Topical Corticosteroids

BACKGROUND

Andrographolide (AP), a bioactive anti-inflammatory compound of Sambiloto, inhibits NF-κB, TNF-α, and interleukin IL-6. Nowadays, molecular docking simulation between AP and dexamethasone against NF-κB receptor presented the energy AP higher than dexamethasone. This becomes a potential treatment for psoriasis.

OBJECTIVE

This manuscript reported the effectiveness of AP from Sambiloto in treating psoriasis compared to topical steroids.

METHODS

This study conducted TLC analysis of AP content and its metabolite impurities, emulgel formulation, molecular docking, in-silico skin toxicity study, and in-vivo anti-psoriatic activity. This was a combination study of an in-silico study and an in-vivo study. This in-silico study was analyzed through multivariate statistical analysis (PCA) to elucidate the data constellation relationship of andrographolide derivatives with several target proteins. The intervention was performed in seven days. The PASI score, molecular parameters (IL-6, IL-17, VEGF, and TNF-a levels), and histopathological findings were assessed.

RESULTS

Molecular docking results revealed andrographolide to exhibit a relatively high binding affinity towards IL-6, NF-kB, and TNF-α which is comparable to the corticosteroids, andrographolide also shares similar residue interaction profile with each of the respective protein's native ligand. In the in-vivo study, we found several parameters statistically significantly different regarding the intervention, including final PASI score (p = 0.017), redness (p = 0.017), scale (p = 0.040), thickness (p = 0.023), total histopathology of psoriasis score (p = 0.037), keratin layer score (p = 0.018).

CONCLUSION

Emulgel AP 0.1% could lower the anti-inflammatory agent, which is vital to psoriasis progression.

Highly Sensitive LC-MS/MS Method for Determination of Dexamethasone in Rat Plasma and Brain Tissue: An Application to Pharmacokinetic Study in Rats

A highly sensitive and rapid LC-MS/MS method was developed and validated for the quantification of dexamethasone in rat plasma and brain tissue. Protein precipitation method was used for sample preparation. The separation of dexamethasone and the IS (labetalol) was achieved on an Atlantis dC18 column using an isocratic mobile phase (10 mM ammonium formate and acetonitrile, 25/75, v/v) delivered at 0.7 mL/min flow-rate. Dexamethasone and the IS were eluted at 1.03 and 1.06 min, respectively. The MS/MS transitions monitored were m/z 393.100 → 373.100 (dexamethasone) and 329.100 → 91.100 (IS). Method validation was performed as per FDA guidelines and all parameters met the acceptance criteria. The assay was validated with a quantification range of 0.05-1046 ng/mL in both matrices. The intraday and interday precision for were in the range of 2.62-7.28 and 2.76%-6.98% and 2.24-6.85 and 2.97%-6.37%, in plasma and brain tissue, respectively. Dexamethasone was stable in a series of stability conditions in both matrices. Post-intravenous administration to rats, dexamethasone concentrations in plasma and brain tissue were quantifiable up to 24 and 10 h, respectively. Dexamethasone half-life was ~2.30 h. Dexamethasone exhibited low clearance and moderate volume of distribution in plasma but in brain tissue the clearance and volume of distribution were high.

Defining the Differential Corticosteroid Response Basis from Multiple Omics Approaches

Since their discovery, corticosteroids have been widely used in the treatment of several diseases, including asthma, acute lymphoblastic leukemia, chronic obstructive pulmonary disease, and many other conditions. However, it has been noted that some patients develop undesired side effects or even fail to respond to treatment. The reasons behind this have not yet been fully elucidated. This poses a significant challenge to effective treatment that needs to be addressed urgently. Recent genomic, transcriptomic, and other omics-based approximations have begun to shed light into the genetic factors influencing interindividual variability in corticosteroid efficacy and its side effects. Here, we comprehensively revise the recent literature on corticosteroid response in various critical and chronic diseases, with a focus on omics approaches, and highlight existing knowledge gaps where further investigation is urgently needed.

Use of corticosteroids in non-infectious uveitis - expert consensus in Taiwan

PURPOSE

To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies.

METHODS

Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established.

RESULTS

A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS.

CONCLUSION

While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.

Neutrophils in Atopic Dermatitis

Neutrophils have a critical role in inflammation. Recent studies have identified their distinctive presence in certain types of atopic dermatitis (AD), yet their exact function remains unclear. This review aims to compile studies elucidating the role of neutrophils in AD pathophysiology. Proteins released by neutrophils, including myeloperoxidase, elastase, and lipocalin, contribute to pruritus progression in AD. Neutrophilic oxidative stress and the formation of neutrophil extracellular traps may further worsen AD. Elevated neutrophil elastase and high-mobility group box 1 protein expression in AD patients' skin exacerbates epidermal barrier defects. Neutrophil-mast cell interactions in allergic inflammation steer the immunological response toward Th2 imbalance and activate the Th17 pathway, particularly in response to allergens or infections linked to AD. Notably, drugs alleviating pruritic symptoms in AD inhibit neutrophilic inflammation. In conclusion, these findings underscore that neutrophils may be therapeutic targets for AD symptoms, emphasizing their inclusion in AD treatment strategies.

The biological basis for current treatment strategies for granulomatous disease in common variable immunodeficiency

PURPOSE OF REVIEW

The pathogenesis of granulomatous disease in common variable immunodeficiency (CVID) is still largely unknown, which hampers effective treatment. This review describes the current knowledge on the pathogenesis of granuloma formation in CVID and the biological basis of the current treatment options.

RECENT FINDINGS

Histological analysis shows that T and B cells are abundantly present in the granulomas that are less well organized and are frequently associated with lymphoid hyperplasia. Increased presence of activation markers such as soluble IL-2 receptor (sIL-2R) and IFN-ɣ, suggest increased Th1-cell activity. Moreover, B-cell abnormalities are prominent in CVID, with elevated IgM, BAFF, and CD21low B cells correlating with granulomatous disease progression. Innate immune alterations, as M2 macrophages and neutrophil dysregulation, indicate chronic inflammation. Therapeutic regimens include glucocorticoids, DMARDs, and biologicals like rituximab.

SUMMARY

Our review links the biological context of CVID with granulomatous disease or GLILD to currently prescribed therapies and potential targeted treatments.

Chronic corticosterone administration alters synaptic mitochondrial function within the hippocampus of C57Bl/6NTac mice

Chronic activation of the hypothalamic-pituitary-adrenal axis increases circulating corticosterone levels, causing a host of downstream behavioral, molecular, and metabolic changes. Here, we assess the effects of chronic exogenous CORT administration on changes in behavior and mitochondrial respiration in hippocampal synaptosomes of male and female mice. Adult male (n = 15) and female (n = 17) C57Bl/6NTac mice were given 35ug/mL CORT or vehicle dissolved in their drinking water for 21 consecutive days. Chronic CORT increased piloerection in males only. Although volume of CORT-containing water consumed was similar between males and females, circulating plasma and fecal corticosterone levels were only elevated in CORT-exposed males. Behavioral effects of CORT were evident in the Y-maze such that CORT caused a decrease in direct revisits in both sexes. There was no observed presentation of anxiety-like behavior following chronic CORT administration. Functional hippocampal synaptosomes were analyzed for mitochondrial respiration using Agilent's Cell Mito Stress test. Chronic CORT caused a decrease in synaptic mitochondria basal respiration, maximal respiration, proton leak, and ATP production in both sexes. Despite only observing an effect of chronic CORT on corticosterone concentrations in fecal and blood samples of males, chronic CORT induced marked changes in hippocampal synaptic mitochondrial function of both sexes. These data highlight the importance of considering effects of stress hormone exposure on neural function even in the absence of measurable peripheral elevations in females.

StressFit: a hybrid wearable physicochemical sensor suite for simultaneously measuring electromyogram and sweat cortisol

This study introduces StressFit, a novel hybrid wearable sensor system designed to simultaneously monitor electromyogram (EMG) signals and sweat cortisol levels. Our approach involves the development of a noninvasive skin patch capable of monitoring skin temperature, sweat pH, cortisol levels, and corresponding EMG signals using a combination of physical and electrochemical sensors integrated with EMG electrodes. StressFit was optimized by enhancing sensor output and mechanical resilience for practical application on curved body surfaces, ensuring accurate acquisition of cortisol, pH, body temperature, and EMG data without sensor interference. In addition, we integrated an onboard data processing unit with Internet of Things (IoT) capabilities for real-time acquisition, processing, and wireless transmission of sensor measurements. Sweat cortisol and EMG signals were measured during cycling exercises to evaluate the sensor suite's performance. Our results demonstrate an increase in sweat cortisol levels and decrease in the EMG signal's power spectral density following exercise. These findings suggest that combining sweat cortisol levels with EMG signals in real-time could serve as valuable indicators for stress assessment and early detection of abnormal physiological changes.

Multi-ancestry genome-wide association study reveals novel genetic signals for lung function decline

Rationale

Accelerated decline in lung function contributes to the development of chronic respiratory disease. Despite evidence for a genetic component, few genetic associations with lung function decline have been identified.

Objectives

To evaluate genome-wide associations and putative downstream functionality of genetic variants with lung function decline in diverse general population cohorts.

Methods

We conducted genome-wide association study (GWAS) analyses of decline in the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and their ratio (FEV1/FVC) in participants across six cohorts in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the UK Biobank. Genotypes were imputed to TOPMed (CHARGE cohorts) or Haplotype Reference Consortium (HRC) (UK Biobank) reference panels, and GWAS analyses used generalized estimating equation models with robust standard error. Models were stratified by cohort, ancestry, and sex, and adjusted for important lung function confounders and genotype principal components. Results were combined in cross-ancestry and ancestry-specific meta-analyses. Selected top variants were tested for replication in two independent COPD-enriched cohorts.

Measurements and Main Results

Our discovery analyses included 52,056 self-reported White (N=44,988), Black (N=5,788), Hispanic (N=550), and Chinese American (N=730) participants with a mean of 2.3 spirometry measurements and 8.6 years of follow-up. Functional mapping of GWAS meta-analysis results identified 361 distinct genome-wide significant (p<5E-08) variants in one or more of the FEV1, FVC, and FEV1/FVC decline phenotypes, which overlapped with previously reported genetic signals for several related pulmonary traits. Of these, 8 variants, or 20.5% of the variant set available for replication testing, were nominally associated (p<0.05) with at least one decline phenotype in COPD-enriched cohorts (White [N=4,778] and Black [N=1,118]). Using the GWAS results, gene-level analysis implicated 38 genes, including eight (XIRP2, GRIN2D, SATB1, MARCHF4, SIPA1L2, ANO5, H2BC10, and FAF2) with consistent associations across ancestries or decline phenotypes. Annotation class analysis revealed significant enrichment of several regulatory processes for corticosteroid biosynthesis and metabolism. Drug repurposing analysis identified 43 approved compounds targeting eight of the implicated 38 genes.

Conclusions

Our multi-ancestry GWAS meta-analyses identified numerous genetic loci associated with lung function decline. These findings contribute knowledge to the genetic architecture of lung function decline, provide evidence for a role of endogenous corticosteroids in the etiology of lung function decline, and identify drug targets that merit further study for potential repurposing to slow lung function decline and treat lung disease.

Current Challenges and Future Directions in the Assessment of Glucocorticoid Status

Glucocorticoid (GC) hormones are secreted in a circadian and ultradian rhythm and play a critical role in maintaining physiological homeostasis, with both excess and insufficient GC associated with adverse effects on health. Current assessment of GC status is primarily clinical, often in conjunction with serum cortisol values, which may be stimulated or suppressed depending on the GC disturbance being assessed. In the setting of extreme perturbations in cortisol levels ie, markedly low or high levels, symptoms and signs of GC dysfunction may be overt. However, when disturbances in cortisol GC status values are less extreme, such as when assessing optimization of a GC replacement regimen, signs and symptoms can be more subtle or nonspecific. Current tools for assessing GC status are best suited to identifying profound disturbances but may lack sensitivity for confirming optimal GC status. Moreover, single cortisol values do not necessarily reflect an individual's GC status, as they are subject to inter- and intraindividual variation and do not take into account the pulsatile nature of cortisol secretion, variation in binding proteins, or local tissue concentrations as dictated by 11beta-hydroxysteroid dehydrogenase activity, as well as GC receptor sensitivity. In the present review, we evaluate possible alternative methods for the assessment of GC status that do not solely rely on the measurement of circulating cortisol levels. We discuss the potential of changes in metabolomic profiles, micro RNA, gene expression, and epigenetic and other novel biomarkers such as growth differentiating factor 15 and osteocalcin, which could in the future aid in the objective classification of GC status.

Leveraging nuclear receptor mediated transcriptional signaling for drug discovery: Historical insights and current advances

Nuclear receptors (NRs) are ligand-activated transcription factors that regulate gene expression in response to physiological signals, such as hormones and other chemical messengers. These receptors either activate or repress the transcription of target genes, which in turn promotes or suppresses physiological processes governing growth, differentiation, and homeostasis. NRs bind to specific DNA sequences and, in response to ligand binding, either promote or hinder the assembly of the transcriptional machinery, thereby influencing gene expression at the transcriptional level. These receptors are involved in a wide range of pathological conditions, including cancer, metabolic disorders, chronic inflammatory diseases, and immune system-related disorders. Modulation of NR function through targeted drugs has shown therapeutic benefits in treating such conditions. NR-targeted drugs, which either completely or selectively activate or block receptor function, represent a significant class of clinically valuable therapeutics. However, the pathways of NR-mediated gene expression and the resulting physiological effects are complex, involving crosstalk between various biomolecular components. As a result, NR-targeted drug discovery is challenging. With improved understanding of how NRs regulate physiological functions and deeper insights into their molecular structure, the process of NR-targeted drug discovery has evolved. While many traditional NR-targeting drugs are associated with side effects of varying severity, new drug candidates are being designed to minimize these adverse effects. Given that NR activity varies according to the tissue in which they are expressed and the specific isoform that is activated or repressed, achieving selectivity in targeting specific tissues and isoform classes may help reduce systemic side effects. In a recent breakthrough, the isoform-selective, hepato-targeted thyroid hormone-β agonist, Resmetirom (marketed as Rezdiffra), was approved for the treatment of non-alcoholic steatohepatitis. This chapter explores the structural and mechanistic principles guiding NR-targeted drug discovery and provides insights into recent developments in this field.

Glucocorticoids influence on rat hematological parameters and catalase activity

In this study, the impact of glucocorticoid, betamethasone dipropionate on enzyme activity in vitro and its effects on hematological parameters in vivo was investigated. The immobilized catalase, crucial for cell oxidative stress response via hydrogen peroxide reduction, exhibited a robust electrocatalytic response, maintaining its biological activity. The in vitro inhibition kinetics of catalase, as determined by electrocatalytic methods and expressed using Lineweaver-Burke diagrams, revealed an uncompetitive type of inhibition with altered Imax and Km in the presence of a range of betamethasone dipropionate concentrations. The in vivo experiments conducted on Rattus norvegicus demonstrated significant alterations in hematological parameters following betamethasone dipropionate administration. These changes included a decrease in erythrocyte count, an increase in hemoglobin, a reduction in mean corpuscular volume (MCV), and an elevation in mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). Notably, the leukocyte counts substantially increased. The observed hematological shifts suggest an impact of betamethasone dipropionate on the hematopoietic system, reinforcing the need for cautious corticosteroid administration. The findings underline the necessity for judicious corticosteroid treatment, acknowledging both enzymatic and systemic repercussions.

Glucocorticoid Receptor Isoforms in Breast Cancer Raise Implications for Personalised Supportive Therapies

Glucocorticoid receptor (GR) activation may promote metastasis in oestrogen receptor-negative and triple-negative breast cancer (TNBC). However, the role of the GRβ isoform, which has opposing effects to the main isoform, has not been studied in clinical samples. We aimed to analyse the intracellular localisation of total GR and GRβ in vitro using plasmid constructs and fluorescent immunocytochemistry. Additionally, our goal was to perform immunostaining for total GR and GRβ on two cohorts: (i) on 194 clinical breast cancer samples to compare the expression in different molecular subtypes, and (ii) on 161 TNBC samples to analyse the association of GR with survival. We supplemented our analysis with RNA data from 1097 TNBC cases. We found that in the absence of the ligand, GR resided in the cytoplasm of breast cancer cells, while upon ligand activation, it translocated to the nucleus. A negative correlation was found between cytoplasmic GRtotal and Ki67 in luminal A tumours, while the opposite trend was observed in TNBC samples. Tumours with strong lymphoid infiltration showed higher cytoplasmic GRtotal staining compared to those with weaker infiltration. Patients with high nuclear GRtotal staining had shorter progression-free survival in univariate analysis. High cytoplasmic GRβ was a marker for better overall survival in multivariate analysis (10-year overall survival HR [95% CI]: 0.46 [0.22-0.95], p = 0.036). As a conclusions, this study is the first to investigate GRβ expression in breast tumours. Different expression and cellular localisation of GRtotal and GRβ were observed in the context of molecular subtypes, underscoring the complex role of GR in breast cancer. An inverse association between cytoplasmic GRtotal and the Ki67 proliferation index was observed in luminal A and TNBC. Regarding the impact of GR on outcomes in TNBC patients, while cytoplasmic GRβ was associated with a better prognosis, patients with nuclear GRtotal staining may be at a higher risk of disease progression, as it negatively affects survival. Caution should be exercised when using glucocorticoids in patients with nuclear GR staining, as it may negatively impact survival.

Effectiveness of Local Glucocorticoid Infiltration Versus Traditional Gauze Bandaging for the Treatment of Onychocryptosis: A Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Local intralesional corticosteroid injections into the periungual fold are used to treat patients with onychocryptosis, but their short- or medium-term effects are unknown. The goal was to compare the efficacy of this treatment in stages IIa, IIb, and III of the condition with a common conservative method such as gauze bandaging.

METHODS

A two-arm randomized trial with 40 patients with stage IIa, IIb, and III onychocryptosis equally assigned into two treatment groups-control (spiculotomy and application of gauze bandaging) and experimental group (spiculotomy and infiltration of corticosteroid)-was performed. Anthropometric data, initial clinical status, pain, and inflammatory measures were collected before and at least one month after the intervention.

RESULTS

Pain reduction was higher in the experimental group (5.5 vs. 4.8 points) but with no significant differences (p = 0.306).Corticosteroids significantly reduced inflammation over gauze bandaging (1.9 vs. 1) with significant differences between them (p = 0.029).

CONCLUSIONS

Corticosteroid infiltration was more effective than gauze bandaging application in reducing inflammation in patients with onychocryptosis, with similar effects on pain. These findings support the clinical importance of corticosteroid treatment for this condition, although a single infiltration may not be sufficient to prevent relapses.

Molecular and Genetics Perspectives on Primary Adrenocortical Hyperfunction Disorders

Adrenocortical disorders encompass a broad spectrum of conditions ranging from benign hyperplasia to malignant tumors, significantly disrupting hormone balance and causing a variety of clinical manifestations. By leveraging next-generation sequencing and in silico analyses, recent studies have uncovered the genetic and molecular pathways implicated in these transitions. In this review, we explored the molecular and genetic alterations in adrenocortical disorders, with a particular focus on the transitions from normal adrenal function to hyperfunction. The insights gained are intended to enhance diagnostic and therapeutic strategies, offering up-to-date knowledge for managing these complex conditions effectively.

Increased Risk of Non-Hodgkin Lymphoma in Autoimmune Hepatitis: A Large Retrospective Cohort Study

Background/Objectives: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease caused by an autoimmune attack on hepatocytes. The first-line treatment for AIH comprises two core components: glucocorticoids and thiopurine analog inhibitors and mycophenolate mofetil (MMF). Numerous studies have suggested an increased risk for lymphoma among patients with either rheumatoid arthritis or inflammatory bowel disease (IBD) who are treated with azathioprine/6-mercaptopurine (6-MP). The relative risk of non-Hodgkin lymphoma (NHL) among autoimmune hepatitis patients treated with these immunosuppressive drugs remains unclear. We aimed at investigating the risk of NHL across a large retrospective AIH cohort after a long-term follow-up. Methods: This retrospective, population-based study comprised approximately 2.7 million adults over two decades. It included adult patients aged 20 years or older at the time of autoimmune hepatitis diagnosis who had initiated treatment with azathioprine, 6-MP, or MMF. The primary outcome was the development of non-Hodgkin lymphoma. Results: The study initially included 834 patients diagnosed with AIH. A total of 685 patients remained in the research cohort after matching the data to the local cancer registry. Compared to the predicted NHL rate in the general population, NHL incidence was considerably higher in AIH patients (Standardized Incidence Ratio, SIR = 36.5). Subgroup studies showed that lymphoma mainly affected patients 45 years of age and over and was detected primarily during the first seven years following the AIH diagnosis. No correlation was found between the incidence of NHL and the treatment drug used. Conclusions: Patients with AIH exhibit a markedly higher risk of NHL compared to the general population.

Targeting of oxidized Macrophage Migration Inhibitory Factor (oxMIF) with antibody ON104 attenuates the severity of glomerulonephritis

The oxidized form of Macrophage Migration Inhibitory Factor (oxMIF) has been identified as the disease-related isoform of MIF, exerting pathological functions in inflamed tissue. In this study, we aimed to explore the in vivo effects of the neutralizing anti-oxMIF antibody ON104 in a rat model of crescentic glomerulonephritis (CGN), to better understand its disease modifying activities. WKY rats received a single intravenous injection of a rabbit nephrotoxic serum (NTS), targeting rat glomerular basement membrane to induce CGN. On day 4 and day 6, ON104 was given intraperitoneally (i.p.) and on day 8 urine, blood and kidney tissue were collected. ON104 substantially attenuated the severity of CGN demonstrated by reduced proteinuria, hematuria, as well as lower levels of kidney injury molecule (KIM)-1. ON104 treatment preserved the glomerular morphology and suppressed crescent formation, a hallmark of the disease. On the cellular level, oxMIF neutralization by ON104 strongly reduced the number of macrophages and neutrophils within the inflamed kidneys. In vitro, we identified human neutrophils, but not monocytes, as main producers of oxMIF among total peripheral cells. The present study demonstrates that oxMIF is a pertinent therapeutic target in a model of CGN which mechanistically resembles human immune mediated CGN. In this model, neutralization of oxMIF by ON104 leads to an improvement in both urinary abnormalities and histological pathological characteristics of the disease. ON104, thus has the potential to become a novel disease-modifying drug for the treatment of glomerulonephritis and other inflammatory kidney diseases.