Type 1 diabetes mellitus

Comprehensive investigation into the discrete toxicity of curcumin on β-cell viability and insulin secretion

BACKGROUND

Curcumin possesses several therapeutic benefits. However, the precise mechanisms underlying these actions have not been fully elucidated. The aim of this study was to highlight the toxic effects on β-cells and islets.

METHODS

The toxic effects of curcumin were investigated on cell viability in ALB/c mouse-isolated Langerhans islets and NIT1 cells (CRL-2055™, a NOD mouse β cell line), and insulin secretion. We evaluated its effects on oxidative stress markers, ROS production, and its role in ER stress through the stimulation of three genes involved in the UPR response. In silico and in vitro studies were conducted to extract a set of genes and curcumin-PPI using a multistep pipeline.

RESULTS

Curcumin increases cell viability and insulin secretion in islets of Langerhans. At 60 μg/mL (0,163 μM), curcumin affected β-cell viability, reducing it by up to 70-75 %, and significantly reduced insulin secretion. It also induces oxidative stress and increases the expression of NFKB1, ATF4, and CHOP. These effects were enhanced when curcumin was combined with STZ. Bioinformatic studies have indicated that curcumin interacts with 14 proteins, including Jund, Ddit3, Dapk3, Cebpa, and the NFkB pathway through NFkBia.

CONCLUSION

At high concentrations, curcumin is cytotoxic. It induces β-cell apoptosis associated with UPR-ER and oxidative stress, implicating the NFkB pathway and its associated proteins.

A decade review on phytochemistry and pharmacological activities of Cynomorium songaricum Rupr.: Insights into metabolic syndrome

BACKGROUND

Cynomorium songaricum Rupr. (CSR), a perennial herb with a rich history in traditional medicine, has demonstrated therapeutic potential against metabolic syndrome (MetS) through its active compounds, including proanthocyanidins, polysaccharides, and triterpenoids. MetS, a global health concern, encompasses interlinked conditions such as obesity, type 2 diabetes mellitus (T2DM), and inflammation. This review synthesizes recent findings on CSR's pharmacological and phytochemical properties, focusing on its role in ameliorating MetS.

METHODS

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were retrieved from PubMed, Web of Science, and CNKI databases up to December 2024. Keywords included "Cynomorium Songaricum Rupr.", "Cynomorii Herba", "Suoyang", "Suo Yang", "Metabolic syndrome", "Proanthocyanidins", "Polysaccharides" and "Triterpenoids" and their combinations. Inclusion criteria emphasized studies exploring CSR's impact on MetS, while duplicate, low-quality studies and studies not written in Chinese, English, or unrelated were excluded.

RESULTS

A total of 92 studies were analyzed, revealing that CSR's active components exhibit multi-target effects. Proanthocyanidins reduce glucose absorption and oxidative stress, polysaccharides enhance insulin sensitivity and gut microbiota composition, and triterpenoids mitigate obesity and mitochondria damage. These mechanisms collectively contribute to the beneficial effects of CSR against MetS.

CONCLUSION

CSR presents a promising natural therapy for MetS, utilizing its pharmacologically active compounds to address core metabolic dysfunctions. Future studies should focus on clinical validation and safety assessments to facilitate CSR's integration into modern therapeutic regimens.

T helper 17 cells and interleukin-17 immunity in type 1 diabetes: From pathophysiology to targeted immunotherapies

Type 1 diabetes (T1D) is a chronic organ-specific autoimmune disorder characterized by a progressive loss of the insulin-secreting pancreatic beta cells, which ultimately results in insulinopenia, hyperglycemia and lifelong need for exogenous insulin therapy. In the pathophysiological landscape of T1D, T helper 17 cells (Th17 cells) and their hallmark cytokine, interleukin (IL)-17, play pivotal roles from disease onset to disease progression. In this narrative mini-review, we discuss the dynamic interplay between Th17 cells and IL-17 in the context of T1D, providing insights into the underlying immunologic mechanisms contributing to the IL-17-immunity-mediated pancreatic beta-cell destruction. Furthermore, we summarized the main animal and clinical studies that investigated Th17- and IL-17-targeted interventions as promising immunotherapies able to alter the natural history of T1D.

The unfolded protein response is a potential therapeutic target in pathogenic fungi

Pathogenic fungal infections cause significant morbidity and mortality, particularly in immunocompromised patients. The frequent emergence of multidrug-resistant strains challenges existing antifungal therapies, driving the need to investigate novel antifungal agents that target new molecular moieties. Pathogenic fungi are subjected to various environmental stressors, including pH, temperature, and pharmacological agents, both in natural habitats and the host body. These stressors elevate the risk of misfolded or unfolded protein production within the endoplasmic reticulum (ER) which, if not promptly mitigated, can lead to the accumulation of these proteins in the ER lumen. This accumulation triggers an ER stress response, potentially jeopardizing fungal survival. The unfolded protein response (UPR) is a critical cellular defense mechanism activated by ER stress to restore the homeostasis of protein folding. In recent years, the regulatory role of the UPR in pathogenic fungi has garnered significant attention, particularly for its involvement in fungal adaptation, regulation of virulence, and drug resistance. In this review, we comparatively analyze the UPRs of fungi and mammals and examine the potential utility of the UPR as a molecular antifungal target in pathogenic fungi. By clarifying the specificity and regulatory functions of the UPR in pathogenic fungi, we highlight new avenues for identifying potential therapeutic targets for antifungal treatments.

Emerging roles of mechanically activated ion channels in autoimmune disease

Mechanically activated (MA) ion channels have rapidly gained prominence as vital conduits bridging aberrant mechanical cues in tissues with the dysregulated immune responses at the core of autoimmune diseases. Once regarded as peripheral players in inflammation, these channels, exemplified by PIEZO1, TRPV4, and specific K2P family members, now play a central role in modulating T-cell effector functions, B- cell activation and the activity of macrophages and dendritic cells. Their gating is intimately tied to physical distortions such as increased tissue stiffness, osmotic imbalances, or fluid shear, triggering a cascade of ionic fluxes that elevate proinflammatory signaling and drive tissue-destructive loops. Recognition of these channels as central mediators of mechanical stress-induced inflammation responses in autoimmune pathogenesis is rapidly expanding. In parallel, the emerging therapeutic strategies aim to restrain overactive mechanosensors or selectively harness them in affected tissues. Small molecules, peptide blockers, and gene-targeting approaches show preclinical promise, although off-target effects and the broader homeostatic roles of these channels warrant caution. This review explores how integrating mechanobiological concepts with established immunological paradigms enables a more detailed understanding of autoimmune pathogenesis. By elucidating how mechanical forces potentiate or dampen pathological immunity, we propose innovative strategies that exploit mechanosensitivity to recalibrate immune responses across a spectrum of autoimmune conditions.

microRNAs in Type 1 Diabetes: Roles, Pathological Mechanisms, and Therapeutic Potential

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by the progressive destruction of pancreatic β-cells, leading to insulin deficiency. The primary drivers of β-cell destruction in T1D involve autoimmune-mediated processes that trigger chronic inflammation and ultimately β-cell loss. Regulatory microRNAs (miRNAs) play a crucial role in modulating these processes by regulating gene expression through post-transcriptional suppression of target mRNAs. Dysregulated miRNAs have been implicated in T1D pathogenesis, serving as both potential diagnostic biomarkers and therapeutic targets. This review explores the role of miRNAs in T1D, highlighting their involvement in disease mechanisms across both rodent models and human patients. While current antidiabetic therapies manage T1D symptoms, they do not prevent β-cell destruction, leaving patients reliant on lifelong insulin therapy. By summarizing key miRNA expression profiles in diabetic animal models and patients, this review explores the potential of miRNA-based therapies to restore β-cell function and halt or slow the progression of the disease.

Emerging Immunotherapies for Disease Modification of Type 1 Diabetes

Type 1 diabetes mellitus (T1DM) is characterized by the progressive, autoimmune-mediated destruction of β cells. As such, restoring immunoregulation early in the disease course is sought to retain endogenous insulin production. Nevertheless, in the more than 100 years since the discovery of insulin, treatment of T1DM has focused primarily on hormone replacement and glucose monitoring. That said, immunotherapies are widely used to interdict autoimmune and autoinflammatory diseases and are emerging as potential therapeutics seeking the preservation of β-cell function among those with T1DM. In the past 4 decades of diabetes research, several immunomodulatory therapies have been explored, culminating with the US Food and Drug Administration approval of teplizumab to delay stage 3 (clinical) onset of T1DM. Clinical trials seeking to prevent or reverse T1DM by repurposing immunotherapies approved for other autoimmune conditions and by exploring new therapeutics are ongoing. Collectively, these efforts have the potential to transform the future of diabetes care. We encapsulate the past 40 years of immunotherapy trials, take stock of our successes and failures, and chart paths forward in this new age of clinically available immune therapies for T1DM.

Bioengineering Platelets Presenting PD-L1, Galectin-9 and BTLA to Ameliorate Type 1 Diabetes

Autoimmune destruction of pancreatic β-cells leads to impaired insulin production and onset of type 1 diabetes (T1D). Hence, immunomodulation of pancreas-infiltrated immune cells especially the β-cells autoreactive-T cells is a promising way to hinder and reverse the progress of T1D. Herein, megakaryocytes are primed with interferon-γ (IFN-γ) to produce platelets presenting high levels of immunosuppressive checkpoint ligands including programmed death-ligand 1 (PD-L1), Programmed Death-Ligand 2 (PD-L2), the B and T lymphocyte attenuator (BTLA) and Galectin-9 (Gal-9), termed as IFN-γ platelets. The IFN-γ platelets bound and interacted with T cells through immune checkpoint ligands and receptors, which efficaciously induced T cell exhaustion and apoptosis in vitro. Virtually, NOD diabetes mice received IFN-γ platelets treatments prominently preserved β-cell integrity and insulin production, ultimately hindering the progress to hyperglycemia. Intriguingly, both the amount and activity of the pancreas infiltrate-T cells intensively reduced, whereas the magnitude of regulatory T cells (Tregs) remarkably increased, which is attributed to IFN-γ platelets treatments. Moreover, IFN-γ platelets treatment instigated macrophage polarization toward an anti-inflammatory M2 phenotype that may stimulate pancreatic angiogenesis, and promote β-cell proliferation, consequently ameliorating the new-onset T1D.

The impact of pancreas transplantation on diabetic complications: A systematic review

BACKGROUND

Pancreas Transplantation (PT) provides optimal treatment for patients with severe complicated Type 1 Diabetes Mellitus (T1DM). Restoration of beta-cell mass allows return to euglycaemia and insulin independence. We aimed to examine its impact on the secondary complications associated with severe T1DM including diabetic eye disease, neuropathy and cardiovascular disease.

METHODS

A database search using MedLINE to identify publications to April 2023 was conducted. Searches were performed using MeSH terms 'Pancreas Transplantation' AND 'Diabetes Mellitus, Type 1' 'Diabetic Retinopathy' OR 'Heart Disease' OR 'Cardiovascular Diseases' OR 'Peripheral Vascular Disease' OR "Amputation' OR 'Neuropathy."

RESULTS

All articles were retrospective with 51.1 % (n = 23) case control studies and 48.9 % (n = 22) cohort studies. 82.2 % (n = 37) examined simultaneous pancreas and kidney (SPK) transplantation and 17.8 % (n = 8) analysed pancreas transplant alone (PTA). Heterogenous outcomes metrics were employed. 15 studies examined diabetic retinopathy (DR) with 53.3 % (n = 8) demonstrated improvements after PT, while the remainder (n = 7) exhibited stabilisation. 16 studies assessed neuropathy and 87.5 % (n = 14) demonstrated beneficial effects of PT on nerve conduction studies, vibration perception threshold or corneal confocal microscopy. There was a positive effect on cardiovascular disease by reduction in the incidence of cardiac events, improvement in metabolic profile and increased left ventricular ejection fraction. 14 studies examined cardiovascular disease (71.4 % (n = 10) improvement; 14.2 % (n = 2) stabilisation; 14.2 % (n = 2) progression).

CONCLUSION

SPK and PTA have beneficial effects in ameliorating or stabilising diabetes complications. Future work should seek to reduce heterogeneity of outcome metrics assessing T1DM complication profile to facilitate robust comparison of beta-cell replacement interventions.

The role of endoplasmic reticulum stress in type 2 diabetes mellitus mechanisms and impact on islet function

Type 2 diabetes mellitus (T2DM) is a globally prevalent metabolic disorder characterized by insulin resistance and dysfunction of islet cells. Endoplasmic reticulum (ER) stress plays a crucial role in the pathogenesis and progression of T2DM, especially in the function and survival of β-cells. β-cells are particularly sensitive to ER stress because they require substantial insulin synthesis and secretion energy. In the early stages of T2DM, the increased demand for insulin exacerbates β-cell ER stress. Although the unfolded protein response (UPR) can temporarily alleviate this stress, prolonged or excessive stress leads to pancreatic cell dysfunction and apoptosis, resulting in insufficient insulin secretion. This review explores the mechanisms of ER stress in T2DM, particularly its impact on islet cells. We discuss how ER stress activates UPR signaling pathways to regulate protein folding and degradation, but when stress becomes excessive, these pathways may contribute to β-cell death. A deeper understanding of how ER stress impacts islet cells could lead to the development of novel T2DM treatment strategies aimed at improving islet function and slowing disease progression.

Pivotal epitopes for islet antigen-specific CD8+ T cell detection improve classification of suspected type 1 diabetes with the HLA-A*0201 allele

A proportion of patients with new-onset diabetes share similar symptoms with type 1 diabetes (T1D) patients but they are negative for islet antigen-specific autoantibodies. This study was to develop an islet antigen-specific CD8+ T-cell assay to provide autoimmune evidence regarding these "suspected" T1D patients. HLA-A*0201 individuals with autoAbs+ T1D, autoAbs- suspected T1D, and type 2 diabetes, along with HLA-A*0201 healthy controls were recruited. Using interferon-γ enzyme-linked immunospot assays, the percentages of participants in each group with various islet antigen-specific CD8+ T cells were determined. Sixteen out of the 28 islet antigen-specific epitopes tested were T1D specific, meaning that there was a significantly (P < 0.05) greater epitope positivity rate in the autoAbs+ T1D cohort than in the healthy controls. Using a cutoff value of two positive epitopes, the 16-epitope panel led to a sensitivity of 75.0% and a specificity of 94.4% regarding the autoAbs+ T1D patients. Even when using an optimized five-epitope panel, the results were highly accurate. Notably, in the application phase of the study, 77.8% of a new cohort of autoAbs- suspected T1D patients exhibited positivity when using the five-epitope optimized panel. This highly accurate method, especially for pediatric patients, will improve clinical diagnosis and etiological classification of autoimmune T1D.

Application and Progression of Single-Cell RNA Sequencing in Diabetes Mellitus and Diabetes Complications

Diabetes is a systemic metabolic disorder primarily caused by insulin deficiency and insulin resistance, leading to chronic hyperglycemia. Prolonged diabetes can result in metabolic damage to multiple organs, including the heart, brain, liver, muscles, and adipose tissue, thereby causing various chronic fatal complications such as diabetic retinopathy, diabetic cardiomyopathy, and diabetic nephropathy. Single-cell RNA sequencing (scRNA-seq) has emerged as a valuable tool for investigating the cell diversity and pathogenesis of diabetes and identifying potential therapeutic targets in diabetes or diabetes complications. This review provides a comprehensive overview of recent applications of scRNA-seq in diabetes-related researches and highlights novel biomarkers and immunotherapy targets with cell-type information for diabetes and its associated complications.

Automated Insulin Delivery Versus Standard of Care in the Management of People Living with Type 1 Diabetes and HbA1c <8%: A Cost-Utility Analysis in The Netherlands

Introduction: Automated insulin delivery (AID) systems improve glycemic control in people living with type 1 diabetes (PwT1D). AID is cost-effective versus other management approaches in a range of country settings and populations. This cost-utility analysis adds an evaluation of the MiniMedTM 780G system versus standard of care (SoC) in PwT1D and baseline glycated hemoglobin (HbA1c) level <8% not reaching glycemic targets, conducted from a societal perspective in The Netherlands. Methods: The analysis was run using the IQVIA CORE Diabetes Model, over 50 years. Costs were discounted at 3% per year, effects at 1.5% per year. Baseline cohort characteristics and treatment effects were sourced from the MiniMed 780G arm of a prospective multicenter study. Costs and utility estimates were taken from Dutch databases and published sources. Sensitivity analyses were conducted to address uncertainty. Results: AID improved life expectancy by 0.52 years and quality-adjusted life expectancy by 0.99 quality-adjusted life-years (QALYs) versus SoC. AID was associated with an incremental combined cost of EUR 28,635 due to higher acquisition costs, which were partially offset by reduced direct treatment costs for diabetes-related complications and reduced indirect costs due to less time off work. Based on combined costs, the MiniMed 780G system was associated with an incremental cost-utility ratio of EUR 29,836 per QALY gained. Conclusions: For PwT1D in The Netherlands, who had a baseline HbA1c <8% and do not reach glycemic targets, AID system initiation was projected to improve long-term clinical outcomes and reduce both direct costs for the treatment of diabetes-related complications and productivity losses. From a societal perspective, the MiniMed 780G likely represents good value for money in The Netherlands.

Screening for autoimmune atrophic gastritis by serum gastrin measurement in subjects with type 1 diabetes

INTRODUCTION

Despite associated risk of anemia and gastric cancer, screening for autoimmune atrophic gastritis (AAG) is underperformed in subjects with type 1 diabetes mellitus (T1DM). We measured the predictive value of serum gastrin as a biomarker of gastric atrophy in subjects with T1DM and parietal cell autoantibodies (PCA).

SUBJECTS AND METHODS

PCA measurements were retrospectively retrieved in 1,425 consecutive subjects with T1DM between 2014 and 2018. Screening for AAG was conducted in PCA+ subjects by measuring blood counts, serum ferritin, vitamin B12 and gastrin; and by performing gastroduodenal fibroscopy, with fundic biopsies for histology and Helicobacter pylori. The performance of blood biomarkers of gastric atrophy was analyzed in comparison with the histopathological gold standard.

RESULTS

PCA were found in 185/1,425 subjects (13 %). PCA positivity was associated with female sex, older age, longer T1DM duration, and co-occurrence of anti-GAD and anti-thyroperoxydase autoantibodies. Of the 185 PCA+ subjects, 122 (66 %) participated in screening. AAG was found in 69/122 (57 %) subjects and Helicobacter pylori infection in 20/122 (16 %). Compared to PCA+ subjects without gastric atrophy, those with gastric atrophy had more frequently iron deficiency (65 % vs. 18 %, P < 0.0001), and/or vitamin B12 deficiency (57 % vs. 7 %, P < 0.0001); 44/69 (64 %) presented a pre-tumoral lesion and 6 % a tumor. Using a cut-off of 1.2-fold above the upper normal limit, serum gastrin concentration displayed 91 % sensitivity and 82 % specificity at predicting gastric atrophy.

CONCLUSION

In subjects with T1DM and PCA, serum gastrin is a reliable biomarker of gastric atrophy that can be used to select subjects requiring gastroduodenal fibroscopy.

Hypoglycemic and Hypolipidemic Effects of Triterpenoid Standardized Extract of Agave durangensis Gentry

Diabetes mellitus is a chronic, degenerative, and multifactorial disease characterized by hyperglycemia, and at least 537 million people suffered from diabetes in 2021. Agave durangensis Gentry, a species of agave native to the state of Durango, reports phenolic compounds, flavonols, flavonoids, and saponins and could be an alternative for the treatment of diabetes. The aim of this work was to identify the compounds in the leaves of Agave durangensis Gentry and their potential activity in diabetes. The leaf extract of Agave durangensis Gentry (EAD) was characterized by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS), and different families of bioactive compounds were quantified by analytical methods. Probable pharmacological targets were identified in silico, and the inhibition of dipeptidyl peptidase-4 (DPP4) was validated in vitro. A model of hyperglycemia was established with streptozotocin in male Wistar rats, and we administered EAD intragastrically at a dose of 300 mg/kg, as well as combinations of the extract with metformin and sitagliptin over 30 days. Biochemical and histological parameters were analyzed. We identified thirty-six major compounds, where triterpenes represented 30% of the extract. Molecular docking showed that the extract could interact with α-glucosidases and DPP4 since a large number of compounds in the extract have a Δ G lower than that reported for the controls, and DPP4 inhibition was confirmed by in vitro assays. In vivo assays demonstrated that the administration of the extract was able to significantly decrease glucose levels by 56.75% and glycosylated hemoglobin by 52.28%, which is higher than that reported for sitagliptin with a decrease of 35.22%. In addition, the extract decreased triglycerides by 59.28% and very-low-density lipoprotein (VLDL) cholesterol by 60.27%, and when administered in combination with metformin, it decreased them more than when metformin was administered alone. For all the above reasons, Agave durangensis Gentry extract could be used for the development of phytomedicine for the treatment of diabetes.

Bidirectional Mendelian Randomization Study Identifies No Genetic Link Between Psoriasis and Diabetes

Epidemiological studies proposed a bidirectional link between psoriasis (Ps) and diabetes mellitus (DM); their causal relationship remains inadequately explored. We obtained summary statistics of genome-wide association analyses for Type 1 diabetes mellitus (T1DM), Type 2 diabetes mellitus (T2DM), and Ps from individuals of European ancestry by accessing the UK Biobank and FinnGen datasets. Inverse-variance weighted (IVW) method was utilized as the primary method. Additional analyses included debiased IVW (dIVW), constrained maximum likelihood with model averaging, robust adjusted profile score, Mendelian randomization (MR)-Egger, weighted median, and weighted mode. Moreover, sensitivity tests were conducted, including Cochran's Q, MR pleiotropy residual sum, and outlier analyses. Eventually, bidirectional MR was conducted to examine the possibility of a causal link between Ps and DM. No significant causal associations were indicated between DM and Ps. Moreover, there was no causal link between Ps and T1DM. Although certain positive correlations were identified between Ps and T2DM, aggregate evidence remains insufficient to establish a causal relationship. The results demonstrated no evidence of horizontal pleiotropy between genetic variants. Furthermore, a leave-one-out test validated the stability and robustness of this correlation. Our study identifies no genetic causal effect of Ps on DM and of DM on Ps in European ancestry. Additional research is warranted to verify the presence of an association between Ps and DM in diverse populations.

Early peripheral nerve impairments in type 1 diabetes are associated with cortical inhibition of ankle joint proprioceptive afference

OBJECTIVE

Diabetic sensorimotor peripheral neuropathy (DSPN) is a common complication of type 1 diabetes mellitus (T1DM). However, it is still unclear how the cortical processing of proprioceptive afference is altered due to DSPN.

METHODS

Cortical responses to right and left ankle joint rotations were recorded with magnetoencephalography and pooled together in 20 T1DM participants and 20 healthy controls for source space comparisons. T1DM participants also underwent a lower limb nerve-conduction study to correlate peripheral nerve function with the cortical responses.

RESULTS

Primary sensorimotor (SM1) cortex activation was wider in T1DM patients during beta suppression, with no between-group differences in the response strength. However, stronger beta suppressions in T1DM patients were correlated with axon-loss in the peripheral sensory afferents (p < 0.05). Weaker beta rebounds and stronger SM1 evoked field amplitudes were associated with impaired conduction velocities in the mixed nerves (p < 0.05). Lastly, stronger SM1 beta power was associated with both demyelination and axon-loss in the lower limb sensory afferents (p < 0.05).

CONCLUSIONS

T1DM is accompanied with wider SM1 cortex activation to proprioceptive stimuli, and the early asymptomatic DSPN impairments are linked to increased levels of cortical inhibition.

SIGNIFICANCE

T1DM is associated with comprehensive central pathophysiology evident in early DSPN.

Mucociliary cell type compositions - bridging the gap between genes and emergent tissue functions

When multiple cell types are brought together to form a tissue-specific collective, the combination of cell functions and cell-cell interactions leads to novel behaviors and properties beyond the simple addition of individual features, often referred to as emergent tissue functions. During evolution, functional adaptations in organs are significantly influenced by changes in cell type compositions, and in diseases, aberrations in cell type compositions result in impaired organ functions. Investigating the mechanisms that regulate cell type compositions could elucidate an important organizational meta-level that bridges gene functions and cellular features de facto facilitating the emergence of collective cell behaviors and novel tissue functions. Due to their unique evolutionary positioning and diverse functions, mucociliary epithelia could provide an optimal system to unravel principle mechanisms of adaptations in cell type compositions that facilitate the evolution of new or optimization of existing tissue functions, and could reveal novel entry points to counteract human diseases. An integrative investigation of signaling, transcriptional, epigenetic and morphogenetic mechanisms across a broad range of mucociliary tissues with different specialized cells and cell type compositions can help us to connect gene functions and contributions to self-organized behaviors in cell collectives determining emergent tissue functions. Taking such route moving forward has the potential to unravel novel principles in mucociliary self-organization and to reveal broadly applicable principles underlying the generation and modification of emergent tissue functions across species and organ systems.

Current and Emerging Assays for Measuring Human T-Cell Responses Against Beta-Cell Antigens in Type 1 Diabetes

Type 1 diabetes (T1D) is an autoimmune disease caused by T-cell mediated destruction of the pancreatic insulin-producing beta cells. Currently, the development of autoantibodies is the only measure of beta-cell autoimmunity used in the clinic. Despite T-cells' well-accepted role in the autoimmune pathogenesis of human T1D, autoimmune T-cell responses against beta cells remain very difficult to measure. An assay capable of measuring beta-cell antigen-specific T-cell responses has been a long-sought goal. Such an assay would facilitate the direct monitoring of T1D-associated T-cell responses facilitating, earlier diagnosis and rapid evaluation of candidate immune therapies in clinical trials. In addition, a simple and robust assay for beta-cell antigen-specific T-cell responses would be a powerful tool for dissecting the autoimmune pathogenesis of human T1D. Here, we review the challenges associated with measuring beta-cell antigen-specific T-cell responses, the current assays which are used to achieve this and, finally, we discuss BASTA, a promising emerging assay for measuring human beta-cell antigen-specific CD4+ T-cell responses.

Unveiling Gestational Diabetes: An Overview of Pathophysiology and Management

Gestational diabetes mellitus (GDM) is characterized by an inadequate pancreatic β-cell response to pregnancy-induced insulin resistance, resulting in hyperglycemia. The pathophysiology involves reduced incretin hormone secretion and signaling, specifically decreased glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), impairing insulinotropic effects. Pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), impair insulin receptor substrate-1 (IRS-1) phosphorylation, disrupting insulin-mediated glucose uptake. β-cell dysfunction in GDM is associated with decreased pancreatic duodenal homeobox 1 (PDX1) expression, increased endoplasmic reticulum stress markers (CHOP, GRP78), and mitochondrial dysfunction leading to impaired ATP production and reduced glucose-stimulated insulin secretion. Excessive gestational weight gain exacerbates insulin resistance through hyperleptinemia, which downregulates insulin receptor expression via JAK/STAT signaling. Additionally, hypoadiponectinemia decreases AMP-activated protein kinase (AMPK) activation in skeletal muscle, impairing GLUT4 translocation. Placental hormones such as human placental lactogen (hPL) induce lipolysis, increasing circulating free fatty acids which activate protein kinase C, inhibiting insulin signaling. Placental 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) overactivity elevates cortisol levels, which activate glucocorticoid receptors to further reduce insulin sensitivity. GDM diagnostic thresholds (≥92 mg/dL fasting, ≥153 mg/dL post-load) are lower than type 2 diabetes to prevent fetal hyperinsulinemia and macrosomia. Management strategies focus on lifestyle modifications, including dietary carbohydrate restriction and exercise. Pharmacological interventions, such as insulin or metformin, aim to restore AMPK signaling and reduce hepatic glucose output. Emerging therapies, such as glucagon-like peptide-1 receptor (GLP-1R) agonists, show potential in improving glycemic control and reducing inflammation. A mechanistic understanding of GDM pathophysiology is essential for developing targeted therapeutic strategies to prevent both adverse pregnancy outcomes and the progression to overt diabetes in affected women.

Two DRB3 residues predictively associate with the progression to type 1 diabetes among DR3 carriers

HLA-DR genes are associated with the progression from stage 1 and stage 2 to onset of stage 3 type 1 diabetes (T1D), after accounting HLA-DQ genes with which they are in high linkage disequilibrium. Based on an integrated cohort of participants from 2 completed clinical trials, this investigation finds that, sharing a haplotype with the DRB1*03:01 (DR3) allele, DRB3*01:01:02 and *02:02:01 have respectively negative and positive associations with the progression. Furthermore, we uncovered 2 residues (β11, β26, participating in pockets 6 and 4, respectively) on the DRB3 molecule responsible for the progression among DR3 carriers; motif RY and LF respectively delay and promote the progression (hazard ratio [HR] = 0.73 and 2.38, P = 0.039 and 0.017, respectively). Two anchoring pockets 6 and 4 probably bind differential autoantigenic epitopes. We further investigated the progression association with the motifs RY and LF among carriers of DR3 and found that carriers of the motif LF have significantly faster progression than carriers of RY (HR = 1.48, P = 0.019 in unadjusted analysis; HR = 1.39, P = 0.047 in adjusted analysis), results of which provide an impetus to examine the possible role of specific DRB3-binding peptides in the progression to T1D.

Explanatory variables of objectively measured physical activity, sedentary behaviour and sleep in adults with type 1 diabetes: A systematic review

AIMS

This systematic review aimed to summarize knowledge on explanatory variables of PA, SB and sleep in adults with T1D to support the development of healthy lifestyle interventions.

METHODS

A systematic search of four databases (PubMed, Web of Science, Scopus and Embase) was performed. Only objective measurements of PA, SB and sleep were included and all explanatory variables were classified according to the socio-ecological model (i.e. intrapersonal, interpersonal, environmental and policy level). Risk of bias (ROB) (Joanna Briggs Institute appraisal checklists) and level of evidence (Evidence-Based Guideline Development) were assessed.

RESULTS

Twenty-one studies were included (66.7% low ROB). Most explanatory variables were situated at the intrapersonal level. A favourable body composition was associated with more time spent in total PA and moderate-to-vigorous PA (MVPA). Men with T1D spent more time in MVPA than women and a younger age was associated with increased MVPA. Barriers to PA were indeterminately associated with MVPA and HbA1c showed an indeterminate association with sleep. Explanatory variables of SB and light PA were not studied in at least two independent studies.

CONCLUSION

This review underscores the focus on the individual level to identify explanatory variables of movement behaviours in adults with T1D, despite the necessity for a socio-ecological approach to develop effective interventions. More evidence on psychological, interpersonal and environmental variables is needed as these are modifiable.

Influence of rs1292037 Genetic Variant on miR-21 Gene Expression in Patients With Type 1 Diabetes Mellitus: A Case-Control Study

Background and Aims

Alterations in the expression pattern of miRNAs seem to be linked with autoimmune diseases such as type 1 diabetes mellitus (T1DM). Regarding the importance of assessing this potential link, we aimed to evaluate the relationship between miR-21 rs1292037 single-nucleotide polymorphism (SNP) and T1DM susceptibility. Furthermore, we investigated the miR-21 expression level in T1DM.

Methods

A total of 250 T1DM patients and 250 controls were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and miR-21 expression levels were assessed using real-time PCR. Moreover, the potential targets of miR-21 were investigated using different bioinformatics web servers.

Results

Our results showed that the T/C genotype and the C allele were more frequent in T1DM patients than in controls. Individuals carrying the T/C genotype in overdominant model were 2.74-fold at a higher risk of T1DM (OR = 2.74; 95%CI, 1.78-4.27; p < 0.0001). In addition, miR-21 expression was more than twofold higher in patients than in controls (p < 0.0001) and it was found to be significantly upregulated when carrying the T/C genotype. Regarding miR-21 predicted target genes, its overexpression may be associated with beta cell death, diabetic nephropathy, inflammatory responses, impaired insulin production or secretion, and T-cell cytotoxicity, which are important in the initiation and progression of T1DM.

Conclusion

Our results suggested that miR-21 rs1292037 may confer genetic susceptibility to T1DM. Therefore, it seems that this genetic link should be further investigated to enhance diagnostic and therapeutic strategies in these patients.

Exploring antigenic variation in autoimmune endocrinopathy

Autoimmune disorders develop owing to a misdirected immune response against self-antigen. Genetic studies have revealed that numerous variants in genes encoding immune system proteins are associated with the development of autoimmunity. Indeed, many of these genetic variants in key immune receptors or transcription factors are common in the pathogenesis of several different autoimmune conditions. In contrast, the proclivity to develop autoimmunity to any specific target organ or tissue is under-researched. This has particular relevance to autoimmune endocrine conditions, where organ-specific involvement is the rule. Genetic polymorphisms in the genes encoding the targets of autoimmune responses have been shown to be associated with predisposition to several autoimmune diseases, including type 1 diabetes, autoimmune thyroid disease and Addison's disease. Mechanistically, variations leading to decreased intrathymic expression, overexpression, different localisation, alternative splicing or post-translational modifications can interfere in the tolerance induction process. This review will summarise the different ways genetic variations in certain genes encoding endocrine-specific antigens (INS, TSHR, TPO, CYP21A2, PIT-1) may predispose to different autoimmune endocrine conditions.

Chronic Inflammation and Glycemic Control: Exploring the Bidirectional Link Between Periodontitis and Diabetes

Periodontitis and diabetes mellitus are two highly prevalent chronic conditions that share a bidirectional relationship, significantly impacting public health. Periodontitis, a gum inflammation caused by microbial dysbiosis, aggravates glycemic control in diabetics, while uncontrolled diabetes heightens periodontitis severity. These conditions create a vicious cycle, where inflammation and microbial dysbiosis mutually drive disease progression, exacerbating systemic health. The underlying mechanisms involve inflammation, immune dysfunction, and microbial dysbiosis, with both diseases contributing to a chain of chronic inflammation that exacerbates systemic health. This relationship is significant because managing one condition can significantly impact the other. In diabetic individuals, interventions such as periodontal therapy have shown effectiveness in improving glycemic control, underscoring the potential of integrated strategies for managing these conditions simultaneously. In this review, we highlight the importance of a deeper understanding of the molecular and immunological interactions between these diseases is essential for developing integrated therapeutic approaches, with the potential to enhance the quality of life of the patient significantly.

An Artificial Intelligence-Based Fuzzy Logic System for Periodontitis Risk Assessment in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Since periodontitis prevalence has increased globally and there is a bidirectional relationship between periodontitis and diabetes mellitus (DM), new methods of preventing and screening involving DM biomarkers could impact periodontitis management. We aimed to develop a fuzzy system to estimate the risk of periodontitis in patients with DM.

METHODS

Body mass index (BMI), glycemia (G), total cholesterol (C), and triglyceride (T) measurements were collected from 87 patients diagnosed with DM. Oral examinations were performed, and the number of the periodontal pockets (nrPPs) was determined. A fuzzy system was developed: BMI and G as inputs resulted in Periodontitis Risk 1 (PRisk1) output; C and T as inputs resulted in Periodontitis Risk 2 (PRisk2) output. From PRisk1 and PRisk2, the cumulative periodontitis risk (PCRisk) was assessed. Linguistic terms and linguistic grades (very small, small, medium, big, and very big) were assigned to the numerical variables by using 25 different membership functions. PCRisk and nrPP values were statistically processed.

RESULTS

In our developed fuzzy system, BMI, G, C, and T as input data resulted in periodontitis risk estimation. PCRisk was correlated with nrPP: when PCRisk increased by 1.881 units, nrPP increased by 1 unit. The fuzzy logic-based system effectively estimated periodontitis risk in type 2 diabetes patients, showing a significant correlation with the number of periodontal pockets. These findings highlight its potential for early diagnosis and improved interdisciplinary care.

Advances in the Pathogenesis and Treatment Strategies for Type 1 Diabetes Mellitus

Type 1 diabetes (T1D) is a complex autoimmune disorder distinguished by the infiltration of immune cells into pancreatic islets, primarily resulting in damage to pancreatic β-cells. Despite extensive research, the precise pathogenesis of T1D remains elusive, with its etiology linked to a complex interplay of genetic, immune, and environmental factors. While genetic predispositions, such as HLA and other susceptibility genes, are necessary, they do not fully account for disease development. Environmental influences such as viral infections and dietary factors may contribute to the disease by affecting the immune system and epigenetic modifications. Additionally, endogenous retroviruses (ERVs) might play a role in T1D pathogenesis. Current therapeutic approaches, including insulin replacement therapy, immune omodulatory therapy, autoantigen immunotherapy, organ transplantation, and genetic modification, offer potential to alter disease progression but are still constrained by limitations. This review presents updated knowledge on T1D, with a focus on risk factors, predisposing hypotheses, and recent advancements in therapeutic strategies.

Exploring the Role of Hypoxia and HIF-1α in the Intersection of Type 2 Diabetes Mellitus and Endometrial Cancer

Diabetes and Cancer are the most complex chronic diseases, accounting for significant global mortality and morbidity. The association between Type 2 DM (T2DM) and endometrial cancer (EC) is multifaced, sharing numerous risk factors, including insulin resistance, obesity, hypoxia, and oxidative stress. Hypoxia plays a vital role in T2DM pathogenesis by altering the insulin level and pancreatic β-cell failure through an imbalance between antioxidant enzymes and cellular oxidative levels, while chronic inflammation contributes to EC malignancy. HIF-1α is a potent transcription factor involved in modulating cellular responses to hypoxia within the disease environment. Targeting the HIF-1α signaling cascade, a major metabolic regulator may contribute to advanced therapeutic advances. This review focuses on the association between T2DM and EC, especially focusing on hypoxia and HIF signaling pathways. These intersect with key pathways involved in T2DM and EC pathology, such as insulin signaling, PI3K/AKT, mTOR pathway, MUC1/HIF-1α pathway, and hormonal imbalance. Understanding this complex relationship paves the way for future researchers to develop HIF-1α-targeted therapies that could lead to novel combination therapies to treat these comorbid conditions.

Immune Evasion in Stem Cell-Based Diabetes Therapy-Current Strategies and Their Application in Clinical Trials

Background/Objectives: Human pancreatic islet transplantation shows promise for long-term glycemic control in diabetes patients. A shortage of healthy donors and the need for continuous immunosuppressive therapy complicates this. Enhancing our understanding of the immune tolerance mechanisms related to graft rejection is crucial to generate safer transplantation strategies. This review will examine advancements in immune protection strategies for stem cell-derived islet therapy and discuss key clinical trials involving stem cell-derived β-cells and their protective strategies against the host immune system. Methods: A comprehensive literature search was performed on peer-reviewed publications on Google Scholar, Pubmed, and Scopus up to September 2024 to extract relevant studies on the various strategies of immune evasion of stem cell-derived β-cells in humans. The literature search was extended to assimilate all relevant clinical studies wherein stem cell-derived β-cells are transplanted to treat diabetes. Results: Our analysis highlighted the importance of human pluripotent stem cells (hPSCs) as a potentially unlimited source of insulin-producing β-cells. These cells can be transplanted as an effective source of insulin in diabetes patients if they can be protected against the host immune system. Various strategies of immune protection, such as encapsulation and genetic manipulation, are currently being studied and clinically tested. Conclusions: Investigating immune tolerance in hPSC-derived islets may help achieve a cure for diabetes without relying on exogenous insulin. Although reports of clinical trials show promise in reducing insulin dependency in patients, their safety and efficacy needs to be further studied to promote their use as a long-term solution to cure diabetes.

A Granzyme B-Cleavable T Cell-Targeted Bispecific Cell Vesicle Connector for Reversing New-Onset Type 1 Diabetes

Type 1 diabetes (T1D) is an autoimmune disorder in which pancreatic β-cells are destroyed by CD8+ T cells. Anti-CD3 antibody effectively treats early-stage T1D when β-cell autoantibodies are detected but before symptoms appear. However, it impairs the immune system temporarily, exposing individuals to infection. A therapeutic that can reverse new-onset T1D without harming the immune system remains urgently needed. Herein, we have constructed cellular vesicles presenting granzyme B-responsive fusion proteins (designated aCD8-GrzBcs-IL2) composed of a single-chain variable fragment of anti-CD8 antibodies and a mutein interleukin-2 (IL2). aCD8-GrzBcs-IL2 is designed to simultaneously inhibit CD8+ T cells and promote Treg cells, especially when CD8+ T cells are attacking β-cells. In vitro, these cellular vesicles can inhibit the cell-killing effect of CD8+ T cells and enhance the expansion of Treg cells. Notably, intravenous administration of aCD8-GrzBcs-IL2-expressed cellular vesicles reversed newly onset diabetes in 77.8% of nonobese diabetic (NOD) mice without reducing blood CD3+ T cells and CD8+ T cells, indicating a favorable safety profile.

Could hypoxic conditioning augment the potential of mesenchymal stromal cell-derived extracellular vesicles as a treatment for type 1 diabetes?

Type1 Diabetes (T1D) is an autoimmune disorder characterised by the loss of pancreatic β-cells. This β cell loss occurs primarily through inflammatory pathways culminating in apoptosis. Mesenchymal stromal cells (MSCs) have been heavily studied for therapeutic applications due to their regenerative, anti-apoptotic, immunomodulatory, and anti-inflammatory properties. The therapeutic effects of MSCs are mediated through cell-to-cell contact, differentiation, and the release of paracrine factors, which include the release of extracellular vesicles (EVs). Culturing MSCs in hypoxia, a low oxygen tension state more analogous to their physiological environment, seems to increase the therapeutic efficacy of MSC cell therapy, enhancing their immunomodulatory, anti-inflammatory, and anti-fibrotic properties. This is also the case with MSC-derived EVs, which show altered properties based on the parent cell preconditioning. In this review, we examine the evidence supporting the potential application of hypoxic preconditioning in strengthening MSC-EVs for treating the inflammatory and apoptotic causes of β cell loss in T1D.

Muscle regeneration and muscle stem cells in metabolic disease

Skeletal muscle has a high regenerative capacity due to its resident adult muscle stem cells (MuSCs), which can repair damaged tissue by forming myofibres de novo. Stem cell dependent regeneration is critical for maintaining skeletal muscle health, and different conditions can draw heavily on MuSC support to preserve muscle function, including metabolic diseases such as diabetes. The global incidence and burden of diabetes is increasing, and skeletal muscle is critical for maintaining systemic metabolic homeostasis and improving outcomes for diabetic patients. Thus, poor muscle health in diabetes, termed diabetic myopathy, is an important complication that must be addressed. The health of MuSCs is also affected by diabetes, responsible for the poor muscle regenerative capacity and contributing to the functional decline in diabetic patients. Here, we review the impact of diabetes and metabolic disease on MuSCs and skeletal muscle, including potential mechanisms for impaired muscle regeneration and MuSC dysfunction, and how these deficits could be addressed.

Diabetes mellitus therapy in the light of oxidative stress and cardiovascular complications

Type 2 diabetes is a chronic disease requiring comprehensive pharmacological and non-pharmacological interventions to slow its progression and prevent or delay its micro- and macrovascular complications. Oxidative stress contributes to the development and progression of type 2 diabetes as well as to the development of its complications through several mechanisms. Therefore, therapeutic targeting of oxidative stress could aid in managing this disease and its complications. In our study, we have collected information on the most frequently used antidiabetic drugs (metformin, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors) in the EU and the USA based on their antioxidant effects. Based on our results, we can conclude that the antioxidant effects of the investigated antidiabetics may contribute significantly to the management of the disease and its complications and may open new therapeutic perspectives in their prevention.

Diabetes exerts a causal impact on the nervous system within the right hippocampus: substantiated by genetic data

INTRODUCTION

Diabetes and neuronal loss in the hippocampus have been observed to be correlated in several studies; however, the exact causality of this association remains uncertain. This study aims to explore the potential causal relationship between diabetes and the hippocampal nervous system.

METHODS

We utilized the two-sample Mendelian randomization (MR) analysis to investigate the potential causal connection between diabetes and the hippocampal nervous system. The summary statistics of Genome-wide association study (GWAS) for diabetes and hippocampus neuroimaging measurement were acquired from published GWASs, all of which were based on European ancestry. Several two-sample MR analyses were conducted in this study, utilizing inverse-variance weighted (IVW), MR Egger, and Weight-median methods. To ensure the reliability of the results and identify any horizontal pleiotropy, sensitivity analyses were undertaken using Cochran's Q test and the MR-PRESSO global test.

RESULTS

Causal associations were found between diabetes and the nervous system in the hippocampus. Type 1 and type 2 diabetes were both identified as having adverse causal connections with the right hippocampal nervous system. This was supported by specific ranges of IVW-OR values (P < 0.05). The consistency of the sensitivity analyses further reinforced the main findings, revealing no significant heterogeneity or presence of horizontal pleiotropy.

CONCLUSIONS

This study delved into the causal associations between diabetes and the hippocampal nervous system, revealing that both type 1 and type 2 diabetes have detrimental effects on the right hippocampal nervous system. Our findings have significant clinical implications as they indicate that diabetes may play a role in the decline of neurons in the right hippocampus among European populations, often resulting in cognitive decline.

Influence of the metabolic control in patients with type 1 diabetes on their oral health status and the need for orthodontic treatment in a group of Spanish children (aged 6-12 years): a cross-sectional study

BACKGROUND

The aim of this study was to analyze the influence of good metabolic control, based on glycosylated hemoglobin (HbA1c) levels, on oral health status and the need for orthodontic treatment in children.

METHODS

This cross-sectional study was carried out at the Dental Clinic of the University of Salamanca (Spain) during the years 2020 and 2024. A total of 260 children with type 1 diabetes (aged between 6 and 12 years) participated. The sample was divided into two study groups based on their metabolic control: good metabolic control (HbA1c < 7%) (n = 130) and poor metabolic control (HbA1c > 7%) (n = 130). Oral health status was assessed using the Decayed, Missing, and Filled Teeth index for permanent teeth (DMF-T) and the need for orthodontic treatment using the Dental Health Component of the Index of Orthodontic Treatment Need (DHC-IOTN).

RESULTS

The mean age was 9.2 ± 1.9 years old. The total sample (n = 260) consisted of 53.8% boys and 46.2% girls. In the group of patients with poor metabolic control, a significant increase was observed in the number of decayed teeth (1.83 ± 1.36), filled teeth (1.05 ± 0.84), and DMF-T score (3.14 ± 1.87) compared to patients with good metabolic control (1.38 ± 1.20 decayed teeth; 0.88 ± 0.86 filled teeth; DMF-T score 2.46 ± 1.87). However, no significant differences were observed in relation to the influence of metabolic control on the need for orthodontic treatment.

CONCLUSIONS

In the sample studied, metabolic control had a negative influence on caries rates in children with type 1 diabetes, but not on the need for orthodontic treatment.

Impact of Virtual Clinics on Diabetes Distress and HbA1c Levels Among Patients with Diabetes Mellitus in Saudi Arabia

Background and Objectives: Diabetes mellitus is a prevalent chronic disease caused by inadequate insulin secretion or ineffective insulin response, leading to complications such as retinopathy, nephropathy, heart attacks, and strokes. Recently, "diabetes distress (DD)" has emerged as a concept, highlighting the significant emotional burden of managing diabetes, which can impact disease outcomes. Thus, this study evaluates the impact of virtual clinics on diabetes distress and glycemic measures in individuals with diabetes mellitus. Materials and Methods: A cross-sectional study was conducted between May and August 2024 at the Endocrine and Diabetes Center in Alahsa, Saudi Arabia, targeting persons aged 18 and older with diabetes who had engaged in-person clinics, virtual clinics, or both between 2019 and 2024. Data were collected through structured phone interviews, supplemented by laboratory results from clinical records. The survey included demographic details, diabetes information, and the Diabetes Distress Scale. Statistical analyses, including descriptive statistics, were performed to explore the relationships between diabetes distress, clinic visit type, and glycemic control, with Mann-Whitney and Chi-Squared tests used to compare variables between two groups. Results: Of the 108 participants, 55.6% were male, with a mean age of 38.5 years. Type 2 diabetes was reported in 51.9% of individuals, while 48.1% had type 1. High emotional burden (44.4%) and regimen-related distress (28.7%) were prevalent, particularly among individuals with suboptimal glycemic control. While virtual visits were not significantly correlated with lower distress levels, individuals with suboptimal glycemic control exhibited significantly higher diabetes distress across various domains, including emotional and regimen-related distress (p < 0.05). Laboratory analysis showed a median HbA1c of 8.2%, with poor control associated with greater distress. Conclusions: Diabetic individuals with suboptimal glycemic control report higher diabetes distress levels, underscoring the need for integrated psychological support in DM care. Although virtual clinic visits did not significantly reduce distress, they provide a feasible option for individual follow-up.

JAK inhibitors: a new choice for diabetes mellitus?

Altered tyrosine kinase signaling is associated with a variety of diseases. Tyrosine kinases can be classified into two groups: receptor type and nonreceptor type. Nonreceptor-type tyrosine kinases are subdivided into Janus kinases (JAKs), focal adhesion kinases (FAKs) and tec protein tyrosine kinases (TECs). The beneficial effects of receptor-type tyrosine kinase inhibitors (TKIs) for the treatment of diabetes mellitus (DM) and the mechanisms involved have been previously described. Recently, several clinical cases involving the reversal of type 1 diabetes mellitus (T1DM) during treatment with JAK inhibitors have been reported, and clinical studies have described the improvement of type 2 diabetes mellitus (T2DM) during treatment with JAK inhibitors. In vivo and in vitro experimental studies have elucidated some of the mechanisms behind this effect, which seem to be based mainly on the reduction in β-cell disruption and the improvement of insulin resistance. In this review, we briefly describe the beneficial effects of JAK inhibitors among nonreceptor tyrosine kinase inhibitors for the treatment of DM and attempt to analyze the mechanisms involved.

Recent advances in pancreatic α-cell transdifferentiation for diabetes therapy

As the global prevalence of diabetes mellitus rises, traditional treatments like insulin therapy and oral hypoglycemic agents often fail to achieve optimal glycemic control, leading to severe complications. Recent research has focused on replenishing pancreatic β-cells through the transdifferentiation of α-cells, offering a promising therapeutic avenue. This review explores the molecular mechanisms underlying α-cell to β-cell transdifferentiation, emphasizing key transcription factors such as Dnmt1, Arx, Pdx1, MafA, and Nkx6.1. The potential clinical applications, especially in type 1 and type 2 diabetes characterized by significant β-cell dysfunction, are addressed. Challenges, including low transdifferentiation efficiency, cell stability, and safety concerns, are also included. Future research directions include optimizing molecular pathways, enhancing transdifferentiation efficiency, and ensuring the long-term stability of β-cell identity. Overall, the ability to convert α-cells into β-cells represents a transformative strategy for diabetes treatment, offering hope for more effective and sustainable therapies for patients with severe β-cell loss.

Early Appearance of Thyroid Autoimmunity in Children Followed From Birth for Type 1 Diabetes Risk

CONTEXT

Autoantibodies to thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) define preclinical autoimmune thyroid disease (AITD), which can progress to either clinical hypothyroidism or hyperthyroidism.

OBJECTIVE

We determined the age at seroconversion in children genetically at risk for type 1 diabetes.

METHODS

TPOAb and TgAb seropositivity were determined in 5066 healthy children with human leukocyte antigen (HLA) DR3- or DR4-containing haplogenotypes from The Environmental Determinants of Diabetes in the Young (TEDDY) study. Children seropositive on the cross-sectional initial screen at age 8 to 13 years had longitudinally collected samples (from age 3.5 months) screened retrospectively and prospectively for thyroid autoantibodies to identify age at seroconversion. The first-appearing autoantibody was related to sex, HLA genotype, family history of AITD, and subsequent thyroid dysfunction and disease.

RESULTS

The youngest appearance of TPOAb and TgAb was age 10 and 15 months, respectively. Girls had higher incidence rates of both autoantibodies. Family history of AITD was associated with a higher risk of TPOAb hazard ratio (HR) 1.90; 95% CI, 1.17-3.08; and TgAb HR 2.55; 95% CI, 1.91-3.41. The risk of progressing to hypothyroidism or hyperthyroidism was not different between TgAb and TPOAb, but children with both autoantibodies appearing at the same visit had a higher risk compared to TPOAb appearing first (HR 6.34; 95% CI, 2.72-14.76).

CONCLUSION

Thyroid autoantibodies may appear during the first years of life, especially in girls, and in children with a family history of AITD. Simultaneous appearance of both autoantibodies increases the risk for hypothyroidism or hyperthyroidism.

Alcohol Consumption and Autoimmune Diseases

Alcohol is the second-most misused substance after tobacco. It has been identified as a causal factor in more than 200 diseases and 5.3% of all deaths and is associated with significant behavioral, social, and economic difficulties. As alcohol consumption may modulate the immune system's regulatory mechanisms to avoid attacking the body's tissues, it has been proven to play a dichotomic role in autoimmune diseases (ADs) based on the quantity of consumption. In this review, we report updated evidence on the role of alcohol in ADs, with a focus on alcohol addiction and the human biological immune system and the relationship between them, with alcohol as a risk or protective factor. Then, in this narrative review, we report the main evidence on the most studied ADs where alcohol represents a key modulator, including autoimmune thyroiditis, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, diabetes, allergic rhinitis, and primary biliary cholangitis. Alcohol at low-moderate dosages seems mostly to have a protective role in these diseases, while at higher dosages, the collateral risks surpass possible benefits. The specific mechanisms by which low-to-moderate alcohol intake relieves AD symptoms are not yet fully understood; however, emerging studies suggest that alcohol may have a systemic immunomodulatory effect, potentially altering the balance of anti-inflammatory innate and adaptive immune cells, as well as cytokines (via the NF-κB or NLRP3 pathways). It might influence the composition of the gut microbiome (increasing amounts of beneficial gut microbes) and the production of their fatty acid metabolites, such as short-chain fatty acids (SCFAs) and polyunsaturated fatty acids (PUFAs), as well as elevated concentrations of acetate, high-density lipoprotein (HDL), and nitric oxide (NO). Unfortunately, a definite acceptable daily intake (ADI) of ethanol is complicated to establish because of the many mechanisms associated with alcohol consumption such that despite the interesting content of these findings, there is a limit to their applicability and risks should be weighed in cases of alcoholic drinking recommendations. The aim of future studies should be to modulate those beneficial pathways involved in the alcohol-protective role of ADs with various strategies to avoid the risks associated with alcohol intake.

Enhanced Electrochemiluminescence from Ruthenium-Tagged Immune Complex at Flexible Chains for Sensitive Analysis of Glutamate Decarboxylase Antibody

Herein, a sensitive electrochemiluminescence (ECL) immunosensor is designed by immobilizing ruthenium-tagged immune complexes at flexible poly-ethylene-glycol (PEG) chains on the electrode surface, which offers more freedom for the collision of the ruthenium complex at the electrode during the initial ECL reaction. The electrochemical characterizations confirm the loose structure of the assembled layer with the immune complex, providing an increase in the current and the resultant enhanced ECL emissions. Comparing the sensors with the rigid structure, a 34-fold increase in the maximal ECL emission is recorded when PEG3400 is used as a linker. Using the optimized protocol, the prepared immunosensor exhibits a wide-ranging linear response to the model antibody (glutamate decarboxylase antibody) ranging from 10 pg/mL to 10 ng/mL. The detection limit is almost two orders lower than the value using the classic enzyme-linked immunosorbent assay, which offers a new design to enhance ECL emissions and the resultant analytical performance.

Optimization of the extraction methods and evaluation of the hypoglycemic effect of Adhatoda Zeylanica extracts on artificially induced diabetic mice

Synthetic antidiabetic drugs are often associated with various adverse side effects, including hypoglycemia, nausea, gastrointestinal disturbances, headaches, and even liver damage. In contrast, plant-derived natural antidiabetic bioactive compounds typically exhibit lower toxicity and fewer side effects and have been reported to aid effectively in diabetes management. These plant extracts regulate diabetes by restoring pancreatic function, enhancing insulin secretion, inhibiting intestinal glucose absorption, and facilitating insulin dependent metabolism. This study explored four extraction methods, including reflux distillation (RD), ultrasound assisted extraction (UAE), microwave assisted extraction (MAE), and enzyme assisted extraction (EAE) to optimize the yield of crude leaf extract and vasicine from Adhatoda zeylanica. RD produced the highest crude extract yield (98.29 g/kg of dried leaf), while MAE was the most effective for vasicine extraction, yielding 2.44 g vasicine per kg dried leaf. High Performance Liquid Chromatography (HPLC) with a diode array detector (DAD) was used to identify and quantify vasicine, a quinazoline alkaloid with known antidiabetic properties. The hypoglycemic effects of leaf extracts were evaluated in alloxan-induced diabetic mice, and the effect of A. zeylanica extract was compared to the extracts of Centella asiatica, Allamanda cathartica, and the standard drug metformin. At a dose of 400 mg/kg body weight (BW), methanolic leaf extracts of A. zeylanica, C. asiatica, and A. cathartica reduced blood glucose level by 78.95 %, 74.50 %, and 70.19 %, respectively, compared to the standard drug metformin, which reduced blood glucose levels by 85.84 %. A. zeylanica at 400 mg/kg BW dose and metformin demonstrated statistically similar and significant blood glucose level reduction (p < 0.001). Additionally, therapeutic doses of A. zeylanica leaf extract exhibited low cytotoxicity (cell survival rate >89 %), highlighting its potential as a safe and effective source of antidiabetic agent.

The Potential of Mesenchymal Stem Cell-Derived Exosomes to Treat Diabetes Mellitus

Diabetes mellitus (DM) is a fatal metabolic disease characterized by persistent hyperglycemia. In recent studies, mesenchymal stem cell (MSC)-derived exosomes, which are being investigated clinically as a cell-free therapy for various diseases, have gained attention due to their biomimetic properties that closely resemble natural cellular communication systems. These MSC-derived exosomes inherit the regenerative and protective effects from MSCs, inducing pancreatic β-cell proliferation and inhibiting apoptosis, as well as ameliorating insulin resistance by suppressing the release of various inflammatory cytokines. Consequently, MSC-derived exosomes have attracted attention as a novel treatment for DM as an alternative to stem cell therapy. In this review, we will introduce the potential of MSC-derived exosomes for the treatment of DM by discussing the studies that have used MSC-derived exosomes to treat DM, which have shown therapeutic effects in both type 1 and type 2 DM.

Interactions of human milk oligosaccharides with the immune system

Human milk oligosaccharides (HMOs) are abundant, diverse and complex sugars present in human breast milk. HMOs are well-characterized barriers to microbial infection and by modulating the human microbiome they are also thought to be nutritionally beneficial to the infant. The structural variety of over 200 HMOs, including neutral, fucosylated and sialylated forms, allows them to interact with the immune system in various ways. Clinically, HMOs impact allergic diseases, reducing autoimmune and inflammatory responses, and offer beneficial support to the preterm infant immune health. This review examines the HMO composition and associated immunomodulatory effects, including interactions with immune cell receptors and gut-associated immune responses. These immunomodulatory properties highlight the potential for HMO use in early stage immune development and for use as novel immunotherapeutics. HMO research is rapidly evolving and promises innovative treatments for immune-related conditions and improved health outcomes.

Effect of diabetes and hyperglycaemia on the physical and mechanical properties of dentine: a systematic review

OBJECTIVES

The aim of this systematic review was to assess the effect of DM (Type 1 and Type 2 Diabetes) and hyperglycaemia on the physical and mechanical properties of dentine which is critical for successful endodontic treatment.

METHOD

An electronic search of the following databases: PubMed, MEDLINE, Web of Science and the grey literature was performed up until July 2024. In vitro and in vivo studies on the effect of DM or hyperglycaemia on the mechanical and physical properties of dentine were included. Non-English language literature was excluded.

RESULTS

Of the 234 articles identified, 15 met the inclusion criteria. Four studies evaluated how artificially induced glycation or natural glycation of dentine due to aging affects the mechanical properties of dentine. Five studies investigated the influence of Type 2 Diabetes (T2D) on dentine's mechanical properties, while two studies focused on the effects of Type 1 Diabetes (T1D). A further, four studies compared the effects of both T1D and T2D on the dentine. The studies were heterogeneous and a range of mechanical and physical properties were evaluated.

CONCLUSION

DM and AGEs negatively influence the physical and mechanical properties of dentine however, there remains a paucity of evidence and further studies are needed.

CLINICAL SIGNIFICANCE

Diabetes Mellitus (DM) is a chronic metabolic disease characterised by hyperglycaemia, an altered immune response and complications associated with collagen connective tissues. DM can influence bone metabolism and alter its physical and mechanical properties via glycation processes within collagen and changes to osteoblast activities. While bone and dentine share similarities, dentine is unique as it is intimately associated with the dental pulp. Inflammation within the pulp can induce calcification and tertiary dentine deposition and so exploring the influence of DM on the mechanical properties of dentine is warranted to understand the clinical significance.

Pre-Type 1 Diabetes in Adolescents and Teens: Screening, Nutritional Interventions, Beta-Cell Preservation, and Psychosocial Impacts

Type 1 Diabetes (T1D) is a progressive autoimmune disease often identified in childhood or adolescence, with early stages detectable through pre-diabetic markers such as autoantibodies and subclinical beta-cell dysfunction. The identification of the pre-T1D stage is critical for preventing complications, such as diabetic ketoacidosis, and for enabling timely interventions that may alter disease progression. This review examines the multifaceted approach to managing T1D risk in adolescents and teens, emphasizing early detection, nutritional interventions, beta-cell preservation strategies, and psychosocial support. Screening for T1D-associated autoantibodies offers predictive insight into disease risk, particularly when combined with education and family resources that promote lifestyle adjustments. Although nutritional interventions alone are not capable of preventing T1D, certain lifestyle interventions, such as weight management and specific nutritional choices, have shown the potential to preserve insulin sensitivity, reduce inflammation, and mitigate metabolic strain. Pharmacological strategies, including immune-modulating drugs like teplizumab, alongside emerging regenerative and cell-based therapies, offer the potential to delay disease onset by protecting beta-cell function. The social and psychological impacts of a T1D risk diagnosis are also significant, affecting adolescents' quality of life, family dynamics, and mental health. Supportive interventions, including counseling, cognitive-behavioral therapy (CBT), and group support, are recommended for managing the emotional burden of pre-diabetes. Future directions call for integrating universal or targeted screening programs within schools or primary care, advancing research into nutrition and psychosocial support, and promoting policies that enhance access to preventive resources. Advocacy for the insurance coverage of screening, nutritional counseling, and mental health services is also crucial to support families in managing T1D risk. By addressing these areas, healthcare systems can promote early intervention, improve beta-cell preservation, and support the overall well-being of adolescents at risk of T1D.

Diabetes and gut microbiome

Diabetes mellitus represents a significant global health problem. The number of people suffering from this metabolic disease is constantly rising and although the incidence is heterogeneous depending on region, country, economic situation, lifestyle, diet and level of medical care, it is increasing worldwide, especially among youths and children, mainly due to lifestyle and environmental changes. The pathogenesis of the two most common subtypes of diabetes mellitus, type 1 (T1DM) and type 2 (T2DM), is substantially different, so each form is characterized by a different causation, etiology, pathophysiology, presentation, and treatment. Research in recent decades increasingly indicates the potential role of the gut microbiome in the initiation, development, and progression of this disease. Intestinal microbes and their fermentation products have an important impact on host metabolism, immune system, nutrient digestion and absorption, gut barrier integrity and protection against pathogens. This review summarizes the current evidence on the changes in gut microbial populations in both types of diabetes mellitus. Attention is focused on changes in the abundance of specific bacterial groups at different taxonomic levels in humans, and microbiome shift is also assessed in relation to geographic location, age, diet and antidiabetic drug. The causal relationship between gut bacteria and diabetes is still unclear, and future studies applying new methodological approaches to a broader range of microorganisms inhabiting the digestive tract are urgently needed. This would not only provide a better understanding of the role of the gut microbiome in this metabolic disease, but also the use of beneficial bacterial species in the form of probiotics for the treatment of diabetes.

Type 2 diabetes prediction method based on dual-teacher knowledge distillation and feature enhancement

Diabetes prediction is an important topic in the field of medical health. Accurate prediction can help early intervention and reduce patients' health risks and medical costs. This paper proposes a data preprocessing method, including removing outliers, filling missing values, and using sparse autoencoder (SAE) feature enhancement. This study proposes a new method for type 2 diabetes classification using a dual Convolutional Neural Network (CNN) teacher-student distillation model (DCTSD-Model), aiming to improve the accuracy and reliability of diabetes prediction. The variables of the original data are expanded by SAE to enhance the expressive power of the features. The proposed CNN and DCTSD-Model models are evaluated on the feature enhancement dataset using 10-fold cross validation. The experimental results show that after data preprocessing, DCTSD-Model adopts the dual teacher model knowledge distillation method to help the student model learn rich category information by generating soft labels, and uses weighted random samplers to learn samples of different categories, which solves the category imbalance problem and achieves excellent classification performance. The accuracy of DCTSD-Model on the classification task reached 98.57%, which is significantly higher than other models, showing higher classification ability and reliability. This method provides an effective solution for diabetes prediction and lays a solid foundation for further research and application.

Hybrid Control Policy for Artificial Pancreas via Ensemble Deep Reinforcement Learning

OBJECTIVE

The artificial pancreas (AP) shows promise for closed-loop glucose control in type 1 diabetes mellitus (T1DM). However, designing effective control policies for the AP remains challenging due to complex physiological processes, delayed insulin response, and inaccurate glucose measurements. While model predictive control (MPC) offers safety and stability through the dynamic model and safety constraints, it lacks individualization and is adversely affected by unannounced meals. Conversely, deep reinforcement learning (DRL) provides personalized and adaptive strategies but struggles with distribution shifts and substantial data requirements.

METHODS

We propose a hybrid control policy for the artificial pancreas (HyCPAP) to address the above challenges. HyCPAP combines an MPC policy with an ensemble DRL policy, leveraging the strengths of both policies while compensating for their respective limitations. To facilitate faster deployment of AP systems in real-world settings, we further incorporate meta-learning techniques into HyCPAP, leveraging previous experience and patient-shared knowledge to enable fast adaptation to new patients with limited available data.

RESULTS

We conduct extensive experiments using the UVA/Padova T1DM simulator across five scenarios. Our approaches achieve the highest percentage of time spent in the desired range and the lowest occurrences of hypoglycemia.

CONCLUSION

The results clearly demonstrate the superiority of our methods for closed-loop glucose management in individuals with T1DM.

SIGNIFICANCE

The study presents novel control policies for AP systems, affirming their great potential for efficient closed-loop glucose control.

The relevance of the heme oxygenase system in alleviating diabetes-related hormonal and metabolic disorders

Heme oxygenase (HO) is an enzyme that catalyzes heme degradation. HO dysfunction is linked to various pathological conditions, including diabetes. Results of animal studies indicate that HO expression and activity are downregulated in experimentally induced diabetes. This is associated with severe hormonal and metabolic disturbances. However, these pathological changes have been shown to be reversed by therapy with HO activators. In animals with experimentally induced diabetes, HO was upregulated by genetic manipulation or by pharmacological activators such as hemin and cobalt protoporphyrin. Induction of HO alleviated elevated blood glucose levels and improved insulin action, among other effects. This effect resulted from beneficial changes in the main insulin-sensitive tissues, i.e., the skeletal muscle, the liver, and the adipose tissue. The action of HO activators was due to positive alterations in pivotal signaling molecules and regulatory enzymes. Furthermore, diabetes-related oxidative and inflammatory stress was reduced due to HO induction. HO upregulation was effective in various animal models of type 1 and type 2 diabetes. These data suggest the possibility of testing HO activators as a potential tool for alleviating hormonal and metabolic disorders in people with diabetes.