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Search Results (1,729)

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20 pages, 1343 KB  
Review
Applying AI Tools for Monitoring Nutrition and Physical Activity in Populations with Obesity: Are We Ready?
by Alessandra Amato, Sara Baldassano and Giuseppe Musumeci
Obesities 2026, 6(2), 19; https://doi.org/10.3390/obesities6020019 - 27 Mar 2026
Abstract
This review examines the current state of development and application of artificial intelligence (AI) tools for monitoring nutrition and physical activity in individuals with obesity, with a focus on the physiological complexity of energy balance and the role of chrono-nutrition. Energy intake and [...] Read more.
This review examines the current state of development and application of artificial intelligence (AI) tools for monitoring nutrition and physical activity in individuals with obesity, with a focus on the physiological complexity of energy balance and the role of chrono-nutrition. Energy intake and expenditure are dynamically coupled and circadian-regulated: meal timing and movement patterns influence insulin sensitivity, thermogenesis, and Non-Exercise Activity Thermogenesis within the same day. Traditional monitoring methods suffer from recall bias and low granularity, while isolated sensors operate in data silos, limiting accuracy. Effective solutions require multimodal, continuous, and temporally aligned data streams. Current AI models exhibit critical limitations in obesity-specific contexts: inaccurate gait and energy expenditure estimates due to biomechanical differences, dietary models underestimating glycemic variability, poor performance on mixed dishes, sauces, and culturally diverse foods, and a lack of validation against gold standards such as doubly labelled water (DLW) and weighed food records. This review proposes a paradigm shift toward obesity-specific AI design, including enriched datasets and multimodal integration. Physical activity monitoring faces similar challenges: systematic measurement bias in wearables, sensor placement issues, and algorithms trained on normal-weight cohorts. In the GLP-1/GIP era, if transparency, ethical safeguards, and equitable access are ensured, AI will act as a catalyst for personalized care, remote monitoring, trial optimization, and next-generation drug discovery. In conclusion, the integration of AI with rigorous validation procedures and inclusive sampling strategies is essential to achieve reliable, fair, and clinically relevant monitoring approaches for obesity management. Full article
(This article belongs to the Special Issue Novel Technology-Based Exercise for Childhood Obesity Prevention)
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23 pages, 1119 KB  
Systematic Review
Comparative Efficacy and Safety of Tirzepatide Versus Dulaglutide in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
by Sadia Qazi, Mohammad Dawar Zahid, Eshal Atif, Anushah Faheem Ilyas, Mazhar Ali, Umair Ali, Muhammad Junaid, Eshal Fatima, Safia Bibi, Rai Muhammad Hassan Ashraf and Muhammad Atif Mazhar
Healthcare 2026, 14(7), 850; https://doi.org/10.3390/healthcare14070850 - 27 Mar 2026
Abstract
Background: Tirzepatide, a dual GIP/GLP-1 receptor agonist, demonstrates substantial glycemic and weight benefits versus GLP-1 receptor agonists in indirect comparisons, but direct comparative safety evidence versus dulaglutide remains limited. We evaluated comparative safety (primary outcome: overall adverse events) and efficacy. Methods: Following PRISMA [...] Read more.
Background: Tirzepatide, a dual GIP/GLP-1 receptor agonist, demonstrates substantial glycemic and weight benefits versus GLP-1 receptor agonists in indirect comparisons, but direct comparative safety evidence versus dulaglutide remains limited. We evaluated comparative safety (primary outcome: overall adverse events) and efficacy. Methods: Following PRISMA 2020 (prospectively registered: PROSPERO CRD420251276594), we searched MEDLINE, Embase, Scopus, and CENTRAL (inception–31 December 2025) for randomized controlled trials (≥26 weeks) comparing once-weekly tirzepatide with dulaglutide in adults with type 2 diabetes. Three trials (N = 13,590 participants) were included. Dichotomous outcomes were pooled using random-effects models (risk ratios [RRs], 95% confidence intervals [CIs]). GRADE assessed certainty of evidence. Results: Overall adverse event incidence did not differ significantly (RR 1.04 [0.98–1.10]; I2 = 36%; moderate-certainty evidence). Discontinuation due to adverse events was consistently higher with tirzepatide (RR 1.32 [1.20–1.45]; I2 = 0%; high-certainty evidence), representing a 32% increased risk across all populations. Categorical HbA1c target achievement was analyzed in two trials; the third trial reported HbA1c as a continuous outcome only. At the primary threshold (HbA1c < 7.0%), tirzepatide was consistently superior with no heterogeneity (RR 1.48 [1.33–1.64]; I2 = 0%; p < 0.00001). Across all thresholds combined, heterogeneity was extreme (I2 = 92%), limiting confidence in any pooled summary estimate; the greatest instability occurred at the strictest threshold (HbA1c < 5.7%; I2 = 98%; p = 0.40). Tirzepatide showed greater HbA1c target attainment in treatment-naive patients receiving dulaglutide 0.75 mg, whereas the glycemic advantage was smaller in patients with established cardiovascular disease receiving dulaglutide 1.5 mg. Categorical weight-loss outcomes were analyzed in two trials; tirzepatide was associated with greater weight-loss threshold achievement (RR 8.80 [4.04–19.17]; very low-certainty evidence), although interpretation is limited by substantial heterogeneity and restricted generalizability. Serious adverse events were not significantly different (RR 0.82 [0.47–1.43]; I2 = 42%). Conclusions: Overall adverse events were similar between treatments, but tirzepatide consistently increased discontinuation risk, indicating a clinically important tolerability-persistence trade-off. Glycemic efficacy was highly population-dependent: benefits were consistent at the primary HbA1c target (<7.0%; I2 = 0%) in early-stage disease, whereas the advantage was smaller in long-standing disease with established cardiovascular disease. Tirzepatide may be favored when glycemic or weight efficacy is prioritized in earlier-stage disease, provided tolerability is proactively managed. Dulaglutide remains appropriate when persistence is threatened by tolerability concerns or cardiovascular risk reduction is the primary goal. Full article
(This article belongs to the Section Clinical Care)
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30 pages, 5837 KB  
Article
Rational Design and Evaluation of Novel TGR5 Agonists for Diabetes
by Rachana S. Bhimanwar, Zachary Detwiler, Jinge G. Zhu, Samuel T. Saghafi, Carolyn A. Winder, Dawn Belt Davis, Amit Mittal, Vikas Sharma, David A. Harris and Snehal N. Chaudhari
Molecules 2026, 31(7), 1093; https://doi.org/10.3390/molecules31071093 - 26 Mar 2026
Abstract
Agonists of the G protein-coupled receptor TGR5 have long been sought-after for their metabolic benefits. Intestinal TGR5 activation induces secretion of the antidiabetic hormone GLP-1, which can systemically improve diabetes phenotypes in multiple organs. However, no TGR5 agonist drug candidate has succeeded in [...] Read more.
Agonists of the G protein-coupled receptor TGR5 have long been sought-after for their metabolic benefits. Intestinal TGR5 activation induces secretion of the antidiabetic hormone GLP-1, which can systemically improve diabetes phenotypes in multiple organs. However, no TGR5 agonist drug candidate has succeeded in clinical trials due to their low potency and unwanted side effects. A challenge in the field has been the development of TGR5 agonists that are non-toxic, long-acting, and have functional selectivity for G protein-biased agonism. In this study, we propose a systematic pipeline for engineering optimal TGR5 agonists with antidiabetic properties. This pipeline is interdisciplinary, combining in silico, in vitro, and in vivo assays to design and validate drug candidates. We identify 2 lead compounds that outline the necessary beneficial properties for a successful TGR5 agonist against diabetes. We uncover the molecular mechanisms that allow TGR5 agonists to induce the transcription of their target, TGR5, in intestinal enteroendocrine cells. Lastly, we investigate the molecular interactions of our lead candidates in the TGR5 binding pocket to identify optimal parameters for stability and biological activity. Our strategy for TGR5 agonist design and evaluation has the potential to guide the discovery process for targeted TGR5 therapeutics for metabolic diseases. Full article
(This article belongs to the Special Issue 30th Anniversary of Molecules—Recent Advances in Chemical Biology)
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17 pages, 3472 KB  
Article
Energy-Metabolism-Enhancing Probiotics Enhance the Therapeutic Response to a Glucagon-like Peptide-1 Receptor Agonist
by A-Ram Kim, Seong-Gak Jeon, So-Jung Park, Byoung-Kook Kim, Mi-Na Kweon, Myoung Ho Jang and Bo-Gie Yang
Nutrients 2026, 18(7), 1050; https://doi.org/10.3390/nu18071050 - 26 Mar 2026
Abstract
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective treatments for obesity, but substantial weight regain is common after therapy is discontinued. This study investigated whether probiotic strains with anti-obesity effects could enhance GLP-1RA-induced weight loss and attenuate post-treatment weight rebound. Methods: [...] Read more.
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective treatments for obesity, but substantial weight regain is common after therapy is discontinued. This study investigated whether probiotic strains with anti-obesity effects could enhance GLP-1RA-induced weight loss and attenuate post-treatment weight rebound. Methods: Candidate lactic acid bacteria were screened for anti-obesity efficacy in a high-fat-diet (HFD)-induced obese mouse model, and the selected strain was further characterized using metabolomic profiling of culture supernatants. To examine its interaction with GLP-1RA therapy, obese mice received dulaglutide for 4 weeks and were monitored for 2 weeks after treatment withdrawal, while the probiotic was orally administered for a total of 6 weeks. Body weight, glycemic parameters, and muscle strength were assessed throughout the study. Results: Limosilactobacillus fermentum GB102 reduced body weight and improved glycemic control in HFD-fed mice. These metabolic benefits were associated with alterations in circulating metabolic hormones, including adipokines, along with attenuated inflammatory responses in adipose tissue. Metabolomic profiling revealed that GB102 produced high levels of succinic acid, a metabolite previously linked to thermogenic activation. This strain increased whole-body energy expenditure in HFD-fed mice, produced glutamine, and showed enhanced conversion of arginine into ornithine and citrulline. When combined with dulaglutide, GB102 enhanced weight loss, preserved muscle strength, and attenuated both weight regain and glycemic rebound following dulaglutide withdrawal. Conclusions: These findings suggest that energy-metabolism-enhancing probiotics such as GB102 may enhance the metabolic effects of GLP-1RA therapy and help attenuate weight regain after treatment discontinuation. Full article
(This article belongs to the Special Issue Probiotics and the Gut Microbiome in Obesity)
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26 pages, 1112 KB  
Article
Disproportionality Analysis of Tirzepatide vs. Semaglutide and Liraglutide: System Organ Class-Level Post-Marketing Reporting Patterns in EudraVigilance
by Ruxandra Cristina Marin, Cosmin Mihai Vesa, Delia Mirela Tit, Andrei-Flavius Radu and Gabriela S. Bungau
Int. J. Mol. Sci. 2026, 27(7), 2988; https://doi.org/10.3390/ijms27072988 - 25 Mar 2026
Abstract
Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist, introduces a mechanistically distinct approach within incretin-based therapies. While its efficacy is established, real-world data comparing post-marketing safety with established GLP-1 receptor agonists remain limited. This study assessed System [...] Read more.
Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist, introduces a mechanistically distinct approach within incretin-based therapies. While its efficacy is established, real-world data comparing post-marketing safety with established GLP-1 receptor agonists remain limited. This study assessed System Organ Class (SOC)-level reporting patterns for tirzepatide versus semaglutide and liraglutide using EudraVigilance data. Aggregated individual case safety reports (ICSRs) were analyzed using pairwise disproportionality analyses based on a case/non-case approach. Reporting odds ratios (RORs) with 95% confidence intervals were calculated. False discovery rate (FDR) correction using the Benjamini–Hochberg procedure and sensitivity analyses restricted to serious and healthcare professional–reported cases were performed to assess robustness. After FDR adjustment, 20 SOCs were significant in tirzepatide–semaglutide and 23 in tirzepatide–liraglutide comparisons; eight SOCs remained significant across all analytical conditions. Compared with semaglutide, tirzepatide showed higher reporting for immune (ROR 1.97, 95% CI 1.75–2.21) and hepatobiliary disorders (ROR 1.71, 95% CI 1.61–1.82). Versus liraglutide, higher odds occurred for musculoskeletal (ROR 2.02, 95% CI 1.85–2.21) and psychiatric disorders (ROR 2.14, 95% CI 1.99–2.30), and lower odds for neoplasms (ROR 0.28, 95% CI 0.26–0.31). Tirzepatide shows heterogeneous reporting patterns compared with GLP-1 receptor agonists, with consistent excess reporting for hepatobiliary, immune, and musculoskeletal disorders. These findings are hypothesis-generating and warrant confirmation in exposure-adjusted studies. Full article
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14 pages, 1580 KB  
Article
MRI Visibility and MR–DSA Concordance of the Nuvascular Harbor Intrasaccular Occlusion Device: A Preclinical Study
by Gökce Hatipoglu Majernik, Andreas Öllerer, Teresa Lassacher, Emre Kaya, Dzmitry Kuzmin, Andrea Janu, Christoph Griessenauer and Monika Killer-Oberpfalzer
Brain Sci. 2026, 16(4), 348; https://doi.org/10.3390/brainsci16040348 - 25 Mar 2026
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Abstract
Background/Objectives: This GLP (Good laboratory practice) study evaluates the MRI compatibility and occlusion performance of the Nuvascular Harbor intrasaccular device for the treatment of bifurcation and sidewall aneurysms in a rabbit aneurysm model. Methods: A total of 27 New Zealand White rabbits with [...] Read more.
Background/Objectives: This GLP (Good laboratory practice) study evaluates the MRI compatibility and occlusion performance of the Nuvascular Harbor intrasaccular device for the treatment of bifurcation and sidewall aneurysms in a rabbit aneurysm model. Methods: A total of 27 New Zealand White rabbits with 33 surgically created aneurysms (22 bifurcation, 11 side wall) were included and allocated to 90-day (n = 12) or 180-day (n = 15) follow-up. After exclusion of one aneurysm due to parent vessel occlusion and one aneurysm unsuitable for treatment, 31 treated aneurysms remained for analysis. All animals underwent DSA and 3T MRI, including TOF-MRA, FLAIR, DWI, and SWI sequences. Occlusion status was independently graded using the Raymond–Roy Occlusion Classification (RROC), and intermodality agreement was assessed. Results: MR-based occlusion assessment demonstrated strong agreement with DSA, with exact Raymond–Roy class concordance in 80.6% of cases and clinically relevant agreement (adequate vs. incomplete occlusion) in 96.8%. Agreement analysis showed substantial concordance (Cohen’s κ = 0.65) and a strong positive correlation (r = 0.79). Adequate occlusion rates were comparable between modalities (87.1% on MRA vs. 83.9% on DSA), supporting the reliability of MR imaging for non-invasive occlusion assessment, reflecting consistent device visibility on MR imaging. Conclusions: The Harbor device provides a promising solution for follow up aneurysm occlusion with increased MR visibility, enabling safer, contrast- and radiation-free follow-up. This study emphasizes the need for future endovascular devices to integrate imaging compatibility into their design to enhance long-term patient follow up. Full article
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26 pages, 1096 KB  
Review
The AMPK/NRF2/FOXO Axis in CKD—Molecular and Clinical Perspectives
by Ivan Lučić, Marina Vojković and Lidija Milković
Antioxidants 2026, 15(4), 409; https://doi.org/10.3390/antiox15040409 - 24 Mar 2026
Viewed by 45
Abstract
Chronic Kidney Disease (CKD) is a global health crisis, projected to be the fifth leading cause of death by 2040. Its progression is driven by a reinforcing loop of mitochondrial dysfunction, oxidative stress, and chronic inflammation. The AMPK-NRF2–FOXO axis serves as a central [...] Read more.
Chronic Kidney Disease (CKD) is a global health crisis, projected to be the fifth leading cause of death by 2040. Its progression is driven by a reinforcing loop of mitochondrial dysfunction, oxidative stress, and chronic inflammation. The AMPK-NRF2–FOXO axis serves as a central “redox-metabolic rheostat” that maintains renal homeostasis but is commonly dysfunctional in CKD. Herein, we explore the molecular crosstalk within this network, where AMPK acts as a metabolic and redox sensor, NRF2 governs the cytoprotective response, and FOXO isoforms regulate autophagy, antioxidative defense, and senescence. We highlight the functional paradoxes within the axis and evaluate the benefits and drawbacks of nutraceuticals and pharmacological agents, such as NRF2 inducer bardoxolone methyl, underscoring the necessity for context-dependent modulation. Furthermore, we examine the AMPK–NRF2–FOXO axis within the current clinical management, according to the 2024/2026 KDIGO guidelines. These guidelines reflect a shift toward a multi-targeted pharmacological approach involving metformin, SGLT2 inhibitors, GLP-1 receptor agonists, finerenone, and hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors. Full article
(This article belongs to the Special Issue Oxidative Stress and NRF2 in Health and Disease—2nd Edition)
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13 pages, 620 KB  
Article
Glucagon-like Peptide-1 Receptor Agonist Therapy and Risk of Pulmonary and Systemic Infections in Diabetic Gastroparesis: A Propensity-Matched Cohort Study
by Muhammad Ali Ibrahim Kazi, Hasan Kamal, Syed Musa Mufarrih, Imran Qureshi, Sanmeet Singh and Adrien Mazer
Adv. Respir. Med. 2026, 94(2), 20; https://doi.org/10.3390/arm94020020 - 24 Mar 2026
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Abstract
Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research [...] Read more.
Introduction: Diabetic gastroparesis increases the risk of aspiration, pneumonia, and sepsis, yet the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on these outcomes is uncertain because of their gastric-emptying effects. Methods: We performed a retrospective cohort study using the TriNetX Global Research Network. Adults (≥18 years) with diabetes mellitus and gastroparesis were identified and divided into two cohorts based on GLP-1 RA exposure. Propensity score matching (1:1) balanced demographics, comorbidities, and antidiabetic medications, yielding 23,371 patients per cohort. Outcomes, assessed from 180 days after index, included pneumonia, pneumonitis, mechanical ventilation, ventilator-associated pneumonia, sepsis, bacteremia, empyema, lung abscess, acute respiratory distress syndrome (ARDS), and need for enteral feeding. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Results: Compared with GLP-1 users, non-GLP-1 patients had higher incidences of pneumonitis (3.6% vs. 2.5%; HR 1.76, 95% CI 1.58–1.95), pneumonia (13.2% vs. 12.2%; HR 1.34, 95% CI 1.27–1.41), mechanical ventilation (4.4% vs. 3.3%; HR 1.63, 95% CI 1.49–1.79), sepsis (12.8% vs. 11.1%; HR 1.44, 95% CI 1.37–1.52), and bacteremia (5.2% vs. 4.4%; HR 1.46, 95% CI 1.35–1.59) (all p < 0.001). Empyema and ARDS were also numerically lower among GLP-1 users, while ventilator-associated pneumonia and lung abscess were rare and similar between groups. No patients required percutaneous endoscopic gastrostomy or nasal enteral feeding. Conclusions: In patients with diabetes and gastroparesis, GLP-1 RA therapy was associated with significantly fewer pulmonary and systemic infectious complications. These data suggest that the systemic benefits of GLP-1 RAs may outweigh concerns regarding delayed gastric emptying in this high-risk population. Full article
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21 pages, 1403 KB  
Review
Integrating GLP-1 Receptor Agonists into Modern Stroke Prevention: Evidence, Mechanisms, and Clinical Consideration—A Narrative Review
by Shayan Khan, William Herbst, Farbod Zahedi Tajrishi, Sonali Notani, Alexander Knight, Zina Jamil and Keith C. Ferdinand
Biomedicines 2026, 14(4), 743; https://doi.org/10.3390/biomedicines14040743 (registering DOI) - 24 Mar 2026
Viewed by 201
Abstract
Stroke remains a major cause of morbidity and mortality worldwide. Although reperfusion therapies and secondary prevention have advanced, the global stroke burden continues to rise, driven by increasing rates of hypertension and diabetes mellitus. Type 2 diabetes (T2DM) increases the risk of acute [...] Read more.
Stroke remains a major cause of morbidity and mortality worldwide. Although reperfusion therapies and secondary prevention have advanced, the global stroke burden continues to rise, driven by increasing rates of hypertension and diabetes mellitus. Type 2 diabetes (T2DM) increases the risk of acute ischemic stroke (AIS) through mechanisms involving chronic hyperglycemia, endothelial dysfunction, inflammation, and accelerated atherogenesis. In recent years, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as promising agents for cardiovascular and cerebrovascular risk reduction in patients with T2DM. Beyond their glucose-lowering properties, GLP-1RAs improve blood pressure regulation and lipid metabolism, as mentioned in the 2025 AHA Journal guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults. Emerging preclinical and clinical evidence indicates that GLP-1RAs also provide direct neurovascular protection by stabilizing the blood–brain barrier, modulating neuroinflammation, and promoting neuronal survival. These mechanisms may reduce ischemic injury, improve recovery after stroke, and protect against cognitive decline. Major cardiovascular outcome trials have demonstrated significant reductions in major adverse cardiovascular events and, to a lesser degree, non-fatal stroke among patients receiving GLP-1RAs. This narrative review evaluates current evidence on the neurovascular, cardiometabolic, and anti-inflammatory actions of GLP-1RAs and their potential role in mitigating stroke risk and promoting cerebrovascular health. Additionally, it highlights gaps in the literature, explores clinical and guideline implications, and outlines future directions for integrating GLP-1RA therapy into comprehensive stroke prevention and recovery strategies. Full article
(This article belongs to the Special Issue Diabetes: Comorbidities, Therapeutics and Insights (3rd Edition))
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24 pages, 9043 KB  
Article
Lingguizhugan Decoction Ameliorates MASLD by Modulating the Gut Microbiota and Enriching Non-12-OH Bile Acids to Activate TGR5-Mediated Thermogenesis
by Yun-Hong Sun, Pei-Lun Ding, Xue Wang, Yi-Rong Wang, Ming-Zhe Zhu, Kai Wang, Liang Dai, Yan-Qi Dang, Guang Ji, Meng Li and Wen-Jun Zhou
Pharmaceuticals 2026, 19(4), 523; https://doi.org/10.3390/ph19040523 - 24 Mar 2026
Viewed by 82
Abstract
Objective: Based on previous findings on the Lingguizhugan (LGZG)-mediated gut–liver axis, this study clarifies the therapeutic mechanisms of LGZG in metabolic dysfunction-associated steatotic liver disease (MASLD), with a focus on the gut microbiota–bile acid–TGR5 (GPBAR1) axis. Methods: C57BL/6J mice were fed [...] Read more.
Objective: Based on previous findings on the Lingguizhugan (LGZG)-mediated gut–liver axis, this study clarifies the therapeutic mechanisms of LGZG in metabolic dysfunction-associated steatotic liver disease (MASLD), with a focus on the gut microbiota–bile acid–TGR5 (GPBAR1) axis. Methods: C57BL/6J mice were fed a high-fat diet (HFD) for 8 weeks to induce MASLD, followed by 4-week LGZG intervention (21.57 g/kg/day, oral gavage). Metabolic phenotypes, gut microbiota (16S rRNA sequencing), serum/hepatic bile acids (targeted metabolomics), and molecular targets (qPCR/Western blot) were analyzed. Results: LGZG significantly alleviated HFD-induced obesity, insulin resistance, and hepatic steatosis, while enhancing whole-body energy expenditure (increased oxygen consumption (VO2), and heat production (p < 0.05). It also reduced serum ALT (p < 0.001) and AST levels (p < 0.01). Mechanistically, LGZG remodeled the gut microbiota, specifically increasing Akkermansia, Bifidobacterium and Lachnospiraceae_NK4A236_group while decreasing Lactobacillus. This shift inhibited the intestinal FXR-Fgf15 axis, concurrently activating the hepatic alternative bile acid synthesis pathway (upregulating CYP27A1 and CYP7B1 protein expression; p < 0.001 and p < 0.01, respectively). Consequently, systemic accumulation of non-12α-hydroxylated bile acids (non-12-OH BAs) such as hyocholic acid (HCA) and 7-ketolithocholic acid (7-ketoLCA) occurred—known TGR5 agonists and intestinal FXR antagonists. These changes elevated serum GLP-1 levels (p < 0.05) and activated adipose TGR5-cAMP/PKA/CREB signaling. The metabolic benefits primarily originated from non-12-OH BAs enrichment and TGR5-mediated adipose browning, not hepatic FXR activation. Conclusions: Our findings show that LGZG ameliorates MASLD by remodeling bile acid profiles via intestinal FXR-Fgf15 axis inhibition and hepatic alternative synthesis pathway activation. This study highlights the TGR5-targeting properties of LGZG, providing a mechanistic basis for its therapeutic use in metabolic disorders. Full article
(This article belongs to the Section Pharmacology)
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14 pages, 381 KB  
Review
The Anti-Inflammatory Role of GLP-1 RAs in Acute Lung Injury and Acute Respiratory Distress Syndrome
by Paul Dumitrescu and Beata Kosmider
Int. J. Mol. Sci. 2026, 27(7), 2922; https://doi.org/10.3390/ijms27072922 - 24 Mar 2026
Viewed by 124
Abstract
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) pose a significant burden on the healthcare system. The mechanisms underlying the pathophysiology of ALI/ARDS are widely studied. However, currently, there are no clinically approved drugs that can effectively reduce the high mortality [...] Read more.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) pose a significant burden on the healthcare system. The mechanisms underlying the pathophysiology of ALI/ARDS are widely studied. However, currently, there are no clinically approved drugs that can effectively reduce the high mortality of patients. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are an increasingly popular class of medications. Their FDA approval was driven by the beneficial effects in patients with type 2 diabetes mellitus. Notably, recent studies are beginning to recognize the role of GLP-1 RAs in immunomodulation and anti-inflammatory responses across various organs, including the lungs. Animal models of ALI demonstrate the potential of these medications for treatment and prophylaxis. Observational studies suggest that patients taking GLP-1 RAs experienced fewer pulmonary complications. Here, we reviewed reports on their impact on the respiratory system in animal models of ALI and in clinical trials. Their effects in the intensive care unit setting and conditions predisposing to ALI/ARDS were also summarized. The mechanisms of action of GLP-1 RAs were reviewed based on in vitro studies using various lung cell types, and experimental approaches. Moreover, the roles of the pharmaceutical industry and patent law in extending the scope of GLP-1 RAs beyond obesity and diabetes were also described. Full article
(This article belongs to the Special Issue Molecular Research in Acute Lung Injury)
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11 pages, 602 KB  
Review
A Pharmacovigilance Analysis of Ocular Adverse Events Associated with GLP-1 Receptor Agonists
by Abdullah Virk and Karen Allison
J. Clin. Med. 2026, 15(6), 2464; https://doi.org/10.3390/jcm15062464 - 23 Mar 2026
Viewed by 228
Abstract
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes in addition to other conditions such as obesity. As their use expands, understanding potential ocular safety signals is important, particularly in populations already at risk for diabetic eye disease. [...] Read more.
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes in addition to other conditions such as obesity. As their use expands, understanding potential ocular safety signals is important, particularly in populations already at risk for diabetic eye disease. The aim of this study is to identify potential pharmacovigilance safety signals for ocular adverse events (AEs) related to GLP-1 RA medications to better inform future clinical practice. Methods: This study utilized the publicly available FDA Adverse Event Reporting System (FAERS) to obtain AE reports related to exenatide, tirzepatide, dulaglutide, liraglutide, and semaglutide from 2005 to 2024. Reports were categorized by demographic and geographic variables. Disproportionality analysis using reporting odds ratios (RORs) was performed to detect potential safety signals. Year-over-year trends in the proportional representation of each drug were also assessed through linear regression and time series plots. Results: Ocular AEs represented 3.61% of all GLP-1 RA related reports. Median age was 63 years, and 62.6% of reports involved female patients. Exenatide accounted for 33.61% of ocular AEs but showed a significant annual decline in reporting (–5.15% per year, p < 0.001). Semaglutide (31.37%) and tirzepatide (12.19%) demonstrated significant year-over-year increases in proportional reporting (2.23% and 0.79% per year, respectively; both p < 0.05), consistent with rapid uptake in clinical practice. Semaglutide demonstrated a modestly elevated ROR (1.46), while tirzepatide showed a low ROR (0.42), though this likely reflects shorter post-marketing exposure rather than lower clinical risk. The most frequently reported events were visual impairment, followed by vision blurred, cataract, and blindness. Conclusions: This pharmacovigilance analysis identifies potential ocular AE signals associated with GLP-1 RAs, particularly semaglutide. While semaglutide showed a statistically significant disproportional reporting signal for ocular AEs, the absence of exposure denominators, comparator groups, and the susceptibility of FAERS to reporting bias means these findings are hypothesis-generating rather than causal. Clinicians should remain vigilant and consider eye care referrals when indicated. Further research is needed to validate these associations and clarify underlying mechanisms. Full article
(This article belongs to the Section Ophthalmology)
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21 pages, 1369 KB  
Review
GLP-1 Receptor Agonists at the Crossroads of Circadian Biology, Sleep, and Metabolic Disease
by Ayush Gandhi, Ei Moe Phyu, Kwame Koom-Dadzie, Kodwo Bosomefi Dickson and Josiah Halm
Int. J. Mol. Sci. 2026, 27(6), 2853; https://doi.org/10.3390/ijms27062853 - 21 Mar 2026
Viewed by 586
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of type 2 diabetes and obesity, yet their actions extend beyond glycemic control and weight loss. This narrative review synthesizes current preclinical and clinical evidence examining the bidirectional relationship between glucagon-like peptide-1 (GLP-1) receptor [...] Read more.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of type 2 diabetes and obesity, yet their actions extend beyond glycemic control and weight loss. This narrative review synthesizes current preclinical and clinical evidence examining the bidirectional relationship between glucagon-like peptide-1 (GLP-1) receptor agonists and circadian biology. A structured literature search was conducted in PubMed using combinations of the terms ‘GLP-1,’ ‘circadian,’ ‘chronobiology,’ ‘sleep,’ ‘obesity,’ and ‘type 2 diabetes’ through January 2026. Accumulating evidence indicates that GLP-1 physiology is closely coupled to circadian timing systems and sleep–wake regulation. In this narrative review, we synthesize emerging data that reframe GLP-1RAs as chronometabolic modulators, acting at the intersection of metabolism, circadian biology, and sleep. We review circadian control of GLP-1 secretion by intestinal L-cells, emphasizing the role of core clock genes and the vulnerability of incretin rhythms to circadian misalignment from shift work, nocturnal light exposure, and sleep loss. We then examine GLP-1 receptor signaling within central and peripheral clock networks, including feedback effects on hypothalamic and hepatic circadian regulation. Emerging data suggest that GLP-1 signaling is under circadian regulation and may, in turn, influence central and peripheral clock systems. Comparative discussion of semaglutide, liraglutide, and tirzepatide highlights agent-specific pharmacokinetics and emerging clinical data linking GLP-1RA therapy to sleep outcomes, particularly obstructive sleep apnea. Finally, we outline translational opportunities for chronotherapy and precision medicine, positioning GLP-1RAs as integrative tools for metabolic and sleep-related disease rather than purely weight-centric therapies. We propose that GLP-1 receptor agonists may function as chronometabolic modulators, with potential implications for personalized chronopharmacological strategies in metabolic disease. Full article
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30 pages, 1120 KB  
Review
New Drugs on the Block: Dietary Management and Nutritional Considerations During the Use of Anti-Obesity Medication
by Eleni C. Pardali, Kalliopi K. Gkouskou, Christos Cholevas, Dimitrios Poulimeneas, Kyriaki Tsiroukidou, Dimitrios G. Goulis and Maria G. Grammatikopoulou
Nutrients 2026, 18(6), 962; https://doi.org/10.3390/nu18060962 - 18 Mar 2026
Viewed by 189
Abstract
Incretin-based pharmacotherapy has rapidly transformed obesity management. However, despite its efficacy, gastrointestinal (GI) adverse events (AEs) are common and represent a major driver of treatment discontinuation. Symptoms such as nausea, vomiting, acid reflux, diarrhea, and constipation, not only impair the quality of life, [...] Read more.
Incretin-based pharmacotherapy has rapidly transformed obesity management. However, despite its efficacy, gastrointestinal (GI) adverse events (AEs) are common and represent a major driver of treatment discontinuation. Symptoms such as nausea, vomiting, acid reflux, diarrhea, and constipation, not only impair the quality of life, but also compromise adherence, thereby limiting the real-world effectiveness of these agents. Targeted nutritional strategies may play a pivotal role in mitigating these symptoms and supporting sustained treatment. However, most clinical trials have relied on generalized lifestyle advice combined with hypocaloric dietary prescriptions, with limited integration of structured, mechanism-based nutritional counseling tailored to the physiological actions of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs. Consequently, practical guidance for clinicians and dietitians remains fragmented. The present review synthesizes the available evidence on GI AEs associated with incretin-based therapies and examines whether structured, targeted nutritional management can meaningfully reduce symptom burden. We also outline key monitoring strategies and focus on important clinical aspects for physicians and dietitians, aiming to optimize patient outcomes. In addition, we provide detailed information on the spectrum of GI AEs to guide effective management and limit intolerance. By bridging pharmacology with applied clinical nutrition, we aim to provide a pragmatic framework for improving tolerability, sustaining adherence, and translating trial efficacy into durable real-world effectiveness. Full article
(This article belongs to the Special Issue Nutritional Perspectives in Obesity Treatments)
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13 pages, 479 KB  
Review
Exploring the Pleiotropic Cardioprotective Effects of GLP-1 Receptor Agonists in Preventing Anthracycline-Induced Cardiotoxicity: A Theoretical Proposal for Future Research
by Matthew L. Repp, Ikeotunye Royal Chinyere, Santiago Teran, Julia Bast and Lavanya Kondapalli
Medicines 2026, 13(1), 10; https://doi.org/10.3390/medicines13010010 - 17 Mar 2026
Viewed by 175
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been shown to reduce morbidity and mortality associated with type II diabetes mellitus, and/or obesity, and/or cardiovascular disease in multiple clinical trials. Their efficacy in reversing cardiovascular disease and mitigating the risk of major adverse cardiac [...] Read more.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been shown to reduce morbidity and mortality associated with type II diabetes mellitus, and/or obesity, and/or cardiovascular disease in multiple clinical trials. Their efficacy in reversing cardiovascular disease and mitigating the risk of major adverse cardiac and vascular events has been well studied, with outcome trials consistently demonstrating benefits such as reduced systemic inflammation, improved endothelial function, and favorable metabolic effects. These pleiotropic actions have nearly innumerable potential applications, with a progressively growing interest in using GLP-1 RAs to mitigate increased cardiovascular disease risk secondary to other off-target pharmacologic agents. Given these effects, the potential to utilize GLP-1 RAs for prophylactic cardioprotection before, during, and/or after chemotherapy regimens is of great interest. These effects are thought to be mediated in part through anti-inflammatory and antioxidant mechanisms that counter inflammation and reactive oxygen species-driven myocardial injury central to anthracycline-induced cardiotoxicity (AIC). Anthracyclines, a widely used class of chemotherapeutics for various malignancies, are frequently associated with dose-dependent and often irreversible cardiotoxicity, leading to heart failure, reduced quality of life, and adverse long-term outcomes. For the past three decades, dexrazoxane has been the sole Food and Drug Administration-approved agent for cardioprotection in this setting. However, in the current era of novel therapies with multi-system benefits—such as GLP-1 RAs—we propose a theoretical framework exploring their potential role in mitigating AIC and underscore the need for further clinical investigation in this new arena in the field of cardio-oncology. Full article
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