Search Results (256)

Background: Postmenopausal women experience an increased risk of cardiovascular diseases due to estrogen deficiency, which induces endothelial dysfunction. Statins primarily lower cardiovascular risk by altering lipid profiles, but they also exert non-lipid-modifying, pleiotropic effects on the vascular endothelium. This prospective observational study was aimed to evaluate and compare the impact of atorvastatin and rosuvastatin on plasma markers of endothelial dysfunction, endocan and endoglin, in postmenopausal women undergoing primary cardiovascular prevention. Methods: A total of 128 postmenopausal Croatian women (aged 45–70 years) with dyslipidemia were prospectively enrolled and assigned to two treatment groups receiving either atorvastatin or rosuvastatin therapy based on primary care clinical management. Cardiovascular risk was evaluated using the SCORE2 algorithm, and statin doses were titrated up to 16 weeks until target LDL-C values were achieved. Plasma concentrations of endocan and endoglin, alongside lipid profiles, were quantified via ELISA and laboratory analyses before and after the treatment period. Results: Atorvastatin and rosuvastatin therapies significantly decreased plasma concentrations of both endocan and endoglin (p < 0.001 for both groups). No statistically significant differences in the absolute changes in these biomarkers were observed between therapy groups. The reduction in endocan and endoglin levels occurred independently of whether the participants achieved their clinical target LDL-C values. While statin-induced reduction in endoglin was directly driven by the extent of LDL-C lowering, the decrease in endocan occurred independently of lipid changes, with both biomarker reductions being greatest in women with higher baseline levels regardless of statin type or dose. ROC curve analysis demonstrated that neither biomarker had significant clinical discriminatory ability to predict the attainment of target LDL-C levels. Conclusions: Atorvastatin and rosuvastatin treatment was associated with significant reductions in plasma endocan and endoglin concentrations in postmenopausal women receiving primary cardiovascular prevention. Full article

Metabolic dysfunction-associated steatohepatitis (MASH), a progressive form of metabolic dysfunction-associated steatotic liver disease, affects approximately 3–5% of the global population and lacks effective therapies. This study examined the impact of near-thermoneutral housing on MASH progression in mice fed a fast-food diet (FFD) enriched in fat, sucrose, and cholesterol. Male C57BL/6J mice were housed under standard (22 °C) or near-thermoneutral (27 °C) conditions and fed chow or FFD for 20 weeks. Body weight, composition, liver pathology, hepatic gene expression, plasma lipids, and adipose thermogenic and inflammatory markers were assessed. FFD increased body weight, fat mass, and lean mass at both temperatures. Near-thermoneutral housing markedly exacerbated MASH in FFD-fed mice, with increased steatosis, fibrosis, inflammation, and elevated liver enzymes. Hepatic lipogenic and fibrosis-related gene expression was upregulated, alongside higher plasma total cholesterol and very-low-density lipoprotein levels. Near-thermoneutral housing also impaired brown adipose tissue thermogenesis, reducing uncoupling protein 1 and other thermogenic genes, and modestly altered inguinal white adipose tissue inflammation and thermogenic signaling. These findings demonstrate that near-thermoneutral housing accelerates MASH progression, accompanied by increased hepatic lipid accumulation, fibrosis, and inflammation and reduced adipose thermogenic signatures. These findings identify environmental temperature as a critical modifier of MASH pathophysiology and suggest that enhancing adipose thermogenesis may offer therapeutic potential. Full article

Background: Population aging is driving a convergent rise in three disorders historically managed in isolation: cardiovascular disease, neurocognitive decline, and osteoporotic bone loss. Mechanistic data indicate that these systems are coupled through shared regulators of calcium trafficking, inflammation resolution, vascular integrity, and inflammaging. On this basis, a “Heart–Brain–Bone” axis has been proposed; it should be understood as an integrative conceptual framework that organizes evidence drawn from three separate studies, not as a validated physiological entity with agreed diagnostic criteria or demonstrated modifiability. Three lipid-soluble nutrients—long-chain omega-3 polyunsaturated fatty acids (EPA/DHA), vitamin D3 (cholecalciferol), and vitamin K2 (menaquinone-7 [MK-7])—act on overlapping nodes of this network. Methods: We performed a structured narrative review. PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science were searched from database inception to 25 June 2026 using predefined term blocks for each nutrient, each organ domain, and each candidate mechanism, and the search was updated on 7 August 2026. Records were screened against prespecified inclusion and exclusion criteria by two authors independently, with disagreements resolved by a third. The strength of evidence for each nutrient–organ relationship was graded with an explicitly defined four-level scheme ((−) to (+++)) applied separately to preclinical, observational, randomized and meta-analytic evidence. Results: Vitamin K2-dependent gamma-carboxylation of matrix Gla protein (MGP) and osteocalcin has been proposed to influence whether calcium is incorporated into the bone matrix or deposited in the arterial wall, offering a candidate mechanistic account of the “calcium paradox” associated with isolated vitamin D3 supplementation; EPA/DHA-derived specialized pro-resolving mediators may support resolution of endothelial and neuronal inflammation; and bone-, vascular- and brain-derived signals (osteocalcin, FGF23, the neurovascular unit) interconnect the three organs. These mechanisms are biologically plausible but remain insufficiently confirmed in humans. The clinical evidence is heterogeneous, formulation- and population-dependent, and comprises positive, neutral and null results: cardiovascular omega-3 trials are discordant (REDUCE-IT, which used icosapent ethyl [an EPA ethyl ester], positive; VITAL/STRENGTH/ASCEND null, predominantly in lower-risk or replete cohorts); cognitive trials are largely null or subgroup-dependent (MAPT, DO-HEALTH, VITAL); and MK-7 improves surrogate bone and calcification biomarkers and slowed coronary artery calcification in one recent randomized imaging trial (VitaK-CAC), whereas combined MK-7 plus vitamin D3 did not slow aortic valve or coronary calcification in AVADEC and MK-7 did not reduce bone loss in early menopausal women. Recognized safety signals include a dose-dependent increase in atrial fibrillation with high-dose omega-3, adverse skeletal effects of high-dose or bolus vitamin D, and clinically relevant interference of even low-dose MK-7 with vitamin K antagonist therapy. Conclusions: No adequately powered randomized trial has demonstrated that the combination of long-chain omega-3, vitamin D3 and MK-7 is superior to its individual components or to placebo for any clinical endpoint. The combined regimen is therefore mechanistically rational and hypothesis-generating rather than clinically established; benefit appears most plausible in individuals with elevated risk or demonstrable nutritional insufficiency, and least in replete, low-risk populations. Findings should be interpreted within a broader healthy-aging context that includes lifestyle and psychosocial factors. Adequately powered factorial randomized controlled trials stratified by baseline Omega-3 index, 25(OH)D and vitamin K status, with prespecified mechanistic biomarkers and hard endpoints, are required. Full article

Immune cells possess an intrinsic covalent signalling system in which endogenous electrophilic species function as molecular regulators of cellular state that integrate metabolic activity, oxidative stress, and inflammatory signals. Lipid peroxidation-derived electrophiles, enzymatically generated electrophilic lipid mediators, nitro-fatty acids, and metabolite-derived electrophiles selectively modify reactive amino acid residues within signalling proteins to regulate immune cell differentiation, metabolic adaptation, stress responses, and tissue responses. This perspective highlights that endogenous electrophilic signalling provides a biological blueprint for the development of next-generation precision covalent immunotherapeutics. Beyond exploiting electrophilic chemistry as a reactive pharmacological strategy, emerging insights reveal that immune cells naturally employ regulated covalent modifications to achieve stimulus-dependent control of signalling networks. Advances in chemoproteomics, structural biology, systems immunology, computational chemistry, and targeted delivery technologies are enabling the identification of electrophile-sensitive regulatory targets and the rational design of selective covalent modulators. The discussion includes how the principles derived from endogenous electrophilic signalling can guide therapeutic innovation across major immunotherapeutic areas, including chronic inflammatory diseases, cancer immunology, inflammasome-driven disorders, fibrotic disease, neuroinflammation, and vascular immunometabolic disorders. By translating endogenous covalent regulatory mechanisms into precision drug design strategies, electrophile-guided pharmacology offers an emerging strategy for developing therapies that reprogramme immune cell states, restore immune homeostasis, and achieve stimulus-dependent modulation of disease-associated immune responses. Full article

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance, pancreatic β-cell dysfunction, and dysregulated glucose and lipid metabolism. Sustained hyperglycemia and hyperlipidemia promote excessive reactive oxygen species (ROS) production, antioxidant defense depletion, and chronic low-grade inflammation, thereby aggravating insulin signaling impairment, β-cell injury, and diabetes-related complications. Although current glucose-lowering therapies have improved glycemic control, weight management, and cardiorenal outcomes, oxidative stress and inflammation remain incompletely addressed in many individuals with T2DM. Curcumin, a natural polyphenol derived from Curcuma longa L., exhibits antioxidant, anti-inflammatory, lipid-regulating, insulin-sensitizing, and tissue-protective activities. Evidence suggests that curcumin may alleviate T2DM-associated oxidative stress by suppressing ROS generation, reducing nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, modulating the advanced glycation end-product/receptor for advanced glycation end-product (AGE/RAGE) axis, activating nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE) signaling, preserving mitochondrial homeostasis, and protecting β-cells. It may also inhibit nuclear factor-κB (NF-κB) and mitogen-activated protein kinase/c-Jun N-terminal kinase (MAPK/JNK) signaling, decrease pro-inflammatory cytokines and C-reactive protein (CRP), improve metabolic tissue inflammation, and attenuate gut-derived inflammation by regulating gut microbiota and intestinal barrier function. However, current clinical evidence mainly supports modest improvements in metabolic, inflammatory, oxidative stress-related, and selected complication-related biomarkers rather than definitive disease-modifying outcomes. Moreover, formulation heterogeneity, low bioavailability, limited pharmacokinetic reporting, and insufficient long-term endpoint data remain major translational barriers. This review summarizes the molecular mechanisms, clinical evidence, formulation-dependent interpretation, safety considerations, and translational limitations of curcumin as a candidate adjunctive intervention for T2DM, rather than as a replacement for evidence-based antidiabetic therapy. Full article

Ketogenic metabolic therapy (KMT), typically implemented as a ketogenic diet (KD), has re-emerged as a potential adjuvant strategy in oncology. Its rationale is grounded in the metabolic reprogramming of cancer cells, including their reliance on glucose and lipid substrates and the signaling functions of ketone bodies. Despite extensive preclinical evidence of anti-proliferative and immunomodulatory effects, clinical translation in cancer therapy has been slow and inconsistent. This review critically examines the mechanistic basis, experimental and clinical evidence, and translational challenges of KMT across epithelial cancers. We emphasize that “ketogenic interventions” comprise mechanistically distinct modalities, including classical KD, fasting, fasting-mimicking diets, and exogenous ketone supplementation, which are frequently conflated yet differ substantially in their endocrine and metabolic contexts. Across clinical studies, KMT is generally feasible and associated with improvements in quality of life and metabolic parameters; however, robust evidence for the survival benefit of KMT remains limited and heterogeneous. Mechanistically, ketone bodies exert both metabolic and signaling functions, including inhibition of histone deacetylases, lysine β-hydroxybutyrylation, and receptor-mediated effects. Tumor responses are highly context-dependent: ketolytic capacity, governed by enzymes such as OXCT1, can render ketones either a metabolic vulnerability or an alternative fuel for cancer cells. KMT can modify the complex tumor microenvironment, exerting potentially opposing effects on cancer cells, immune cell populations, fibroblasts, and adipocytes. We argue that the central limitation of the field is not a lack of biological activity, but of insufficient integration of tumor-intrinsic metabolism, host physiology, and microenvironmental context. KD/KMT should therefore be regarded not as a universal anticancer therapy, but as a stratified metabolic intervention, whose progress will depend on biomarker-guided patient selection, improved experimental models, and rational combination strategies within a “press-pulse” therapeutic framework. Full article

Obesity is an increasingly important and modifiable driver of chronic kidney disease (CKD), with effects that extend well beyond its associations with type 2 diabetes, hypertension, and dyslipidemia. To synthesize the evidence that excess adiposity is a causal and modifiable determinant of kidney disease, and to examine how specific adipose depots injure the glomerulus and the tubulointerstitium, and then map these mechanisms onto established and emerging therapies. Throughout, obesity-related kidney disease (ORKD) denotes the full spectrum of diposity-driven renal injury, whereas obesity-related glomerulopathy (ORG) is reserved for the biopsy-defined glomerular lesion. Central, visceral, perirenal and renal-sinus adiposity act first through structural and haemodynamic mechanisms, promoting glomerular hyperfiltration, mechanical renal compression and activation of the adipose-derived renin–angiotensin–aldosterone system (RAAS). In parallel, these depots drive cellular and metabolic injury through lipotoxicity, adipokine imbalance, sterile inflammation, oxidative stress, gut dysbiosis, mitochondrial dysfunction, epigenetic remodelling and cellular senescence. Ectopic lipid accumulation within the renal parenchyma—fatty kidney—offers a unifying description of these changes and is most marked in type 2 diabetes mellitus. These interacting processes converge on podocyte stress, tubular metabolic failure, endothelial dysfunction and interstitial fibrosis, producing a phenotypic continuum that ranges from early albuminuria to obesity-related glomerulopathy and progressive CKD. Within the RAAS limb we highlight two comparatively underappreciated, adiposity-linked routes to injury: adipocyte-derived leptin directly upregulates adrenal aldosterone synthase (CYP11B2), and mast-cell chymase generates angiotensin II independently of angiotensin-converting enzyme, together reinforcing aldosterone- and angiotensin II–mediated damage that conventional RAAS blockade only partially interrupts. We further consider the counter-regulatory ghrelin–leptin axis, in which the suppression of ghrelin that accompanies obesity may withdraw an antioxidant, anti-inflammatory and podocyte-protective signal precisely as leptin-driven glomerular injury intensifies, positioning ghrelin as a plausible modulator and candidate biomarker of obesity-related kidney injury. We also examine how obesity complicates renal risk assessment, drug dosing, dialysis delivery and transplant access. Emerging, mechanism-matched therapies—SGLT2 inhibitors, GLP-1 receptor agonists, finerenone, structured lifestyle intervention, metabolic-bariatric surgery and, most recently, aldosterone synthase inhibitors that suppress the chymase- and leptin-driven aldosterone escaping receptor blockade—now enable a precision cardiovascular-kidney-metabolic framework that aligns adipose-depot biology, biomarkers, histology and treatment response to guide mechanism-based care in ORKD. Full article

Background/Objectives: Metabolic dysregulation has emerged as a potential modifier of disease activity and disability in multiple sclerosis (MS). However, the relationship between glycemic status and clinical outcomes in patients with MS remains incompletely understood. This study aimed to investigate the associations of glycemic regulation with disease severity, relapse activity, inflammatory markers, and metabolic characteristics in patients with MS. Methods: In this retrospective single-center observational study, 455 patients with MS aged 18–65 years were included. Patients were categorized into normoglycemia (n = 241), prediabetes (n = 98), and diabetes (n = 116) according to American Diabetes Association criteria and documented diabetes diagnosis. Demographic characteristics, Expanded Disability Status Scale (EDSS) scores, annualized relapse rate (ARR), disease-modifying therapy (DMT), hematological indices, inflammatory markers, and metabolic parameters were retrieved from electronic medical records. Associations between glycemic status and clinical outcomes were evaluated using group comparisons, Spearman correlation analyses, and multivariable linear regression models. Results: Significant differences were observed among glycemic groups for age, disease duration, EDSS score, ARR, MS phenotype, platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipid parameters, estimated glomerular filtration rate, alanine aminotransferase, gamma-glutamyl transferase, triglyceride–glucose (TyG) index, and atherogenic index of plasma (all p < 0.05). HbA1c, FPG, TyG index, lipid parameters, CRP, and ESR were positively correlated with EDSS scores (all p < 0.05). In contrast, these markers showed inverse correlations with ARR. However, after adjustment for demographic and clinical variables, including age, sex, disease duration, MS phenotype, and disease-modifying therapy (DMT), neither prediabetes nor diabetes remained independently associated with disability, as measured by the EDSS score, or with ARR. Progressive MS phenotype, older age, and longer disease duration were independently associated with higher disability, whereas age, disease duration, and progressive phenotype were independently associated with lower ARR. Conclusions: Impaired glycemic status is associated with greater disability, unfavorable metabolic profiles, and increased systemic inflammation in patients with MS. Nevertheless, glycemic status was not independently associated with disability or relapse activity after adjustment for major clinical confounders. These findings suggest that metabolic dysregulation accompanies more severe clinical characteristics but may not independently drive disease progression in MS. Full article

Cardiovascular disease remains a leading cause of mortality despite major advances in lipid lowering and risk-factor control, highlighting the importance of residual cardiovascular risk. Inflammation is a central driver of atherosclerosis, while obesity promotes chronic low-grade inflammation, adipose tissue dysfunction, ectopic fat accumulation, and vascular injury. This narrative review focuses on obesity-associated inflammation as an upstream contributor to residual atherosclerotic risk and evaluates whether incretin-based therapies modify this pathway through weight loss, metabolic improvement, and additional inflammatory or vascular mechanisms. Data from mechanistic studies, biomarker analyses, vascular imaging studies, and cardiovascular outcome trials are reviewed. Anti-inflammatory trials support inflammation as a modifiable therapeutic pathway, although clinical benefit depends on the therapeutic target, timing, and patient selection. Glucagon-like peptide-1 receptor agonists reduce inflammatory and oxidative stress biomarkers and show anti-atherosclerotic effects in experimental models, but human vascular imaging data remain inconclusive. Cardiovascular outcome trials establish benefit with several GLP-1 receptor agonists, including semaglutide in selected patients with overweight or obesity without diabetes. However, direct human evidence for receptor-mediated anti-inflammatory or anti-atherosclerotic effects remains limited, and the relative contributions of weight loss, metabolic improvement, and additional mechanisms remain uncertain. Full article

Background: Alzheimer’s disease (AD) affects >55 million people worldwide and lacks disease-modifying therapies. Microglia, the CNS resident immune cells, dynamically transition between protective and pathological states during AD progression. Recent advances in single-cell sequencing and metabolomics reveal that microglial roles extend beyond simple M1/M2 polarization. This review synthesizes these advances into a framework integrating microglial plasticity, metabolic reprogramming, and intercellular communication in AD. Methods: We reviewed recent (2020–2026) studies on microglial biology in AD, focusing on DAM (disease-associated microglia) ontogeny, metabolic reprogramming, immune checkpoints, and glial crosstalk. Results: Microglia exhibit spatiotemporal heterogeneity, shifting from protective phagocytic phenotypes (M2, DAM1/2) in early AD to pro-inflammatory and exhausted states (M1, terminal inflammatory microglia [TIM], lipid droplet-accumulating microglia [LDAM]) as pathology advances. Key pathways—TREM2/SYK phagocytosis, Piezo1 mechanotransduction, TAM (Tyro3, Axl, Mer) receptor signaling, and metabolic regulators (HK2, iron, APOE4-driven lipid metabolism)—orchestrate these transitions. Microglia also interact with astrocytes, T cells, and peripheral immune cells via IL-3, complement C3, MHC-I and MHC-II, forming glial-immune networks that modulate Aβ clearance, tau propagation, and synaptic integrity. Conclusions: Precisely targeting microglial functional states, rather than broad immunosuppression, is a promising disease-modifying strategy for AD. Future therapies should integrate metabolic reprogramming, glial network regulation, and immune checkpoint modulation to preserve protective microglial phenotypes in early AD while suppressing pathological activation and exhaustion in advanced disease. Full article

Background/Objectives: Pulmonary fibrosis is a progressive and fatal disease characterized by excessive extracellular matrix deposition and irreversible lung remodeling. Although modified mRNA (modRNA) therapeutics offer a promising strategy for regulating disease-driving pathways, effective pulmonary delivery remains challenging due to the inherent liver tropism of conventional lipid nanoparticles (LNPs). This study aimed to establish an optimized platform for lung-selective modRNA delivery and therapeutic screening for pulmonary fibrosis. Methods: A panel of charge-modified LNP formulations was evaluated in vivo for pulmonary tropism following systemic administration of luciferase (Luc) modRNA. Administration routes, biodistribution in healthy and bleomycin (BLM)-induced fibrotic lungs, and endogenous microRNA (miRNA)-mediated de-targeting strategies were assessed. Candidate antifibrotic modRNAs targeting the transforming growth factor-beta (TGF-β) signaling pathway were subsequently evaluated in normal human lung fibroblasts (NHLFs). Results: Among the formulations tested, 50% DOTAP MC3 LNPs demonstrated the most favorable balance of pulmonary transfection, physicochemical properties, and limited off-target expression. Intravenous (IV) administration achieved robust lung expression with a superior safety profile compared with intratracheal (IT) delivery. Importantly, pulmonary biodistribution was preserved in BLM-induced fibrotic lungs despite extensive tissue remodeling. Incorporation of miR-122 recognition sites further enhanced selectivity, resulting in 94.5% of total transgene expression being localized to the lungs while substantially reducing residual hepatic expression. In vitro screening identified dominant-negative TGF-β receptor II (DNTGFBR2) modRNA as a potent inhibitor of TGF-β-induced fibrotic activation, significantly suppressing α-SMA and CTGF expression. Conclusions: These findings establish a comprehensive platform for pulmonary modRNA therapeutic development by integrating lung-selective LNP engineering, optimal systemic delivery, miRNA-mediated de-targeting, and therapeutic payload screening. This strategy provides a foundation for the development of targeted RNA therapies for pulmonary fibrosis and other organ-specific diseases. Full article

Background and Objectives: Physical inactivity is a major modifiable lifestyle factor associated with type 2 diabetes mellitus (T2DM). However, real-world primary care datasets often rely on pragmatic clinical estimates of physical activity (PA) and may lack HbA1c, fasting glucose, dietary data, diabetes duration, and detailed medication information. Therefore, PA–T2DM associations in routine care must be interpreted within the limitations of cross-sectional observational data. Materials and Methods: This cross-sectional observational study analyzed 863 adult patients from a real-world primary care cohort. Participants were categorized into low, moderate, and high PA groups according to self-reported habitual weekly activity levels estimated during routine physician interviews. PA categories were based on clinically meaningful weekly activity thresholds consistent with public health recommendations. The primary outcome was documented T2DM. Secondary variables included lipid profile, blood pressure, body mass index, waist circumference, smoking status, and statin therapy. Multivariable logistic regression models were used to assess associations between PA category and T2DM, with high PA as the reference group. Results: T2DM prevalence showed a graded inverse cross-sectional association across PA categories, being highest in the low PA group (29.7%), intermediate in the moderate PA group (16.7%), and lowest in the high PA group (8.9%) (p < 0.001). In the fully adjusted model, low PA was strongly associated with higher odds of T2DM compared with high PA (odds ratio [OR] 4.32, 95% confidence interval [CI] 2.61–7.15, p < 0.001). Moderate PA was also associated with higher odds of T2DM compared with high PA (OR 2.07, 95% CI 1.23–3.48, p = 0.006). LDL-C differed significantly across PA groups, with the lowest values observed in the high PA group, whereas most other cardiometabolic parameters were comparable. Conclusions: Lower self-reported PA was strongly associated with higher T2DM prevalence after multivariable adjustment in this real-world primary care cohort. These findings support routine PA assessment as part of lifestyle-based cardiometabolic risk stratification. Because dietary intake, HbA1c, diabetes duration, glucose-lowering medication details, and regulatory biomarkers were not available, causal and mechanistic conclusions cannot be drawn. Future studies should integrate PA, nutritional assessment, glycemic markers, medication data, and physiological regulatory measures to better characterize lifestyle-related diabetes risk. Full article

Background/Objectives: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of diabetes mellitus characterized by progressive nerve degeneration and chronic neuropathic pain. Current therapies, including pregabalin, primarily provide symptomatic pain relief and have limited effects on preventing structural nerve damage. Therefore, the development of disease-modifying therapies remains an important unmet clinical need. This study investigated the neuroprotective effects of choline alfoscerate (CA) and its ability to attenuate mechanical hypersensitivity in a streptozotocin (STZ)-induced rat model of DPN. Methods: Diabetes was induced in rats using STZ, and administration protocols were optimized to establish sustained hyperglycemia while minimizing mortality. CA treatment was initiated immediately after STZ administration and continued throughout the study period. Mechanical sensitivity was assessed using the von Frey test. Histopathological examination of sciatic nerves was performed to evaluate structural alterations, and serum biochemical and lipid parameters were analyzed to assess systemic metabolic changes. Results: STZ-treated diabetic rats developed persistent hyperglycemia, mechanical allodynia, elevated serum triglyceride levels, and marked structural deterioration of sciatic nerve fascicles. CA treatment significantly increased paw withdrawal thresholds despite sustained hyperglycemia, indicating attenuation of mechanical hypersensitivity independent of glycemic control. Histopathological evaluation demonstrated reduced nerve fiber degeneration, attenuation of edema-like changes, and preservation of sciatic nerve architecture in CA-treated animals. In addition, CA significantly reduced serum triglyceride levels compared with diabetic controls. Conclusions: CA attenuated mechanical hypersensitivity and exerted neuroprotective effects in STZ-induced diabetic rats. These benefits occurred independently of glucose lowering and were accompanied by improvements in nerve morphology and lipid metabolism. The findings suggest that CA may represent a promising therapeutic candidate for preserving peripheral nerve integrity and attenuating neuropathic progression in diabetic peripheral neuropathy. Full article

Background: Dyslipidemia is a modifiable risk factor and predictive biomarker for acute ischemic stroke (AIS) that necessitates early, aggressive lipid-lowering therapy to achieve target low-density lipoprotein cholesterol (LDL-C) levels for primary and secondary prevention. In certain patients, this can be difficult to achieve with statins alone. Proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) lipid-lowering agents may improve outcomes when introduced early. This review assessed whether early PCSK9i administration (within 3 weeks of AIS) reduced early neurological deterioration (END), recurrent stroke/transient ischemic attack (TIA), poor functional outcomes, and mortality. Methods: This systematic review and meta-analysis included randomized clinical trials (RCTs) and observational studies. Random-effects meta-analysis and subgroup and sensitivity analyses were used to assess whether effects differed by treatment timing (≤72 vs. >72 h) and study design. Results: Eight studies (three randomized clinical trials) in East Asian cohorts were included. Early PCSK9i initiation significantly reduced END compared with usual care (odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.26–0.57). Stroke/TIA recurrence and all-cause mortality within 6 months of stroke were also significantly reduced in the PCSK9i group (OR: 0.47; 95% CI: 0.28–0.77 and OR: 0.33; 95% CI: 0.15–0.72, respectively), and early initiation was associated with a greater likelihood of good functional outcomes at 90 days (OR: 2.28; 95% CI: 1.48–3.51). Sensitivity analyses yielded consistent results. Conclusions: Early PCSK9i initiation within 3 weeks of AIS onset was associated with lower rates of END, recurrent stroke/TIA, and mortality, although the certainty of evidence was limited by the small number of included studies and the predominantly observational data. Outcomes did not differ significantly by initiation timing within this period. Large-scale trials in diverse populations are needed to define the optimal initiation window and long-term clinical effects. Full article

Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and is increasingly driven by cardiometabolic disease, including type 2 diabetes mellitus (T2DM), obesity, and insulin resistance. These conditions promote atrial electrical instability and a permissive substrate through mitochondrial dysfunction, oxidative stress, inflammation, calcium-handling abnormalities, and profibrotic signaling, culminating in atrial fibrosis and conduction heterogeneity. Metformin, the foundational glucose-lowering therapy for T2DM, exerts pleiotropic actions that intersect with these upstream pathways. Beyond glycemic control, metformin induces mild mitochondrial complex I modulation with reduction of reverse electron transfer-derived reactive oxygen species, activates adenosine monophosphate (AMP) activated protein kinase, and attenuates nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)-mediated cytokine signaling; experimental data further suggest favorable effects on adiponectin–sarcoendoplasmic reticulum calcium adenosine triphosphatase (SERCA) 2a-dependent calcium cycling, connexin expression, small-conductance Ca²⁺-activated K+ channel remodeling, lipid handling, and transforming growth factor-β (TGF)-β-associated fibrotic remodeling. Observational cohort studies have reported associations between metformin exposure and a modest reduction in incident AF, particularly with longer treatment duration and in higher-risk metabolic phenotypes; device-based surveillance cohorts support a preventive association for new-onset AF rather than reduction of established AF burden. Data after catheter ablation suggest improved freedom from recurrence in metformin-treated patients, whereas evidence in postoperative AF is largely neutral, likely reflecting distinct acute mechanisms. Collectively, metformin may be best conceptualized as a potential substrate-modifying, upstream therapy candidate; however, confounding, exposure misclassification, and heterogeneity in comparators limit causal inference, underscoring the need for prospective randomized trials with AF endpoints. In practice, integration with comprehensive risk-factor modification (blood pressure, weight, sleep apnea, and glycemic optimization) remains essential when considering AF prevention strategies. Full article