Damian Sendler Women of childbearing age are more likely to have diabetes mellitus than men, yet many of them go untreated or undiagnosed1. Diabetes during pregnancy can have a long-term impact on the health and well-being of the child2,3. There has been a lack of research into the link between gestational diabetes and adult disease risk in the next generation. Here, we demonstrate that pre-pregnancy hyperglycemia increases the risk of glucose intolerance in the offspring. Hyperglycemia (HG) in mice and diabetes (DM) in humans both cause lower levels of TET3 dioxygenase (the enzyme that oxidizes 5-methoxycytosine and demethylates DNA) to be expressed in oocytes. Hypermethylation of several insulin secretion genes, including the glucokinase gene (Gck), which persists from zygote to adult, is caused by insufficient demethylation by oocyte TET3 and promotes impaired glucose homeostasis largely as a result of the defect in glucose-stimulated insulin secretion. Maternal heterozygous and homozygous Tet3 deletion-derived mouse progeny both exhibit glucose intolerance and epigenetic abnormalities that are consistent with the findings of the HG mice’s oocytes, supporting these findings. Additional research shows that exogenous Tet3 mRNA expression improves the offspring’s maternal effect. Rather than a direct change in the oocyte epigenome, our findings point to an environment-sensitive window in oocyte development that confers a predisposition to glucose intolerance in subsequent generations through TET3 insufficiency. According to this study, pre-conception interventions in pregnant women may help protect their children’s health.
Treating chronic plaque psoriasis with systemic medications
Damian Jacob Sendler For those who don’t know: Psoriasis is a chronic immune-mediated disease that can manifest as itchy skin or painful joints. Despite the lack of a cure for psoriasis, a variety of treatment options allow for long-term management of the disease’s symptoms. Because there aren’t enough studies comparing these treatments side by side, it’s difficult to determine how effective each one is. For this reason, we decided to conduct a network meta-analysis.
Methods: To compare the efficacy and safety of systemic agents, small molecules, and biologics for people with moderate to severe psoriasis, and provide a ranking of these treatments based on their efficacy and safety using a network meta-analysis.
Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and Embase were searched monthly through October 2021 for the living systematic review’s search methods.
Dr. Sendler RCTs of systemic treatments in adults over the age of 18 with moderate to severe plaque psoriasis, at any treatment stage, compared to placebo or another active agent are eligible for inclusion in this study. The primary outcomes were the percentage of participants who achieved clear or nearly clear skin (PASI 90) and the percentage of participants who experienced serious adverse events (SAEs) during the induction phase of therapy (8 to 24 weeks after randomisation).
We conducted data extraction, risk of bias assessment, and analysis of data from multiple studies. Pairwise and network meta-analysis (NMA) methods were used to compare treatments and rank them based on their effectiveness and acceptability (PASI 90 score) (inverse of SAEs). For the two primary outcomes and all comparisons using CINeMA, we rated the degree of certainty in the NMA evidence as “very low,” “low,” “moderate,” or “high.” When data was unclear or missing, we contacted the study authors. A treatment hierarchy of 0 percent (least effective or safest) to 100 percent was inferred using the surface under the cumulative ranking curve (SUCRA) (best for effectiveness or safety).
A total of 167 studies are now incorporated into this update, which results in 58,912 randomly assigned participants, with 67.2% of those being men and the vast majority having been recruited from hospitals. The average person was 44.5 years old, with a PASI score of 20.4 as a starting point (range: 9.5 to 39). Controlled trials were used in most cases (57 percent ). Twenty treatments were evaluated by us. There were an estimated 140 multicentric trials (two to 231 centres). One-third of the studies (57/167) had a high risk of bias; 23 had an unclear risk; and 87 had a low risk. A pharmaceutical company provided funding for the majority of studies (127 out of 167); 24 studies did not disclose their funding source. Non-biological systemic agents, small molecules, and biological treatments all showed a higher proportion of patients reaching PASI 90 than placebo in network meta-analysis at the class level. Only anti-IL23 treatment showed a lower percentage of patients reaching PASI 90 than anti-IL17. Anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha biologic treatments increased the proportion of patients who reached PASI 90 compared to non-biological systemic agents. PASI 90 was achieved with the following medications: infliximab RR 50.19 (95 percent CI 20.92 to 120.45), bimekizumab RR 30.27 (95 percent CI 25.45 – 36.01), ixekizumab RR 30-19 (95 percent CI 25.38 – 35.93), and risankizumab RR 30.19 (all high-certainty evidence) (RR 28.75, 95 percent CI 24.03 to 34.39). When compared to each other, the clinical efficacy of these drugs was comparable. Other anti-IL17 drugs (secukinumab and brodalumab) as well as guselkumab showed a lower proportion of patients reaching PASI 90 than bimekizumab, ixekizumab, and risankizumab. Infliximab, anti-IL17 drugs (bimekizumab, ixekizumab, secukinumab, and brodalumab) and anti-IL23 drugs (risankizumab and guselkumab) except tildrakizumab, showed a higher proportion of patients reaching PASI 90 than ustekinumab and three anti-TNF alpha agents (adalimumab, certolizumab and etanercept). We found ustekinumab was superior to certolizumab, and etanercept was superior to adalimumob and ustekinumab. Cyclosporin and methotrexate were found to be indistinguishable from apremilast. When it came to the risk of SAEs, there was no discernible difference between any of the treatments and the placebo. Methotrexate was found to have a lower risk of serious adverse events (SAEs) than most other treatments. A very small number of events with low to moderate certainty underlay the SAE analyses, however (except methotrexate versus placebo, which was high-certainty). As a result, the findings should be treated with skepticism. Other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1) showed similar outcomes to those of PASI 90. Many of the interventions did not provide information on the quality of life of their patients.
Patients with depression treated with antidepressants have improved HRQoL.
Damian Jacob Markiewicz Sendler The efficacy of antidepressant medications for the treatment of depression disorder has been supported by empirical evidence, but the medication’s effect on patients’ overall well-being and health-related quality of life (HRQoL) remains unclear. For patients with depression, this study examines the impact of antidepressant medication use on patient-reported HRQoL.
Using data from the United States’ Medical Expenditures Panel Survey for patients with depression, a comparative cohort, secondary database analysis was performed. The SF-12 was used to measure HRQoL, and the results were reported as summaries of the physical and mental components (PCS and MCS). Patients who took antidepressants were compared to patients who didn’t take them. To determine the significance of the PCS and MCS mean change from baseline to follow-up, D-I-D analyses were used in both univariate and multivariate fashions.
A total of 17.5 million adults were given a depression disorder diagnosis each year between 2005 and 2016. Antidepressant medications were prescribed to a higher percentage of females (67.9%). (60.5 percent vs. 51.5 percent of males). D-I-D univariate analysis found no significant difference between the two groups in PCS (-0.35 vs. -0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405), despite antidepressant use being associated with some improvement on the MCS. These findings were bolstered by the use of multivariate D-I-D analyses.
Antidepressant medication does not have a long-term positive effect on HRQoL in the real world. Long-term effects of pharmacological and nonpharmacological interventions on HRQoL in these patients should be investigated in future studies, rather than just looking at the short-term effects of pharmacotherapy.
Incidence of Death from Resistance Training
All-cause, cardiovascular, and cancer mortality were examined in this study, which aimed to conduct a systematic review and meta-analyze the relationship between resistance training and mortality.
Damien Sendler Using PRISMA guidelines, a systematic review and meta-analysis was performed (International Prospective Register of Systematic Reviews CRD42019136654). Embase, Emcare, SPORTDiscus and The Cochrane Library were searched from inception to June 6, 2021, using MEDLINE (OVID). All-cause mortality, cardiovascular disease-specific mortality, and cancer-specific mortality were all reported as outcomes in the included studies. We only included research done on non-clinical adult populations (those over the age of 18) and that was written in English.
The meta-analyses drew on a total of ten different studies. Resistance training reduced the risk of all-cause mortality by 15 percent, cardiovascular disease mortality by 19 percent, and cancer mortality by 14 percent when compared to no resistance training (RR of 6 studies=0.85; 95% CI=0.77, 0.93). A dose-response meta-analysis of four studies found a nonlinear relationship between resistance training and mortality risk. Around 60 minutes of resistance training per week resulted in a 27% reduction in risk (RR=0.74; 95% CI=0.64, 0.86). There was a decrease in mortality risk reductions at higher volumes.
Damian Jacob Sendler
Resistant training is associated with a reduced risk of all-cause, cardiovascular, and cancer-specific death, according to the strongest evidence to date. Research is needed to determine if the benefits of resistance training diminish at higher volumes.
Following hypomethylating therapy, oncogene demethylation and upregulation were observed.
It is unknown whether hypomethylating agents can also reactivate and up-regulate oncogenes in cancer patients, even though they are currently used in cancer treatment.
A well-known oncogene involved in myelodysplastic syndrome and other cancers, SALL4, was tested for its effect on hypomethylating agents. When comparing pre- and post-treatment bone marrow samples from two groups of patients with myelodysplastic syndrome, researchers found a strong correlation between changes in SALL4 expression and treatment response, as well as clinical outcomes. Low or undetectable expression of SALL4 was used to study the relationship between SALL4 methylation and expression. CRISPR-DNMT1-interacting RNA (CRISPR-DiR), a locus-specific demethylation technology, was used to identify the CpG island critical for SALL4 expression.
In cohort 1, SALL4 up-regulation was found in 10% of patients (40%) and in 30% of patients (13%) after hypomethylating agent treatment, and it was linked to a worse outcome. The demethylation of a CpG island in the 5′ untranslated region of SALL4 was discovered using CRISPR-DiR. Treatment with a hypomethylating agent led to the demethylation of the same CpG region and an increase in SALL4 expression in cell lines and patients.
We found that demethylation and up-regulation of an oncogene after treatment with a hypomethylating agent can indeed occur and should be further studied, using CRISPR-DiR technology. This research was supported by a grant from the Italian Association for Cancer Research and others.
CD8+ T cell quiescence is maintained by the CD8-PILR interaction.
However, the underlying molecular mechanisms for maintaining a wide repertoire of antigens against a wide range of microbes and tumors remain largely unknown. We demonstrate here that CD8 is necessary for the maintenance of CD8+ T cells in peripheral lymphoid organs in a physiologically quiescent state. No specific antigens were required for the CD8+ T cells to acquire activation phenotypes and then die after the CD8 gene was inducibly deleted. Both in mice and in humans, PILR was found to be a ligand for CD8, and disrupting this interaction was able to break the quiescence of CD8+ T cells. In the absence of antigen exposure, the CD8-PILR interaction actively maintains the size of the peripheral T cell pool.