Accuracy of FIB-4 to Detect Elevated Liver Stiffness Measurements in Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study in Referral Centers

The identification of advanced fibrosis by applying noninvasive tests is still a key component of the diagnostic algorithm of NAFLD. The aim of this study is to assess the concordance between the FIB-4 and liver stiffness measurement (LSM) in patients referred to two liver centers for the ultrasound-based diagnosis of NAFLD. Fibrosis 4 Index for Liver Fibrosis (FIB-4) and LSM were assessed in 1338 patients. A total of 428 (32%) had an LSM ≥ 8 kPa, whereas 699 (52%) and 113 (9%) patients had an FIB-4 < 1.3 and >3.25, respectively. Among 699 patients with an FIB-4 < 1.3, 118 (17%) had an LSM ≥ 8 kPa (false-negative FIB-4). This proportion was higher in patients ≥60 years, with diabetes mellitus (DM), arterial hypertension or a body mass index (BMI) ≥ 27 kg/m². In multiple adjusted models, age ≥ 60 years (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.19–3.23)), DM (OR = 2.59, 95% CI 1.63–4.13), body mass index (BMI) ≥ 27 kg/m² (OR = 2.17, 95% CI 1.33–3.56) and gamma-glutamyltransferase ≥ 25 UI/L (OR = 2.68, 95% CI 1.49–4.84) were associated with false-negative FIB-4. The proportion of false-negative FIB-4 was 6% in patients with none or one of these risk factors and increased to 16, 31 and 46% among those with two, three and four concomitant risk factors, respectively. FIB-4 is suboptimal to identify patients to refer to liver centers, because about one-fifth may be false negative at FIB-4, having instead an LSM ≥ 8 KPa.     

Molecular Genetics of GLUT1DS Italian Pediatric Cohort: 10 Novel Disease-Related Variants and Structural Analysis

GLUT1 deficiency syndrome (GLUT1DS1; OMIM #606777) is a rare genetic metabolic disease, characterized by infantile-onset epileptic encephalopathy, global developmental delay, progressive microcephaly, and movement disorders (e.g., spasticity and dystonia). It is caused by heterozygous mutations in the SLC2A1 gene, which encodes the GLUT1 protein, a glucose transporter across the blood-brain barrier (BBB). Most commonly, these variants arise de novo resulting in sporadic cases, although several familial cases with AD inheritance pattern have been described. Twenty-seven Italian pediatric patients, clinically suspect of GLUT1DS from both sporadic and familial cases, have been enrolled. We detected by trios sequencing analysis 25 different variants causing GLUT1DS. Of these, 40% of the identified variants (10 out of 25) had never been reported before, including missense, frameshift, and splice site variants. Their structural mapping on the X-ray structure of GLUT1 strongly suggested the potential pathogenic effects of these novel disease-related mutations, broadening the genotypic spectrum heterogeneity found in the SLC2A1 gene. Moreover, 24% is located in a vulnerable region of the GLUT1 protein that involves transmembrane 4 and 5 helices encoded by exon 4, confirming a mutational hotspot in the SLC2A1 gene. Lastly, we investigated possible correlations between mutation type and clinical and biochemical data observed in our GLUT1DS cohort, revealing that splice site and frameshift variants are related to a more severe phenotype and low CSF parameters.     

The Generation of Nitric Oxide from Aldehyde Dehydrogenase-2: The Role of Dietary Nitrates and Their Implication in Cardiovascular Disease Management

Reduced bioavailability of the nitric oxide (NO) signaling molecule has been associated with the onset of cardiovascular disease. One of the better-known and effective therapies for cardiovascular disorders is the use of organic nitrates, such as glyceryl trinitrate (GTN), which increases the concentration of NO. Unfortunately, chronic use of this therapy can induce a phenomenon known as “nitrate tolerance”, which is defined as the loss of hemodynamic effects and a reduction in therapeutic effects. As such, a higher dosage of GTN is required in order to achieve the same vasodilatory and antiplatelet effects. Mitochondrial aldehyde dehydrogenase 2 (ALDH2) is a cardioprotective enzyme that catalyzes the bio-activation of GTN to NO. Nitrate tolerance is accompanied by an increase in oxidative stress, endothelial dysfunction, and sympathetic activation, as well as a loss of the catalytic activity of ALDH2 itself. On the basis of current knowledge, nitrate intake in the diet would guarantee a concentration of NO such as to avoid (or at least reduce) treatment with GTN and the consequent onset of nitrate tolerance in the course of cardiovascular diseases, so as not to make necessary the increase in GTN concentrations and the possible inhibition/alteration of ALDH2, which aggravates the problem of a positive feedback mechanism. Therefore, the purpose of this review is to summarize data relating to the introduction into the diet of some natural products that could assist pharmacological therapy in order to provide the NO necessary to reduce the intake of GTN and the phenomenon of nitrate tolerance and to ensure the correct catalytic activity of ALDH2.     

In Vitro Selection of Lactobacillus and Bifidobacterium Probiotic Strains for the Management of Oral Pathobiont Infections Associated to Systemic Diseases

The human oral pathobionts Aggregatibacter actinomycetemcomitans, Streptococcus mitis and Streptococcus mutans, in dysbiosis-promoting conditions, lead to oral infections, which also represent a threat to human systemic health. This scenario may be worsened by antibiotic misuse, which favours multi-drug resistance, making the research on pathogen containment strategies more than crucial. Therefore, we aimed to in vitro select the most promising probiotic strains against oral pathogen growth, viability, biofilm formation, and co-aggregation capacity, employing both the viable probiotics and their cell-free supernatants (CFSs). Interestingly, we also assessed probiotic efficacy against the three-pathogen co-culture, mimicking an environment similar to that in vivo. Overall, the results showed that Lactobacillus CFSs performed better than the Bifidobacterium, highlighting Limosilactobacillus reuteri LRE11, Lacticaseibacillus rhamnosus LR04, Lacticaseibacillus casei LC04, and Limosilactobacillus fermentum LF26 as the most effective strains, opening the chance to deeper investigation of their action and CFS composition. Altogether, the methodologies presented in this study can be used for probiotic efficacy screenings, in order to better focus the research on a viable probiotic, or on its postbiotics, suitable in case of infections.     

Sustainable Bioactive Packaging Based on Thermoplastic Starch and Microalgae

This study combines the use of corn starch and Tetradesmus obliquus microalgae for the production of antioxidant starch films as flexible packaging material. Starch was plasticized with glycerol and blended with 1 w% polyallylamine chosen as an agent to modify the film physical properties. The addition of polyallylamine improved film water stability and water vapor transmission rate as well as mechanical stiffness and tenacity. The dried Tetradesmus obliquus microalgae, which showed an EC₅₀ value of 2.8 mg/mg DPPH (2.2-Diphenyl-1-picrylhydrazyl radical), was then used as antioxidant filler. The addition of microalgae provided the films with good antioxidant activity, which increased with microalgae content increasing. To our knowledge, this is the first study reporting the development of sustainable bioactive packaging films composed of almost 100% starch, and follows the European union’s goals on plastics strategy concerning the promotion of bio-based, compostable plastics and the setting up of approaches to prevent food waste with a simple plastic packaging.     

Exploring the impact of formulation and temperature shock on metered dose inhaler priming

The interplay between canister, valve design, formulation, and environmental temperature is crucial to dose retention in metered dose inhalers (MDIs). Previous studies that have utilized MDIs with polymeric capillary retention valves, have shown that exposure to environmental changes can create a temporary temperature gradient between the formulation retained in the metering chamber and the formulation reservoir in the metal canister, which can cause inconsistencies in the dose delivered to the patient. The purpose of this study was to more fully quantify these effects. This was achieved by deliberately varying the temperature difference between inhalers and environment within ranges representative of routine usage, and assessing the resulting loss of prime effect via shot weight and delivered dose testing.

The shot weights delivered by three fixed-dose commercial MDIs—Foster®, flutiform® and Seretide®, were investigated under different experimental conditions. Exposure to temperature changes of up to 15°C did not appear to affect unprimed shot weights (USW) or subsequent doses from the Foster product. In contrast, flutiform maintained prime at a temperature differential of 8.6°C, but delivered a low USW following exposure to a ΔT of 15°C under both realistic and controlled conditions. Seretide exhibited loss of prime at lower temperature differentials (ΔT 8.6°C) and a reduction in USW. The results suggest that the inclusion of ethanol in a solution-based formulation may inhibit loss of prime, leading to more robust performance in the face of temperature variations.

Delivered dose testing was carried out to assess the effect of loss of prime on the device ability to deliver a dose to within 80–120% of the label claim. The results suggest that the drainage of propellant from the metering chamber of suspension MDIs leaves active pharmaceutical ingredient (API) residue, causing an increase in subsequent doses once the prime has been restored. Taken together, the results provide valuable insight into the likely performance of MDIs subjected to routine daily use, highlighting design and formulation strategies that could be applied to make performance more robust.     

Nano-to-macroporous TiO2 (anatase) by cold sintering process

Cold Sintering Process (CSP) was applied on commercial nanopowders to produce nanostructured TiO₂ anatase with nano-to-macro porosity. Nanoporous TiO₂ based materials were obtained by applying CSP at 150 °C and pressures up to 500 MPa on three TiO₂ nanopowders with different specific surface area (s.s.a. = 50, 90 and 370 m²/g), using water as transient aqueous environment. Although TiO₂ is insoluble in water, a density of 68% and s.s.a. = 117 m²/g were achieved from the powder with the highest specific surface area. A post annealing process at 500 °C increased the density up to 73% with a s.s.a. = 59 m²/g, and the crystallites dimensions passed from 110 Å in the powder to 130 Å in CSP material and 172 Å after post annealing. Finally, macroporosity was produced by using thermoplastic polymer beads as sacrificial templates within TiO₂ nanopowder during CSP, followed by a debonding at 500 °C.     

Structure, dynamics and interactions of complex sol-gel hybrid materials through SSNMR and DSC: Part II, ternary systems based on PE-PEG block copolymer, PHS and silica

This work is the second part of a study aimed at understanding in more depth structure, dynamics, interactions and correlations between morphology and barrier properties against oxygen diffusion of complex PE-PEG/PHS/SiO₂ hybrids prepared through a sol-gel process. Using a combined DSC and solid-state NMR approach, including ¹³C and ²⁹Si experiments and ¹H ultra-fast MAS spectra, the structural, phase and interaction properties of three PE-PEG/PHS/SiO₂ samples with different compositions, exhibiting different barrier performances, have been investigated, also taking into account the results obtained for the simpler one- and two-component systems (Part I). While the structure of the silica domains has been found to be not affected by composition, many differences have been observed concerning the phase and dynamic properties of the organic components (PE and PEG crystallinity and mobility of their amorphous domains) and the inter-component interactions (strength of the hydrogen bonds between PHS and both silica and PEG and PHS/PEG miscibility). In particular peculiar phase and interaction properties of the sample exhibiting the best barrier properties have been identified and characterized.     

EPA or DHA Supplementation Increases Triacylglycerol,but not Phospholipid,Levels in Isolated Rat Cardiomyocytes

It is well recognized that a high dietary intake of long-chain polyunsaturated fatty acids (LC-PUFA) has profound benefits on health and prevention of chronic diseases. In particular, in recent years there has been a dramatic surge of interest in the health effects of n-3 LC-PUFA derived from fish, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. Notwithstanding, the metabolic fate and the effects of these fatty acids once inside the cell has seldom been comprehensively investigated. Using cultured neonatal rat cardiomyocytes as model system we have investigated for the first time, by means of high-resolution magic-angle spinning nuclear magnetic resonance (HR-MAS NMR) spectroscopy in combination with gas chromatography (GC), the modification occurring in the cell lipid environment after EPA and DHA supplementation. The most important difference between control and n-3 LC-PUFA-supplemented cardiomyocytes highlighted by HR-MAS NMR spectroscopy is the increase of signals from mobile lipids, identified as triacylglycerols (TAG). The observed increase of mobile TAG is a metabolic response to n-3 LC-PUFA supplementation, which leads to an increased lipid storage. The sequestration of mobile lipids in lipid bodies provides a deposit of stored energy that can be accessed in a regulated fashion according to metabolic need. Interestingly, while n-3 LC-PUFA supplementation to neonatal rat cardiomyocytes causes a huge variation in the cell lipid environment, it does not induce detectable modifications in water-soluble metabolites, suggesting negligible interference with normal metabolic processes.     

Cavitand-Based Coordination Cages: Achievements and Current Challenges

The research results obtained in the self-assembly of cavitand-based coordination cages are presented. Cavitands are ideal multidentate ligands for the creation of coordination cages due to their structural rigidity, concave structure, and great versatility in terms of synthetic modularity. The introduction of the ligand moieties on the resorcinarene building block proceeds at the upper rim of the cavity, to take full advantage of the structural rigidity of the cavitand scaffold. Two different synthetic strategies are employed for the formation of multidentate cavitand ligands: (a) functionalization at the apical positions and (b) introduction of the ligands as bridging units. The key features to control the cage self-assembly process emerging from this overview are the preorganization, for the cavitands, and kinetic versus thermodynamic stability of the resulting complexes, for the connecting metal. The versatility of this class of coordination cages is demonstrated by the formation of their heterotopic and heteronuclear versions, as well as their self-assembly on gold and silicon surfaces. Desymmetrization of the cages is appealing because of the resulting differentiation of the inner cavities in terms of shape and interactivity, while surface self-assembly represents an important opportunity to expand the application range of these objects.