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Renal Medullary but Not Cerebral Hypoxia in a Large Animal Model of Heart Failure With Mildly Reduced Ejection Fraction. 射血分数轻度降低的心力衰竭大动物模型的肾髓性缺氧而非脑性缺氧。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70081
Anton L Trask-Marino, Lachlan F Miles, Terase F Lancefield, Taku Furukawa, Lars I P Snel, Sally G Hood, Connie Pei Chen Ow, Lindsea C Booth, Jai Raman, Clive N May, Yugeesh R Lankadeva

Background: Chronic kidney disease and cognitive impairment are common in heart failure, but how changes in microcirculatory perfusion and oxygenation contribute to these complications remains unclear. We investigated how heart failure with mildly reduced ejection fraction (HFmrEF) affects renal and cerebral perfusion and oxygenation, renal blood flow (RBF), and renal function in adult female sheep (Ovis aries, Linnaeus 1758).

Methods: HFmrEF was induced in Merino ewes (n = 10) via progressive ligation of coronary artery branches. Sham-operated controls (n = 10) underwent thoracotomy without ligation. Three weeks later, fiber-optic probes were implanted in the renal cortex, renal medulla, and frontal cerebral cortex to measure tissue perfusion and oxygenation. Transit-time flow probes and vascular catheters enabled continuous assessment of systemic hemodynamics, left atrial pressure, and RBF. Bladder catheterization allowed urine output measurement, and plasma and urine samples were collected to calculate creatinine clearance. Systolic function was assessed by two-dimensional echocardiography.

Results: Animals with HFmrEF exhibited reduced left ventricular ejection fraction (50.6% ± 1.4% vs. 77.8% ± 0.9%; p < 0.0001), elevated left atrial pressure (7.5 ± 0.9 vs. 3.3 ± 0.8 mmHg; p = 0.003), and clinical signs of heart failure. Renal medullary oxygenation was significantly reduced (41.4 ± 4.3 vs. 54.7 ± 2.7 mmHg; p = 0.02), while renal cortical and cerebral oxygenation were preserved. Systemic hemodynamics, RBF, and creatinine clearance were similar between groups.

Conclusions: In this large mammalian model of HFmrEF, selective renal medullary hypoxia occurred despite preserved renal function and systemic hemodynamics. These findings underscore the vulnerability of the renal medulla and support the need for early markers and interventions targeting renal microcirculation in heart failure.

背景:慢性肾脏疾病和认知障碍在心力衰竭中很常见,但微循环灌注和氧合的改变如何导致这些并发症尚不清楚。我们研究了心力衰竭伴轻度射血分数降低(HFmrEF)对成年母羊肾和脑灌注和氧合、肾血流量(RBF)和肾功能的影响(Ovis aries, Linnaeus 1758)。方法:采用渐进式结扎冠状动脉分支的方法在美利奴母羊(n = 10)体内诱导HFmrEF。假手术对照组(n = 10)行开胸手术,未结扎。3周后,将光纤探针植入肾皮质、肾髓质和大脑额叶皮质,测量组织灌注和氧合情况。瞬时血流探头和血管导管可以连续评估全身血流动力学、左房压和RBF。膀胱导尿可以测量尿量,收集血浆和尿液样本来计算肌酐清除率。通过二维超声心动图评估收缩功能。结果:HFmrEF动物左心室射血分数降低(50.6%±1.4% vs. 77.8%±0.9%);p结论:在这个HFmrEF大型哺乳动物模型中,尽管肾功能和全身血流动力学得到保留,但仍发生了选择性肾髓质缺氧。这些发现强调了肾髓质的脆弱性,并支持在心力衰竭中针对肾微循环进行早期标记和干预的必要性。
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引用次数: 0
Geltrex-Enhanced Two-Dimensional Culture as a Viable Alternative to Primary Rat Hepatocyte Sandwich Models. geltrex增强二维培养作为原代大鼠肝细胞三明治模型的可行替代。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70082
Eda Beldek, Matilda Holtz, Adil Denizli, Osman Berk Usta

Primary hepatocytes rapidly lose viability and function in conventional two-dimensional (2D) cultures due to the absence of a physiologically relevant extracellular matrix (ECM). The collagen sandwich method improves polarization and function but creates a diffusion barrier that limits nutrient and signal exchange. This study investigates whether daily supplementation of a diluted, non-gelling Geltrex layer can sustain hepatocyte function and viability in 2D culture, offering a practical alternative to the sandwich method. Primary rat hepatocytes were cultured for 15 days under four conditions: monolayer (ML), monolayer with Geltrex (ML + GT), sandwich (SW), and sandwich with Geltrex (SW + GT). Cell morphology, confluency, viability (CCK-8, live/dead staining), and functionality (urea synthesis, albumin production, CYP3A4 activity) were assessed. The ML group showed significant declines in confluency, viability, and functional markers over time. Geltrex supplementation preserved confluency (~97% at day 15), improved viability, and maintained higher albumin production and CYP3A4 activity compared to ML. Functional outputs in ML + GT were comparable to SW and SW + GT groups, without the diffusion limitations of the sandwich top gel. Daily supplementation with low-dose Geltrex creates a biochemically enriched, diffusion-permissive microenvironment that supports long-term viability and function of primary rat hepatocytes in 2D culture. This method represents a simple and effective alternative to traditional sandwich cultures for liver cell studies and drug testing applications.

由于缺乏生理相关的细胞外基质(ECM),原代肝细胞在常规二维(2D)培养中迅速失去活力和功能。胶原蛋白三明治法改善了极化和功能,但造成了扩散障碍,限制了营养和信号交换。本研究探讨了每日补充稀释的非胶凝Geltrex层是否可以维持二维培养中肝细胞的功能和活力,为三明治法提供了一种实用的替代方案。将大鼠原代肝细胞在单层(ML)、单层加Geltrex (ML + GT)、夹层(SW)和夹层加Geltrex (SW + GT)四种条件下培养15 d。评估细胞形态、合流性、活力(CCK-8、活/死染色)和功能(尿素合成、白蛋白生成、CYP3A4活性)。随着时间的推移,ML组在流畅性、生存能力和功能标记物方面表现出明显的下降。与ML组相比,补充Geltrex保持了细胞的融合性(第15天约97%),提高了细胞活力,并保持了更高的白蛋白产量和CYP3A4活性。ML + GT组的功能输出与SW组和SW + GT组相当,没有三明治顶部凝胶的扩散限制。每日补充低剂量Geltrex可创造生化富集、扩散允许的微环境,支持2D培养大鼠原代肝细胞的长期生存能力和功能。这种方法代表了一种简单而有效的替代传统的三明治培养肝细胞研究和药物测试应用。
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引用次数: 0
Hepatoblastoma-Derived Exosomal FASN Affected the Differentiation of Hepatic Stellate Cells Into Cancer-Associated Fibroblasts by Regulating the Stability of HK2 and Mediating Histone Lactylation. 肝母细胞瘤源性外泌体FASN通过调节HK2的稳定性和介导组蛋白乳酸化影响肝星状细胞向癌症相关成纤维细胞的分化。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70080
Qin Zhu, Yifan Zhou, Yuyin Wang, Xin Wu, Yu Hu, Hongyan Zai

Cancer-associated fibroblasts (CAFs) interact with tumor cells in the tumor microenvironment (TME), enhancing glycolysis in CAFs and tumor malignancy. However, the regulatory mechanisms between hepatoblastoma (HB) cells and CAFs are unclear. This study aimed to elucidate the crosstalk mechanism between HB cells and CAFs and identify a new therapeutic target for HB. Exosomes were successfully extracted from Huh-6/HepG2 cells, and hepatic stellate cells (LX2) were treated with conditioned medium or exosomes from these cells. We found that HB cells may stimulate the differentiation of LX2 cells into CAFs through exosomes and enhance histone lactylation. Additionally, HB cell exosome-derived fatty acid synthase (FASN) promoted the transformation of LX2 cells into CAFs and histone lactylation. Mechanistically, FASN affected the transformation of LX2 cells into CAFs and histone lactylation by regulating hexokinase 2 (HK2). FASN regulated HK2 stability by competitively combining with MARCHF1. Activated fibroblasts promoted HB progression by secreting CXCL1/CXCL5. In vivo experiments have demonstrated that HB cell exosome-derived FASN affected the transformation of LX2 cells into CAFs and histone lactylation. Clinical sample analysis revealed that FASN protein expression was significantly positively correlated with the levels of HK2, lactate, and H3K18la, thereby validating the clinical relevance of this regulatory pathway. In conclusion, HB-derived exosomal FASN affected the transformation of LX2 cells into CAFs by regulating the stability of HK2 and mediating histone lactylation, providing novel insights into the crosstalk between HB cells and CAFs and highlighting exosomal FASN as a potential therapeutic target for HB.

癌症相关成纤维细胞(CAFs)在肿瘤微环境(TME)中与肿瘤细胞相互作用,增强CAFs中的糖酵解和肿瘤恶性。然而,肝母细胞瘤(HB)细胞和CAFs之间的调控机制尚不清楚。本研究旨在阐明HB细胞与CAFs之间的串扰机制,寻找新的HB治疗靶点。成功地从Huh-6/HepG2细胞中提取外泌体,并用条件培养基或这些细胞的外泌体处理肝星状细胞(LX2)。我们发现HB细胞可能通过外泌体刺激LX2细胞向CAFs分化,并增强组蛋白乳酸化。此外,HB细胞外泌体衍生的脂肪酸合成酶(FASN)促进了LX2细胞向CAFs的转化和组蛋白的乳酸化。机制上,FASN通过调节己糖激酶2 (HK2)影响LX2细胞向CAFs的转化和组蛋白的乳酸化。FASN通过与MARCHF1竞争性结合调控HK2的稳定性。活化的成纤维细胞通过分泌CXCL1/CXCL5促进HB进展。体内实验表明,HB细胞外泌体衍生的FASN影响LX2细胞向CAFs的转化和组蛋白乳酸化。临床样本分析显示,FASN蛋白表达与HK2、乳酸、H3K18la水平显著正相关,从而验证了该调控通路的临床相关性。总之,HB来源的外泌体FASN通过调节HK2的稳定性和介导组蛋白乳酸化影响LX2细胞向CAFs的转化,为HB细胞和CAFs之间的串扰提供了新的见解,并突出了外泌体FASN作为HB的潜在治疗靶点。
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引用次数: 0
Physiological Differences Underlying Divergent Hypoxia Responses and Altitude Adaptations in Humans, Rats and Mice. 人类、大鼠和小鼠不同缺氧反应和海拔适应的生理差异。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70077
Johannes Burtscher, Robert T Mallet, Anupam Sah, Max Gassmann, Martin Burtscher, Rodrigo Iturriaga

Hypobaric hypoxia, a defining feature of high-altitude environments, poses a considerable physiological challenge to both humans and rodents. To withstand hypoxic stress, mammals have developed cellular and systemic adaptations that not only safeguard against acute and future episodes of oxygen deprivation but may also enhance overall resilience and functional capacity. A central aim of current research is to harness these health-promoting effects of hypoxic exposure as a therapeutic strategy for a range of medical conditions. To date, much of the evidence regarding the safety and efficacy of such interventions derives from rodent studies. In this review, we summarize current knowledge on hypoxia tolerance, oxygen transport, and oxygen consumption in humans, rats, and mice, and evaluate the extent to which findings from rodent models can be extrapolated to humans. While the anatomical, physiological, and molecular foundations of oxygen transport and utilization are broadly conserved across species, there are important quantitative differences-largely linked to body-mass variation-as well as qualitative distinctions. Mice that evolved in high-altitude environments, display remarkable hypoxia tolerance. Their physiological repertoire includes highly efficient pulmonary gas exchange, metabolic downregulation, and substantial plasticity of the mitochondrial electron transport system under hypoxic conditions. In contrast, rats exhibit heightened vulnerability in hypoxia, manifesting as right ventricular hypertrophy, excessive erythropoiesis, and myocardial injury. These interspecies differences highlight that the robust hypoxia tolerance of mice-and the potentially comparatively greater susceptibility of rats than humans-must be carefully considered when translating findings from rodent hypoxia research into human contexts.

低气压缺氧是高海拔环境的一个显著特征,对人类和啮齿动物都构成了相当大的生理挑战。为了抵御缺氧压力,哺乳动物已经发展出细胞和系统适应,不仅可以防止急性和未来的缺氧发作,还可以增强整体的恢复能力和功能能力。当前研究的一个中心目标是利用低氧暴露的这些促进健康的作用作为一系列医疗条件的治疗策略。迄今为止,关于此类干预措施的安全性和有效性的大部分证据来自啮齿动物研究。在这篇综述中,我们总结了目前关于人类、大鼠和小鼠的缺氧耐受性、氧气运输和氧气消耗的知识,并评估了啮齿动物模型的发现在多大程度上可以外推到人类身上。尽管不同物种之间氧运输和利用的解剖学、生理学和分子基础大致上是保守的,但它们之间存在着重要的数量差异——主要与体重变化有关——以及质量差异。在高海拔环境中进化的小鼠表现出非凡的耐缺氧能力。它们的生理功能包括在缺氧条件下高效的肺气体交换、代谢下调和线粒体电子传递系统的大量可塑性。相比之下,大鼠在缺氧时表现出更高的易感性,表现为右心室肥厚、红细胞生成过多和心肌损伤。这些物种间的差异突出表明,在将啮齿动物缺氧研究的结果应用于人类环境时,必须仔细考虑小鼠强大的缺氧耐受性——以及大鼠相对于人类更大的潜在易感性。
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引用次数: 0
Advantage of Semaglutide: Comprehensive Analysis of Metabolic Impact of Semaglutide-Treated and Pair-Fed Rats. 西马鲁肽的优势:西马鲁肽治疗和配对喂养大鼠代谢影响的综合分析。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70083
Suyeun Byun, Morgan R Sotzen, Mya A Knappenberger, Madison T Bento, Mohammed Asker, Doris I Olekanma, Karolina P Skibicka

Semaglutide (SEMA), a GLP-1 receptor agonist, effectively reduces body weight. Yet its mechanisms of action remain incompletely understood. It is unclear whether SEMA promotes weight loss solely through reduced food intake or also through intake-independent mechanisms, and whether these effects differ by sex. To address these questions, we used a pair-feeding design in diet-induced obese rats, comparing SEMA-treated rats with both ad libitum-fed controls and SEMA intake-matched groups over 4-week treatment. Analyses included sex-stratified outcomes, depot-specific brown and white adipose profiling, thermogenesis, locomotor activity, and circulating metabolic hormone measurements. SEMA reduced food intake of both hypercaloric, high-fat/high-sugar diet and chow and produced body weight loss beyond the effects of caloric restriction alone. SEMA also curbed the hunger hormone ghrelin. It reduced visceral adiposity and increased activity, albeit more potently in females compared to males. Across adipose depots SEMA promoted smaller adipocyte size, white adipose tissue browning, and enhanced sympathetic innervation, while these changes were largely absent in pair-fed rats. SEMA rescued caloric restriction-associated hypothermia and small reductions in circulating thyroid hormones; it also potentiated local thyroid input. SEMA induced sex-dependent, depot-specific adipose remodeling and sustained increases in locomotor activity independent of food intake. Our integrative approach provides new insight into SEMA's mechanisms and highlights the importance of evaluating sex as a biological variable in mechanistic studies of obesity therapies. Metabolic benefits of the SEMA treatment far outweighed those offered by comparable caloric restriction, indicating that its mechanism of action involves not only hypophagia but also adipose tissue remodeling and browning.

SEMA是一种GLP-1受体激动剂,可有效减轻体重。然而,它的作用机制仍然不完全清楚。目前尚不清楚SEMA是否仅仅通过减少食物摄入来促进体重减轻,还是通过与摄入无关的机制来促进体重减轻,以及这些效果是否因性别而异。为了解决这些问题,我们在饮食诱导的肥胖大鼠中采用了配对喂养设计,在4周的治疗期间,将SEMA治疗的大鼠与随意喂养的对照组和摄入SEMA匹配的组进行比较。分析包括性别分层结果、仓库特异性棕色和白色脂肪谱、产热、运动活动和循环代谢激素测量。SEMA减少了高热量、高脂肪/高糖饮食和食物的摄入,并产生了体重减轻,而不仅仅是热量限制的效果。SEMA还能抑制饥饿激素ghrelin。它减少了内脏脂肪,增加了活动,尽管女性比男性更有效。在脂肪储存库中,SEMA促进脂肪细胞变小,白色脂肪组织褐化,增强交感神经支配,而这些变化在成对喂养的大鼠中基本不存在。SEMA挽救了热量限制相关的低温和循环甲状腺激素的少量减少;它还增强了局部甲状腺输入。SEMA诱导性别依赖的、储存特异性的脂肪重塑和独立于食物摄入的运动活动的持续增加。我们的综合方法为SEMA的机制提供了新的见解,并强调了在肥胖治疗机制研究中将性别作为生物学变量进行评估的重要性。SEMA治疗的代谢益处远远超过类似热量限制所提供的益处,表明其作用机制不仅涉及吞咽,还涉及脂肪组织重塑和褐变。
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引用次数: 0
Organ Crosstalk During Injury: Mechanisms of Lung-Kidney Interaction in Critical Illness. 损伤过程中的器官串扰:危重疾病中肺肾相互作用的机制。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70069
Kathryn M Sullivan, Kathleen D Liu, Michael A Matthay

The kidneys and lungs are frequent sites of organ injury during critical illness. Acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) are clinical syndromes resulting from kidney and lung injury respectively. Complex pathophysiologic mechanisms underlie the development of these two syndromes individually, and a substantial body of evidence now indicates that crosstalk between the lungs and the kidneys occurs after organ injury. Here we review the pathophysiology of AKI and ARDS, animal models of kidney and lung injury, and mechanisms of organ crosstalk after injury has occurred. We focus the discussion on how either kidney injury or lung injury may propagate damage in the other organ, which is relevant to multiorgan injury commonly encountered in the intensive care unit. The reviewed literature contains more mechanistic preclinical studies of lung injury after AKI compared with AKI after lung injury. Identified mechanisms of lung injury after AKI include leukocyte recruitment, inflammatory signaling, activation of pattern recognition receptors, formation of neutrophil extracellular traps, osteopontin signaling, metabolic dysfunction, and impaired alveolar fluid clearance. After lung injury, AKI is instigated by inflammatory signaling, the effects of mechanical ventilation, and consequences of fluid management.

肾脏和肺是危重疾病中常见的器官损伤部位。急性肾损伤(AKI)和急性呼吸窘迫综合征(ARDS)分别是由肾损伤和肺损伤引起的临床综合征。复杂的病理生理机制是这两种综合征各自发展的基础,大量证据表明,肺和肾脏之间的串扰发生在器官损伤后。本文综述了AKI和ARDS的病理生理学、肾和肺损伤的动物模型以及损伤后器官串扰的机制。我们重点讨论肾损伤或肺损伤如何在其他器官传播损害,这与重症监护病房中常见的多器官损伤有关。所回顾的文献包含更多的AKI后肺损伤的临床前研究,而不是肺损伤后的AKI。已确定的AKI后肺损伤机制包括白细胞募集、炎症信号、模式识别受体的激活、中性粒细胞胞外陷阱的形成、骨桥蛋白信号、代谢功能障碍和肺泡液清除受损。肺损伤后,AKI是由炎症信号、机械通气的影响和液体处理的后果引发的。
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引用次数: 0
Insulin as an Accelerator and Brake of Aging: From Molecular Landscape to Clinical Interventions. 胰岛素作为衰老的加速器和制动器:从分子景观到临床干预。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70079
Shi-Cheng Chen, Xiao-Dong Sun, Yuan-Yuan Zhang

Population aging poses a significant threat to quality of life and contributes to an increasing medical burden. The concept of healthy aging has emerged to represent an aging process that is relatively well controlled. However, due to the multifaceted hallmarks and complex mechanisms underlying aging, there is a need for novel therapeutic targets to promote healthy aging comprehensively. As a fundamental hormone regulating nutrient anabolism and cell proliferation, insulin plays a central role in the aging process. Insulin resistance (IR), which triggers compensatory insulin secretion, along with β-cell dysfunction and impaired insulin clearance, is an established aging phenotype. These alterations of insulin synergistically contribute to the decline in insulin level and sensitivity during aging, making hyperglycemia a prominent risk factor for healthy aging. The decline of insulin signaling with age is associated with pro-aging effects, particularly by promoting dysregulated nutrient sensing and cellular senescence. Current hypoglycemic agents necessitate careful consideration of their potential pro-aging effects due to the overactivation of insulin signaling. Thus, a critical challenge for targeted interventions is to preserve the hypoglycemic benefits of insulin signaling while mitigating its downstream pro-aging effects. Herein, we analyzed current evidence on the complex changes in insulin synthesis, function, and clearance during aging, concentrating on the roles of insulin in hepatocytes, skeletal muscle cells, and adipocytes in the aging process. Additionally, current anti-aging interventions and their mechanisms were discussed from the perspective of regulating insulin signaling, aiming to provide new strategies and pharmacological targets for promoting healthy aging.

人口老龄化对生活质量构成重大威胁,并造成日益沉重的医疗负担。健康老龄化的概念已经出现,它代表了一个相对可控的衰老过程。然而,由于衰老具有多方面的特征和复杂的机制,需要新的治疗靶点来全面促进健康衰老。胰岛素作为调节营养物质合成代谢和细胞增殖的基础激素,在衰老过程中起着核心作用。胰岛素抵抗(IR)触发代偿性胰岛素分泌,同时伴有β细胞功能障碍和胰岛素清除受损,是一种成熟的衰老表型。这些胰岛素的改变协同作用导致了衰老过程中胰岛素水平和敏感性的下降,使高血糖成为健康衰老的重要危险因素。随着年龄的增长,胰岛素信号的下降与促衰老作用有关,特别是通过促进失调的营养感知和细胞衰老。由于胰岛素信号的过度激活,目前的降糖药需要仔细考虑其潜在的促衰老作用。因此,有针对性干预的一个关键挑战是保持胰岛素信号的降糖益处,同时减轻其下游的促衰老作用。在此,我们分析了目前关于衰老过程中胰岛素合成、功能和清除的复杂变化的证据,重点研究了胰岛素在肝细胞、骨骼肌细胞和脂肪细胞中在衰老过程中的作用。并从调节胰岛素信号的角度探讨当前抗衰老干预措施及其作用机制,以期为促进健康衰老提供新的策略和药理靶点。
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引用次数: 0
Lab, Patients, and Percussion: A Day in the Life of Andreas Herrlich, MD, PhD, Washington University (USA). 实验室、病人和打击乐:Andreas Herrlich的一天,医学博士,华盛顿大学(美国)。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70070
Paul Trevorrow, Andreas Herrlich
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引用次数: 0
Interconnected Organs: Exploring the Impact of Kidney-Lung Crosstalk in Critically Ill Neonates and Children. 互联器官:探讨肾肺串扰对危重新生儿和儿童的影响。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70084
Michelle C Starr, Stephen Gorga, Katja M Gist

Acute kidney injury (AKI) and acute lung injury (ALI) are common in critically ill neonates, children, and those with severe cardiac disease. Although kidney and lung dysfunction can occur independently, molecular signaling and organ crosstalk significantly influence the function of each organ. Additionally, there is a link between AKI and fluid balance disorders. A bidirectional and synergistic relationship exists between AKI and fluid imbalance, with fluid management potentially becoming compromised before or after AKI. Fluid accumulation can further worsen ALI by impairing gas exchange. Organ crosstalk involves both pro-inflammatory and anti-inflammatory cytokines, as well as other modulating factors. Both AKI and ALI have harmful effects in pediatric patients, and AKI can lead to long-term consequences, especially in premature neonates, who are at much higher risk for bronchopulmonary dysplasia and chronic lung disease following AKI. Unfortunately, supportive treatments for ALI, such as positive pressure ventilation, can increase right ventricular afterload and central venous pressure, which may worsen renal perfusion, creating a cycle of ongoing multiple organ dysfunction. Pediatric research has provided insights into potential treatment strategies for preventing ALI, even without AKI. Prophylactic peritoneal dialysis may help remove pro-inflammatory cytokines that contribute to AKI and ALI in children undergoing cardiac surgery. Future studies are necessary to explore interventions that can prevent or reduce the harmful effects of kidney and lung injuries in critically ill children.

急性肾损伤(AKI)和急性肺损伤(ALI)常见于危重新生儿、儿童和严重心脏病患者。虽然肾和肺功能障碍可以独立发生,但分子信号和器官串扰显著影响每个器官的功能。此外,AKI与体液平衡紊乱之间存在联系。AKI与体液失衡之间存在双向和协同关系,在AKI之前或之后,体液管理可能会受到损害。液体积聚可通过损害气体交换进一步恶化ALI。器官串扰涉及促炎和抗炎细胞因子,以及其他调节因子。AKI和ALI对儿科患者都有有害影响,AKI可导致长期后果,特别是早产儿,他们在AKI后发生支气管肺发育不良和慢性肺部疾病的风险要高得多。不幸的是,ALI的支持性治疗,如正压通气,可增加右心室后负荷和中心静脉压,这可能会加重肾灌注,造成持续的多器官功能障碍循环。儿科研究为预防ALI的潜在治疗策略提供了见解,即使没有AKI。在接受心脏手术的儿童中,预防性腹膜透析可能有助于清除导致AKI和ALI的促炎细胞因子。未来的研究需要探索能够预防或减少危重儿童肾和肺损伤有害影响的干预措施。
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引用次数: 0
Beyond Structure: The Interplay of Bone and Brain During Alzheimer's Disease. 结构之外:阿尔茨海默病期间骨和脑的相互作用。
IF 5.2 2区 医学 Q1 PHYSIOLOGY Pub Date : 2025-12-01 DOI: 10.1002/cph4.70075
Ananya Pinnamaneni, Anika Akkiraju, Hannah I Park, Radha Sai Rupesh Ch V, Vishnu Ayalasomayajula, Mounica Bandela, Siddharth Kaipa, Sundeep Khosla, Michael Zeineh, Vidyani Suryadevara

Alzheimer's disease (AD), a leading cause of dementia in the elderly, is traditionally characterized by neurodegeneration driven by amyloid-beta plaques and tau tangles. However, emerging evidence reveals that AD's impact extends beyond the brain, significantly affecting skeletal health. This review integrates clinical and transgenic mouse model data to elucidate the mechanistic interplay between AD pathology and bone metabolism. AD patients exhibit increased risk for hip fractures and low bone mineral density (BMD), independent of cognitive impairment severity. We found altered calcium and alkaline phosphate levels in the blood of patients with mild cognitive impairment and AD, as assessed from the Alzheimer's Disease Neuroimaging Initiative data. Convergent risk factors-age, sex, APOE4 genotype, smoking, and vitamin D deficiency-contribute to both neurodegeneration and bone fragility. Key molecular pathways, such as Wnt/β-catenin signaling and TREM2-mediated osteoclast regulation, underscore shared mechanisms driving disease pathology in both systems. Mouse models of AD consistently demonstrate disrupted bone remodeling, impaired osteoblast function, and heightened osteoclast activity. Therapeutic strategies targeting overlapping pathways, including lithium, anti-FSH antibodies, and NF-κB inhibitors, show promise in mitigating both cognitive decline and bone loss. Collectively, these insights advocate for a more integrated view of AD that includes skeletal comorbidities, potentially guiding the development of dual-purpose interventions.

阿尔茨海默病(AD)是老年人痴呆症的主要原因,传统上以淀粉样斑块和tau缠结驱动的神经变性为特征。然而,新出现的证据表明,阿尔茨海默病的影响超出了大脑,严重影响骨骼健康。本文综述了临床和转基因小鼠模型数据,以阐明AD病理与骨代谢之间的机制相互作用。AD患者表现出髋部骨折和低骨密度(BMD)的风险增加,与认知障碍的严重程度无关。根据阿尔茨海默病神经影像学倡议的数据,我们发现轻度认知障碍和AD患者血液中的钙和碱性磷酸盐水平发生了改变。年龄、性别、APOE4基因型、吸烟和维生素D缺乏等综合危险因素会导致神经变性和骨骼脆弱。关键的分子通路,如Wnt/β-catenin信号传导和trem2介导的破骨细胞调节,强调了这两个系统中驱动疾病病理的共同机制。阿尔茨海默病小鼠模型一致显示骨重塑中断,成骨细胞功能受损,破骨细胞活性升高。针对重叠通路的治疗策略,包括锂、抗fsh抗体和NF-κB抑制剂,显示出减轻认知能力下降和骨质流失的希望。总的来说,这些见解提倡对包括骨骼合并症在内的AD进行更综合的看法,可能指导双重目的干预措施的发展。
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Comprehensive Physiology
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