Current Opinion in Endocrinology & Diabetes and Obesity最新文献

Purpose of review: Familial hypercholesterolemia (FH) in pregnancy poses several challenges, requiring a delicate balance between maternal atherosclerotic cardiovascular disease (ASCVD) risk and foetal safety. The review synthesizes current evidence, research gaps, evaluates emerging data on existing lipid-lowering strategies and highlights evolving guideline recommendations.

Recent findings: Pregnancy in women with FH has unique considerations for both the mother and the foetus. Data from registries and observational studies indicate that heterozygous FH (HeFH) does not significantly increase foetal adverse outcomes such as congenital malformation, prematurity, low birth weight although there may be a predisposition to early atherogenesis. Maternal risks include preeclampsia, endothelial dysfunction and prothrombotic tendency. Pregnant women with homozygous FH (HoFH) carry a substantially higher morbidity. Management strategies emphasize the need for timely, multidisciplinary care, dietary optimization, selective use of low-dose statins in high-risk HoFH and LDL apheresis for severe cases. Despite emerging evidence of lack of a major teratogenic risk, statins remain contraindicated in most guidelines, during pregnancy and lactation. Time off statins represent a critical gap in ASCVD prevention.

Summary: Pregnancy in FH requires a nuanced, stage-specific, individualized approach. Expansion of FH pregnancy registries and prospective studies is essential to guide evidence based care and refine recommendations for the future.

Purpose of review: Hypertriglyceridemia (HTG) is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and acute pancreatitis (AP). Early detection and treatment are important to prevent such complications. This review briefly outlines the etiology and novel treatments of HTG and recent findings from contemporary HTG registries.

Recent findings: HTG is associated with an increased prevalence of cardiometabolic risk factors, including obesity, diabetes, and hepatic steatosis. Novel ribonucleic acid-based treatments for HTG have shown a substantial reduction in plasma triglycerides and a lower incidence of AP. A recent trial confirmed such benefit in patients with triglycerides >500 mg/dl (5.6 mmol/l), albeit with an increase in low-density lipoprotein-cholesterol, a reduction in remnant cholesterol and no change in apolipoprotein B. There is a need to harmonize the definitions of HTG and improve the care of individuals with severe HTG and familial chylomicronemia syndrome. New and evolving international registries are beginning to provide useful real-world data.

Summary: Patient registries for HTG have provided valuable data for understanding the link between HTG and other cardiometabolic disorders; they can inform the planning of clinical services and the translation of the findings of new and future clinical trials of triglyceride-lowering therapies.

Purpose of review: Familial chylomicronemia (FCS) and multifactorial or persistent chylomicronemia syndromes (MCS, pCS) are rare, severe disorders characterized by extreme hypertriglyceridemia and a high risk of recurrent, potentially life-threatening acute pancreatitis. Most patients do not achieve adequate triglyceride control with lifestyle interventions or conventional lipid-lowering therapies, leaving them exposed to persistent complications. This review critically examines emerging therapeutic strategies aimed at improving triglyceride control and reducing acute pancreatitis risk.

Recent findings: Advances targeting key molecular regulators of triglyceride metabolism have shown substantial promise. APOC3 inhibitors, including volanesorsen, olezarsen, and plozasiran, achieve up to 80% reductions in triglycerides and markedly lower AP incidence, with favorable safety profiles. ANGPTL3 inhibition via evinacumab may benefit patients with residual lipoprotein lipase activity, including polygenic or mixed chylomicronemia, and could be used during acute sHTG episodes. Lomitapide, acting independently of LPL, is effective in selected FCS patients but requires careful hepatic monitoring. FGF21 analogs, such as pegozafermin, are in early development and show potential for metabolic dysfunction-associated steatotic liver disease, though their impact on acute pancreatitis prevention remains to be established.

Summary: These emerging mechanism-based therapies are reshaping the management of severe hypertriglyceridemia, offering targeted approaches to reduce triglycerides and acute pancreatitis risk. Ongoing studies will clarify long-term safety, durability of response, and optimal patient selection, providing a framework for improved clinical outcomes.

Purpose of review: To summarize recent advances in therapeutic strategies targeting angiopoietin-like protein 3 (ANGPTL3), a central regulator of triglyceride and remnant lipoprotein metabolism, and to discuss the potential of emerging pharmacologic approaches.

Recent findings: Several pharmacologic approaches have demonstrated robust lipid-lowering efficacy through ANGPTL3 inhibition. Monoclonal antibodies (evinacumab, SHR-1918) and RNA-based therapies (vupanorsen, zodasiran, solbinsiran) effectively reduce triglycerides, apoprotein B (apoB)-containing lipoproteins, and nonhigh-density lipoprotein cholesterol. The newest and most promising innovation is CRISPR-mediated disruption of ANGPTL3 (CTX310).

Summary: ANGPTL3 inhibition represents one of the most powerful current strategies for lowering triglyceride-rich lipoproteins and residual cardiovascular risk. While monoclonal antibodies and RNA-based drugs offer effective, repeat-dose therapies, in vivo CRISPR editing could enable a one-time, lifelong correction of hypertriglyceridemia and mixed dyslipidemia. The main challenge ahead lies in ensuring safety, scalability, and equitable access if long-term efficacy and tolerability are confirmed in phase 3 trials.

Purpose of review: Recent advances in metabolomics, multi-omics integration, and neurogastroenterology have fundamentally reshaped understanding of the human gut microbiome. Rather than microbial composition alone, emerging evidence highlights microbial secretory and signaling activity as a central regulator of brain-gut communication. Understanding how microbiome-derived molecules interact with epithelial, immune, endocrine, and neural pathways is essential for advancing mechanistic insight and precision interventions in disorders of gut-brain interaction (DGBI).

Recent findings: Recent studies demonstrate that the gut microbiome functions as a metabolic and endocrine signaling system, producing compounds such as short-chain fatty acids, bile acids, tryptophan-derived metabolites, polyamines, and lipid mediators that act on enteroendocrine cells, immune circuits, mechanosensory pathways, and vagal afferents. These signals are integrated centrally through brainstem and cortical networks, shaping gastrointestinal motility, visceral sensitivity, stress responsiveness, and affective processing. Functional dysbiosis and altered microbial signaling - rather than consistent taxonomic changes - appear to be primary modulators of brain-gut axis dysregulation.

Summary: Emerging data calls for a reframing of gut-brain disorders as conditions of disrupted microbial signaling. Clinically, they support mechanism-based stratification and targeted dietary, microbiome-directed, and neuromodulatory therapies. The findings identify a need for functional biomarkers and targeted molecular approaches to advance precision medicine in DGBIs.

Purpose of review: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in people with type 2 diabetes mellitus (T2DM). Endothelial dysfunction is a precursor of atherosclerosis. This is a silent process that occurs over years. Focus on primary prevention to identify and target endothelial dysfunction early can slow down the atherosclerotic process and prevent ASCVD.

Recent findings: Emerging blood-based methods include novel endothelial related biomarkers, such as endothelial specific extracellular vesicles, markers of endothelial regeneration and endothelial specific polygenic risk score. Physiology imaging-based method includes the flow-mediated dilation of the brachial artery, a noninvasive procedure that had gained attention for standardization in an international consensus guideline. Recognizing the role of endothelial function in ASCVD, studies are increasingly incorporating endothelial function biomarkers and FMD as surrogate markers of response. There is also emerging evidence on how nonpharmacological and pharmacological strategies improve endothelial function.

Summary: Blood and imaging-based assessment of endothelial function is a promising area that can enhance early preventive efforts. Future studies to assess the incremental value of endothelial function assessment in contemporary longitudinal cohorts across diverse populations is necessary to identify the high-risk asymptomatic individuals who will benefit from intensive primary prevention.

Purpose of review: To highlight the recent advancements in understanding the influence of psychological factors on the causation and management of obesity, which holds significance for clinical practice.

Recent findings: This review explores developments in understanding psychological risk factors, sequelae, and treatments for obesity. Despite good evidence for psychological therapies in weight management, there are no standardized protocols for assessing patients requiring metabolic and bariatric surgery. Psychological therapies are synergistic with obesity medications.

Summary: Obesity is a complex health issue with psychological dimensions. Stress, emotional dysregulation, and cognitive factors contribute to obesity. Stress's physiological impact on adipose tissue distribution and metabolic function, mediated by cortisol, demonstrates this interaction. Obesity leads to psychological consequences, including depression, low self-esteem, and reduced quality of life. The relationship between depression and obesity is modulated by demographic factors and biological mechanisms. Body composition reflects interactions between habits and cultural ideals, and medical models may increase stigma. Psychological interventions like cognitive-behavioral therapy and motivational interviewing effectively maintain weight loss. Psychological assessments before bariatric surgery are crucial for identifying mental health issues. This review highlights psychological dimensions in obesity prevention and treatment strategies.

Purpose of review: Diabetes mellitus affects one in nine adults worldwide, with timely diagnosis and accurate classification being essential for patient management. C-peptide is an important biomarker in the diagnostic workup. As diabetes sub-typing and treatment options continue to evolve, this review will highlight the important aspects of C-peptide analysis and interpretation and additionally, evaluate its current and emerging clinical role.

Recent findings: Several sample types and testing strategies such as fasting, random and stimulated C-peptide are available which are reviewed here. Random nonfasting C-peptide is convenient to perform in clinic and performs well compared to gold standard testing for classification of severe insulin deficiency and insulin dependence. C-peptide measurement may also be useful for classifying type 2 diabetes subtypes and in predicting response to treatment. Despite ongoing efforts towards standardization of C-peptide, variation still exists between analytical methods.

Summary: This review summarizes recent literature relating to preanalytical, analytical and clinical aspects of C-peptide testing. Future research in this area may build on the role of C-peptide in predicting glycaemic control, clinical complications and response to pharmacotherapy.

Purpose of review: Peroxisome proliferator-activated receptors (PPARs) are transcription factors that regulate metabolic homeostasis and play a key role in the management of a number of metabolic disorders (e.g. diabetes and liver steatosis). This review aims to provide an overview on the impact of the three isoforms, PPAR-α, PPAR-β/δ and PPAR-γ, on diabetic-driven metabolic diseases.

Recent findings: The lack of clinical benefit observed in the PROMINENT trial with pemafibrate (a selective PPAR-α agonist) has raised questions regarding the therapeutic potential of PPAR-α activation in the prevention of major cardiovascular events. Conversely, evidence suggests a possible therapeutic role in peripheral artery disease. To reduce the adverse effects occurring consequently to PPAR-γ activation, partial agonists or selective PPAR-γ modulators (SPPARγMs) have been developed. In the context of metabolic dysfunction associated steatohepatitis, pan-PPAR agonism appears necessary to achieve significant improvements in histological endpoints.

Summary: These diversified effects, albeit with a limited risk of significant side effects, make PPAR agonists an area of growing interest and with an expanding range of potential applications.