Pub Date : 2023-09-01Epub Date: 2023-09-07DOI: 10.1080/17446651.2023.2256407
Melissa E Chen, Chirag S Desai
Introduction: Chronic pancreatitis and recurrent acute pancreatitis comprise a spectrum of disease that results in complications related to exocrine and endocrine insufficiency and chronic pain with narcotic dependence and poor quality of life. The mainstay of therapy has been medical and endoscopic therapy; surgery, especially total pancreatectomy, was historically reserved for few select patients as the obligate exocrine insufficiency and pancreatogenic diabetes (type 3C) are challenging to manage. The addition of islet cell autotransplantation after total pancreatectomy helps to mitigate brittle type 3c diabetes and prevents mortality related to severe hypoglycemic episodes and hypoglycemic unawareness. There have been more recent data demonstrating the safety of surgery and the beneficial long-term outcomes.
Areas covered: The purpose of this review is to describe the current practices in the field of islet cell autotransplantation including the selection and evaluation of patients for surgery, their preoperative work up and management, surgical approach, post-operative management and outcomes.
Expert opinion: Total pancreatectomy and islet cell autotransplantation has the ability to drastically improve quality of life and prevent brittle diabetes for patients suffering with chronic pancreatitis.
{"title":"Current practices in islet cell autotransplantation.","authors":"Melissa E Chen, Chirag S Desai","doi":"10.1080/17446651.2023.2256407","DOIUrl":"10.1080/17446651.2023.2256407","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pancreatitis and recurrent acute pancreatitis comprise a spectrum of disease that results in complications related to exocrine and endocrine insufficiency and chronic pain with narcotic dependence and poor quality of life. The mainstay of therapy has been medical and endoscopic therapy; surgery, especially total pancreatectomy, was historically reserved for few select patients as the obligate exocrine insufficiency and pancreatogenic diabetes (type 3C) are challenging to manage. The addition of islet cell autotransplantation after total pancreatectomy helps to mitigate brittle type 3c diabetes and prevents mortality related to severe hypoglycemic episodes and hypoglycemic unawareness. There have been more recent data demonstrating the safety of surgery and the beneficial long-term outcomes.</p><p><strong>Areas covered: </strong>The purpose of this review is to describe the current practices in the field of islet cell autotransplantation including the selection and evaluation of patients for surgery, their preoperative work up and management, surgical approach, post-operative management and outcomes.</p><p><strong>Expert opinion: </strong>Total pancreatectomy and islet cell autotransplantation has the ability to drastically improve quality of life and prevent brittle diabetes for patients suffering with chronic pancreatitis.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10180089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-11-28DOI: 10.1080/17446651.2023.2267120
Jacqueline Jonklaas
{"title":"Is euthyroidism within reach for all?","authors":"Jacqueline Jonklaas","doi":"10.1080/17446651.2023.2267120","DOIUrl":"10.1080/17446651.2023.2267120","url":null,"abstract":"","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41118862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-14DOI: 10.1080/17446651.2023.2236693
Ana Raimunda Dâmaso, Lian Tock, Nayra Figueiredo, Flávia Campos Corgosinho
Obesity in childhood and adolescence has increased worldwide and is being considered a public health issue [1]. Obesity is associated with a chronic proinflammatory state and many comorbidities, including, metabolic syndrome (MS) and nonalcoholic fatty liver diseases (NAFLD) [2,3]. Enlarged adipose tissue is a consequence of multifactorial conditions such as genetic and lifestyle factors including the increase in ultraprocessed and high caloric food consumption and a decrease in physical activity [4,5]. The expansion of adipose tissue promotes dysregulation of adipokine action, increasing the secretion of proinflammatory (i.e. leptin, resistin, plasminogen activator inhibitor-1, vistatin, angiotensin, tumor necrosis factor-alpha, interleukin 6) and concomitant reduction the anti-inflammatory adipokines like (adiponectin and interleukin 10). This pro-inflammatory state is considered key to the development of comorbidities related to obesity, such as MS [6]. The World Health Organization (WHO) defines MS as a pathological condition characterized by excessive abdominal obesity, insulin resistance, hypertension, and hyperlipidemia and its high prevalence around the world has today become a truly global challenge [1,7]. In fact, in adolescents with obesity, the prevalence of MS can reach up to 60%, which may disrupt its control in long-term weight loss interventions, with insulin resistance and visceral fatty being strong predictors [8]. Furthermore, the hyperleptinemic state is a common factor present in obesity in adolescents. The hyperleptinemic state is associated with disruption of neuroendocrine regulation of energy balance, atherosclerosis in early stage of the life, impairment on lung function and depression symptoms. In addition, it may impair the effects of interdisciplinary weight loss approach in the long term considering the pediatric population [9–12]. Inversely, the hypoadiponectinemia present in obesity can be reversed after leptin concentration was normalized with approximately 10% of weight loss. It is suggested that the balance between leptin and adiponectin may orchestrate the impact of weight loss therapy in adolescents with obesity and MS. In fact, previously, our research team showed that the adiponectin/leptin ratio is more effective as a biomarker of inflammation than these adipokines itself and should be considered in clinical practice [13–15]. Healthcare professionals must know what is behind the obesity phenotype in order to achieve reasonable goals in each patient and to define what strategy in each area should be used in order to improve not just body weight but body composition, inflammation profile, and metabolic disorders. Importantly, it has been shown that the impact of weight loss therapy in adolescents with MS occurs as a dependent manner considering of the presence of low or high number of altered parameters. Individuals with MS might need a longer time of multidisciplinary therapy to obtain similar results to tho
{"title":"What is the best clinical approach to adolescents with obesity and metabolic syndrome?","authors":"Ana Raimunda Dâmaso, Lian Tock, Nayra Figueiredo, Flávia Campos Corgosinho","doi":"10.1080/17446651.2023.2236693","DOIUrl":"10.1080/17446651.2023.2236693","url":null,"abstract":"Obesity in childhood and adolescence has increased worldwide and is being considered a public health issue [1]. Obesity is associated with a chronic proinflammatory state and many comorbidities, including, metabolic syndrome (MS) and nonalcoholic fatty liver diseases (NAFLD) [2,3]. Enlarged adipose tissue is a consequence of multifactorial conditions such as genetic and lifestyle factors including the increase in ultraprocessed and high caloric food consumption and a decrease in physical activity [4,5]. The expansion of adipose tissue promotes dysregulation of adipokine action, increasing the secretion of proinflammatory (i.e. leptin, resistin, plasminogen activator inhibitor-1, vistatin, angiotensin, tumor necrosis factor-alpha, interleukin 6) and concomitant reduction the anti-inflammatory adipokines like (adiponectin and interleukin 10). This pro-inflammatory state is considered key to the development of comorbidities related to obesity, such as MS [6]. The World Health Organization (WHO) defines MS as a pathological condition characterized by excessive abdominal obesity, insulin resistance, hypertension, and hyperlipidemia and its high prevalence around the world has today become a truly global challenge [1,7]. In fact, in adolescents with obesity, the prevalence of MS can reach up to 60%, which may disrupt its control in long-term weight loss interventions, with insulin resistance and visceral fatty being strong predictors [8]. Furthermore, the hyperleptinemic state is a common factor present in obesity in adolescents. The hyperleptinemic state is associated with disruption of neuroendocrine regulation of energy balance, atherosclerosis in early stage of the life, impairment on lung function and depression symptoms. In addition, it may impair the effects of interdisciplinary weight loss approach in the long term considering the pediatric population [9–12]. Inversely, the hypoadiponectinemia present in obesity can be reversed after leptin concentration was normalized with approximately 10% of weight loss. It is suggested that the balance between leptin and adiponectin may orchestrate the impact of weight loss therapy in adolescents with obesity and MS. In fact, previously, our research team showed that the adiponectin/leptin ratio is more effective as a biomarker of inflammation than these adipokines itself and should be considered in clinical practice [13–15]. Healthcare professionals must know what is behind the obesity phenotype in order to achieve reasonable goals in each patient and to define what strategy in each area should be used in order to improve not just body weight but body composition, inflammation profile, and metabolic disorders. Importantly, it has been shown that the impact of weight loss therapy in adolescents with MS occurs as a dependent manner considering of the presence of low or high number of altered parameters. Individuals with MS might need a longer time of multidisciplinary therapy to obtain similar results to tho","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9856451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-05-18DOI: 10.1080/17446651.2023.2209176
Kevin C Maki, Carol F Kirkpatrick, David B Allison, Kishore M Gadde
Introduction: Obesity is highly prevalent in the U.S. and is associated with an increased risk of major adverse cardiovascular events (MACE). Modalities for the management of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery.
Areas covered: This review describes the evidence on the effects of weight loss therapies on MACE risk. Lifestyle interventions and older antiobesity pharmacotherapies have been associated with <12% body weight reduction and no clear benefit to reduce MACE risk. Bariatric surgery is associated with substantial weight reduction (20-30%) and markedly lower subsequent risk for MACE. Newer antiobesity pharmacotherapies, particularly semaglutide and tirzepatide, have shown greater efficacy for weight reduction compared with older medications and are being evaluated in cardiovascular outcomes trials.
Expert opinion: Current practice for cardiovascular risk reduction in patients with obesity is lifestyle intervention for weight loss, combined with the treatment of obesity-related cardiometabolic risk factors individually. The use of medications to treat obesity is relatively rare. In part, this reflects concerns about long-term safety and weight loss effectiveness, possible provider bias, as well as lack of clear evidence of MACE risk reduction. If ongoing outcomes trials demonstrate the efficacy of newer agents in reducing MACE risk, this will likely lead to expanded use in obesity management.
{"title":"Pharmacotherapy for obesity: recent evolution and implications for cardiovascular risk reduction.","authors":"Kevin C Maki, Carol F Kirkpatrick, David B Allison, Kishore M Gadde","doi":"10.1080/17446651.2023.2209176","DOIUrl":"10.1080/17446651.2023.2209176","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is highly prevalent in the U.S. and is associated with an increased risk of major adverse cardiovascular events (MACE). Modalities for the management of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery.</p><p><strong>Areas covered: </strong>This review describes the evidence on the effects of weight loss therapies on MACE risk. Lifestyle interventions and older antiobesity pharmacotherapies have been associated with <12% body weight reduction and no clear benefit to reduce MACE risk. Bariatric surgery is associated with substantial weight reduction (20-30%) and markedly lower subsequent risk for MACE. Newer antiobesity pharmacotherapies, particularly semaglutide and tirzepatide, have shown greater efficacy for weight reduction compared with older medications and are being evaluated in cardiovascular outcomes trials.</p><p><strong>Expert opinion: </strong>Current practice for cardiovascular risk reduction in patients with obesity is lifestyle intervention for weight loss, combined with the treatment of obesity-related cardiometabolic risk factors individually. The use of medications to treat obesity is relatively rare. In part, this reflects concerns about long-term safety and weight loss effectiveness, possible provider bias, as well as lack of clear evidence of MACE risk reduction. If ongoing outcomes trials demonstrate the efficacy of newer agents in reducing MACE risk, this will likely lead to expanded use in obesity management.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9857176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-05-26DOI: 10.1080/17446651.2023.2216794
Roberta Balestrino, Marco Losa, Luigi Albano, Lina R Barzaghi, Pietro Mortini
Introduction: Known for its effect on labor and lactation and on emotional and social functions, oxytocin has recently emerged as a key modulator of feeding behavior and indeed suggested as a potential treatment for obesity. The potential positive effect of oxytocin on both metabolic and psychological-behavioral complications of hypothalamic lesions makes it a promising tool in the management of these conditions.
Areas covered: The aim of the present review article is to provide an overview of the mechanism of action and clinical experience of the use of oxytocin in different forms of obesity.
Expert opinion: Current evidence suggests a potential role of oxytocin in the treatment of obesity with different causes. Several challenges remain: an improved understanding of the physiological regulation, mechanisms of action of oxytocin, and interplay with other endocrine axes is fundamental to clarify its role. Further clinical trials are needed to determine the safety and efficacy of oxytocin for the treatment of different forms of obesity. Understanding the mechanism(s) of action of oxytocin on body weight regulation might also improve our understanding of obesity and reveal possible new therapeutic targets - as well as promoting advances in other fields in which oxytocin might be used.
{"title":"Intranasal oxytocin as a treatment for obesity: safety and efficacy.","authors":"Roberta Balestrino, Marco Losa, Luigi Albano, Lina R Barzaghi, Pietro Mortini","doi":"10.1080/17446651.2023.2216794","DOIUrl":"10.1080/17446651.2023.2216794","url":null,"abstract":"<p><strong>Introduction: </strong>Known for its effect on labor and lactation and on emotional and social functions, oxytocin has recently emerged as a key modulator of feeding behavior and indeed suggested as a potential treatment for obesity. The potential positive effect of oxytocin on both metabolic and psychological-behavioral complications of hypothalamic lesions makes it a promising tool in the management of these conditions.</p><p><strong>Areas covered: </strong>The aim of the present review article is to provide an overview of the mechanism of action and clinical experience of the use of oxytocin in different forms of obesity.</p><p><strong>Expert opinion: </strong>Current evidence suggests a potential role of oxytocin in the treatment of obesity with different causes. Several challenges remain: an improved understanding of the physiological regulation, mechanisms of action of oxytocin, and interplay with other endocrine axes is fundamental to clarify its role. Further clinical trials are needed to determine the safety and efficacy of oxytocin for the treatment of different forms of obesity. Understanding the mechanism(s) of action of oxytocin on body weight regulation might also improve our understanding of obesity and reveal possible new therapeutic targets - as well as promoting advances in other fields in which oxytocin might be used.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9909052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-08-17DOI: 10.1080/17446651.2023.2248242
Tina Reinson, Ryan M Buchanan, Christopher D Byrne
Cancer is a leading cause of premature mortality in patients with type 2 diabetes mellitus (T2DM) [1] and T2DM is strongly associated with site-specific cancers including hepatocellular carcinoma (HCC) [2]. In 2020, 830,200 people died from HCC and the incidence of HCC is expected to increase by 55% in the next 20 years [3]. HCC is now the fastest growing indication for liver transplantation [4] and is predicted to become the third most common cause of cancer death worldwide by 2030 [5]. HCC has a very poor prognosis with a 5-year survival of just ~ 20%; however, if cases are identified at an early-stage, curative treatments are available which include surgical resection, liver transplant, or tumor ablation [6]. A major risk factor for the increasing numbers of HCC is the increasing global prevalence of T2DM [3,5,7]. T2DM is strongly associated with central obesity, insulin resistance (IR), and other features of the metabolic syndrome; and of these linked risk factors, IR in particular is strongly linked with the development of liver steatosis, inflammation, fibrosis, and liver cirrhosis. When insulin resistance is present, in the absence of excess alcohol consumption, it is most likely that NAFLD is responsible for the development of chronic liver disease. Importantly, patients with NAFLD-related cirrhosis have a risk of developing HCC at least similar to [8] that reported for patients with cirrhosis occurring from other etiologies. There is a high prevalence of all chronic liver diseases in people living with T2DM compared to the general population [9]. All stages of NAFLD occur with T2DM [10–13], and we now know that there is a bi-directional causality between NAFLD and T2DM [14,15]. A recent study of 561 patients from the United States showed a high prevalence of liver fibrosis and cirrhosis in patients with T2DM, leading to the authors advocating the need for screening [11]. This study showed that, in patients with T2DM, significant fibrosis was present in 6% and severe fibrosis or cirrhosis in 9% of patients [11]. NAFLD represents a spectrum of liver conditions that begins with hepatic steatosis and progresses to nonalcoholic steatohepatitis (NASH), liver fibrosis, and cirrhosis. Occasionally, hepatic steatosis occurs without changes in easily measured concentrations of liver enzymes such as alanine aminotransferase (ALT) that is commonly measured in primary care. However, it is important to recognize that increases in ALT concentration do not parallel the stages of liver disease and serum concentrations of ALT occurring within the laboratory normal range may occur in NAFLD. Sometimes patients with NAFLD may have ALT concentrations below laboratory upper limits of normal and consequently, people living with T2DM may have undiagnosed NAFLD. With that in mind, the American College of Gastroenterology (ACG) suggests that current upper limits of normal are too high and that there should be sex-specific thresholds for the upper limits of normal.
{"title":"Identification of individuals at risk of hepatocellular carcinoma: screening for clinically significant liver fibrosis in patients with T2DM.","authors":"Tina Reinson, Ryan M Buchanan, Christopher D Byrne","doi":"10.1080/17446651.2023.2248242","DOIUrl":"10.1080/17446651.2023.2248242","url":null,"abstract":"Cancer is a leading cause of premature mortality in patients with type 2 diabetes mellitus (T2DM) [1] and T2DM is strongly associated with site-specific cancers including hepatocellular carcinoma (HCC) [2]. In 2020, 830,200 people died from HCC and the incidence of HCC is expected to increase by 55% in the next 20 years [3]. HCC is now the fastest growing indication for liver transplantation [4] and is predicted to become the third most common cause of cancer death worldwide by 2030 [5]. HCC has a very poor prognosis with a 5-year survival of just ~ 20%; however, if cases are identified at an early-stage, curative treatments are available which include surgical resection, liver transplant, or tumor ablation [6]. A major risk factor for the increasing numbers of HCC is the increasing global prevalence of T2DM [3,5,7]. T2DM is strongly associated with central obesity, insulin resistance (IR), and other features of the metabolic syndrome; and of these linked risk factors, IR in particular is strongly linked with the development of liver steatosis, inflammation, fibrosis, and liver cirrhosis. When insulin resistance is present, in the absence of excess alcohol consumption, it is most likely that NAFLD is responsible for the development of chronic liver disease. Importantly, patients with NAFLD-related cirrhosis have a risk of developing HCC at least similar to [8] that reported for patients with cirrhosis occurring from other etiologies. There is a high prevalence of all chronic liver diseases in people living with T2DM compared to the general population [9]. All stages of NAFLD occur with T2DM [10–13], and we now know that there is a bi-directional causality between NAFLD and T2DM [14,15]. A recent study of 561 patients from the United States showed a high prevalence of liver fibrosis and cirrhosis in patients with T2DM, leading to the authors advocating the need for screening [11]. This study showed that, in patients with T2DM, significant fibrosis was present in 6% and severe fibrosis or cirrhosis in 9% of patients [11]. NAFLD represents a spectrum of liver conditions that begins with hepatic steatosis and progresses to nonalcoholic steatohepatitis (NASH), liver fibrosis, and cirrhosis. Occasionally, hepatic steatosis occurs without changes in easily measured concentrations of liver enzymes such as alanine aminotransferase (ALT) that is commonly measured in primary care. However, it is important to recognize that increases in ALT concentration do not parallel the stages of liver disease and serum concentrations of ALT occurring within the laboratory normal range may occur in NAFLD. Sometimes patients with NAFLD may have ALT concentrations below laboratory upper limits of normal and consequently, people living with T2DM may have undiagnosed NAFLD. With that in mind, the American College of Gastroenterology (ACG) suggests that current upper limits of normal are too high and that there should be sex-specific thresholds for the upper limits of normal.","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10017170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-09-08DOI: 10.1080/17446651.2023.2256841
Viola Trevisani, Lorenzo Iughetti, Laura Lucaccioni, Barbara Predieri
Introduction: Immune-checkpoint inhibitor therapy modulates the response of the immune system acting against cancer. Two pathways impacted by this kind of treatment are the CTLA4 and the PD-1/PD-L1 pathways. ICI therapy can trigger autoimmune adverse effects, known as immune-related Adverse Events (irAEs).
Areas covered: This review focuses on irAEs which affect the endocrine system. This review elucidates the pathways used by these drugs with a focus on the hypothetical pathogenesis at their basis. In fact, the pathophysiology of irAEs concerns the possibility of an interaction between cellular autoimmunity, humoral immunity, cytokines, chemokines, and genetics. The endocrine irAEs examined are thyroid dysfunctions, immune related-hypophysitis, diabetes, peripheral adrenal insufficiency, and hypoparathyroidism.
Expert opinion: There is still much to investigate in endocrine irAES of checkpoint inhibitors. In the future, checkpoint inhibitors will be increasingly utilized therapies, and therefore it is crucial to find the proper diagnostic-therapeutic program for irAEs, especially as endocrine irAEs are nonreversible and require lifelong replacement therapies.
{"title":"Endocrine immune-related adverse effects of immune-checkpoint inhibitors.","authors":"Viola Trevisani, Lorenzo Iughetti, Laura Lucaccioni, Barbara Predieri","doi":"10.1080/17446651.2023.2256841","DOIUrl":"10.1080/17446651.2023.2256841","url":null,"abstract":"<p><strong>Introduction: </strong>Immune-checkpoint inhibitor therapy modulates the response of the immune system acting against cancer. Two pathways impacted by this kind of treatment are the CTLA4 and the PD-1/PD-L1 pathways. ICI therapy can trigger autoimmune adverse effects, known as immune-related Adverse Events (irAEs).</p><p><strong>Areas covered: </strong>This review focuses on irAEs which affect the endocrine system. This review elucidates the pathways used by these drugs with a focus on the hypothetical pathogenesis at their basis. In fact, the pathophysiology of irAEs concerns the possibility of an interaction between cellular autoimmunity, humoral immunity, cytokines, chemokines, and genetics. The endocrine irAEs examined are thyroid dysfunctions, immune related-hypophysitis, diabetes, peripheral adrenal insufficiency, and hypoparathyroidism.</p><p><strong>Expert opinion: </strong>There is still much to investigate in endocrine irAES of checkpoint inhibitors. In the future, checkpoint inhibitors will be increasingly utilized therapies, and therefore it is crucial to find the proper diagnostic-therapeutic program for irAEs, especially as endocrine irAEs are nonreversible and require lifelong replacement therapies.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10173918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-11-28DOI: 10.1080/17446651.2023.2267672
Danae C Gross, C Ray Cheever, John A Batsis
Introduction: Sarcopenic obesity (SarcO) is defined as the confluence of reduced muscle mass and function and excess body fat. The scientific community is increasingly recognizing this syndrome, which affects a subgroup of persons across their lifespans and places them at synergistically higher risk of significant medical comorbidity and disability than either sarcopenia or obesity alone. Joint efforts in clinical and research settings are imperative to better understand this syndrome and drive the development of urgently needed future interventions.
Areas covered: Herein, we describe the ongoing challenges in defining sarcopenic obesity and the current state of the science regarding its epidemiology and relationship with adverse events. The field has demonstrated an emergence of data over the past decade which we will summarize in this article. While the etiology of sarcopenic obesity is complex, we present data on the underlying pathophysiological mechanisms that are hypothesized to promote its development, including age-related changes in body composition, hormonal changes, chronic inflammation, and genetic predisposition.
Expert opinion: We describe emerging areas of future research that will likely be needed to advance this nascent field, including changes in clinical infrastructure, an enhanced understanding of the lifecourse, and potential treatments.
{"title":"Understanding the development of sarcopenic obesity.","authors":"Danae C Gross, C Ray Cheever, John A Batsis","doi":"10.1080/17446651.2023.2267672","DOIUrl":"10.1080/17446651.2023.2267672","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenic obesity (SarcO) is defined as the confluence of reduced muscle mass and function and excess body fat. The scientific community is increasingly recognizing this syndrome, which affects a subgroup of persons across their lifespans and places them at synergistically higher risk of significant medical comorbidity and disability than either sarcopenia or obesity alone. Joint efforts in clinical and research settings are imperative to better understand this syndrome and drive the development of urgently needed future interventions.</p><p><strong>Areas covered: </strong>Herein, we describe the ongoing challenges in defining sarcopenic obesity and the current state of the science regarding its epidemiology and relationship with adverse events. The field has demonstrated an emergence of data over the past decade which we will summarize in this article. While the etiology of sarcopenic obesity is complex, we present data on the underlying pathophysiological mechanisms that are hypothesized to promote its development, including age-related changes in body composition, hormonal changes, chronic inflammation, and genetic predisposition.</p><p><strong>Expert opinion: </strong>We describe emerging areas of future research that will likely be needed to advance this nascent field, including changes in clinical infrastructure, an enhanced understanding of the lifecourse, and potential treatments.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10842411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41233604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-11-28DOI: 10.1080/17446651.2023.2272865
Julienne K Kirk, Clifford F Gonzales
Introduction: Patients undergoing surgery require a thorough assessment preoperatively. Hyperglycemia is associated with poor outcomes, and stability of glucose levels is an important factor in preoperative management. Diabetes presents a particular challenge since patients are often on multiple medications encompassing glycemic management and cardiovascular therapies.
Areas covered: A PubMed search of published data and reviews on preoperative approaches in diabetes was conducted. Consensus opinion drives most of the guidelines and recommendations for management of diabetes in surgical patients. Pathophysiology is often complex with varying levels of glucose and surgical stress. Establishing well-controlled diabetes prior to surgical intervention should be standard practice in non-emergent procedures. We review the best practices for implementing preoperative assessment, with diabetes with a focus on diabetes medications.
Expert opinion: The management of a patient preoperatively varies by region and country. Institutions differ in approaches to preoperative evaluation and the establishment of consistent approaches would provide a platform for monitoring patient outcomes. Multidisciplinary teams and pre-assessment clinics for preoperative evaluation can enhance patient care for those undergoing surgery.
{"title":"Preoperative considerations for patients with diabetes.","authors":"Julienne K Kirk, Clifford F Gonzales","doi":"10.1080/17446651.2023.2272865","DOIUrl":"10.1080/17446651.2023.2272865","url":null,"abstract":"<p><strong>Introduction: </strong>Patients undergoing surgery require a thorough assessment preoperatively. Hyperglycemia is associated with poor outcomes, and stability of glucose levels is an important factor in preoperative management. Diabetes presents a particular challenge since patients are often on multiple medications encompassing glycemic management and cardiovascular therapies.</p><p><strong>Areas covered: </strong>A PubMed search of published data and reviews on preoperative approaches in diabetes was conducted. Consensus opinion drives most of the guidelines and recommendations for management of diabetes in surgical patients. Pathophysiology is often complex with varying levels of glucose and surgical stress. Establishing well-controlled diabetes prior to surgical intervention should be standard practice in non-emergent procedures. We review the best practices for implementing preoperative assessment, with diabetes with a focus on diabetes medications.</p><p><strong>Expert opinion: </strong>The management of a patient preoperatively varies by region and country. Institutions differ in approaches to preoperative evaluation and the establishment of consistent approaches would provide a platform for monitoring patient outcomes. Multidisciplinary teams and pre-assessment clinics for preoperative evaluation can enhance patient care for those undergoing surgery.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01Epub Date: 2023-07-19DOI: 10.1080/17446651.2023.2237103
Russel J Reiter, Ramaswamy Sharma, Dun-Xian Tan, Gang Huang, Luis Gustavo de Almeida Chuffa, George Anderson
Introduction: Melatonin, originally isolated from the mammalian pineal gland, was subsequently identified in many animal cell types and in plants. While melatonin was discovered to inhibit cancer more than 5 decades ago, its anti-cancer potential has not been fully exploited despite its lack of serious toxicity over a very wide dose range, high safety margin, and its efficacy.
Areas covered: This review elucidates the potential mechanisms by which melatonin interferes with tumor growth and metastasis, including its ability to alter tumor cell metabolism, inhibit epithelial-mesenchymal transition, reverse cancer chemoresistance, function synergistically with conventional cancer-inhibiting drugs while limiting many of their side effects. In contrast to its function as a potent antioxidant in normal cells, it may induce oxidative stress in cancer cells, contributing to its oncostatic actions.
Expert opinion: Considering the large amount of experimental data supporting melatonin's multiple and varied inhibitory effects on numerous cancer types, coupled with the virtual lack of toxicity of this molecule, it has not been thoroughly tested as an anti-cancer agent in clinical trials. There seems to be significant resistance to such investigations, possibly because melatonin is inexpensive and non-patentable, and as a result there would be limited financial gain for its use.
{"title":"Melatonin modulates tumor metabolism and mitigates metastasis.","authors":"Russel J Reiter, Ramaswamy Sharma, Dun-Xian Tan, Gang Huang, Luis Gustavo de Almeida Chuffa, George Anderson","doi":"10.1080/17446651.2023.2237103","DOIUrl":"10.1080/17446651.2023.2237103","url":null,"abstract":"<p><strong>Introduction: </strong>Melatonin, originally isolated from the mammalian pineal gland, was subsequently identified in many animal cell types and in plants. While melatonin was discovered to inhibit cancer more than 5 decades ago, its anti-cancer potential has not been fully exploited despite its lack of serious toxicity over a very wide dose range, high safety margin, and its efficacy.</p><p><strong>Areas covered: </strong>This review elucidates the potential mechanisms by which melatonin interferes with tumor growth and metastasis, including its ability to alter tumor cell metabolism, inhibit epithelial-mesenchymal transition, reverse cancer chemoresistance, function synergistically with conventional cancer-inhibiting drugs while limiting many of their side effects. In contrast to its function as a potent antioxidant in normal cells, it may induce oxidative stress in cancer cells, contributing to its oncostatic actions.</p><p><strong>Expert opinion: </strong>Considering the large amount of experimental data supporting melatonin's multiple and varied inhibitory effects on numerous cancer types, coupled with the virtual lack of toxicity of this molecule, it has not been thoroughly tested as an anti-cancer agent in clinical trials. There seems to be significant resistance to such investigations, possibly because melatonin is inexpensive and non-patentable, and as a result there would be limited financial gain for its use.</p>","PeriodicalId":12107,"journal":{"name":"Expert Review of Endocrinology & Metabolism","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9856914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}