Current Medicinal Chemistry - Online First

Ischemic Stroke (IS) represents the most prevalent subtype of cerebrovascular disease, characterized by complex pathophysiological mechanisms that remain inadequately characterized, particularly concerning mitochondrial dysfunctions. These mitochondrial impairments are increasingly recognized as contributory factors in IS pathogenesis, emphasizing the need for further investigation into the underlying molecular mechanisms involved.

In this study, we integrated transcriptomic datasets from the Gene Expression Omnibus (GEO) with the comprehensive MitoCarta3.0 mitochondrial proteome inventory to elucidate the role of dysregulated Mitochondrial-Related Genes (MRGs) in IS. We employed an advanced bioinformatics and machine learning pipeline, incorporating differential expression profiling alongside network-based prioritization using CytoHubba. Rigorous feature selection was conducted through LASSO regression, Support Vector Machine (SVM), and Random Forest (RF) algorithms to derive a robust core MRG signature. Our methodology included training and validation cohorts to construct diagnostic models, which were critically evaluated via Receiver Operating Characteristic (ROC) curves, nomograms, and calibration analyses.

Our analysis identified a seven-gene signature comprising DNAJA3, ACSL1, HSDL2, ECHDC2, ECHDC3, ALDH2, and PDK4, which demonstrated significant correlation with activated CD8⁺ T-cell and natural killer cell infiltration. Furthermore, integrative network analyses revealed intricate regulatory interactions among MRGs, microRNAs, and transcription factors. Notably, drug-target predictions indicated Bezafibrate as a promising therapeutic agent for modulating mitochondrial homeostasis in the context of IS.

These findings offer a novel framework for ischemic stroke diagnosis and therapy, yet their computational derivation underscores the need for thorough experimental validation of MRGs and drug candidates, along with the integration of diverse clinical data to confirm their real-world applicability.

Our findings underscore mitochondrial dysfunction not only as a critical factor in IS pathogenesis but also as a viable therapeutic target. The identified MRG signature presents potential for clinical application in diagnostic and pharmacological strategies aimed at ameliorating ischemic injury. This study highlights the translational significance of systems biology approaches within cerebrovascular medicine, warranting further mechanistic exploration of mitochondrial-immune interactions in stroke pathology.

Neuroinflammation, primarily mediated by activated microglia, is a significant contributor to neurodegenerative diseases, such as Alzheimer's and Parkinson's disease. Quercetin (QCT), a dietary flavonoid, has demonstrated anti-inflammatory and neuroprotective properties; however, the detailed molecular mechanisms behind these effects remain unclear. This study aimed to investigate the anti-inflammatory actions of QCT, particularly focusing on its potential to suppress the activation of microglia and subsequent neuroinflammation.

BV2 microglial cells were stimulated with lipopolysaccharide (LPS) to induce an inflammatory response and were subsequently treated with various concentrations of QCT. Cell viability was assessed using the MTT assay. Levels of pro-inflammatory cytokines (IL-6, TNF-α) and nitric oxide (NO) were quantified through ELISA and Griess reaction methods, respectively. Western blot analysis was conducted to examine inducible nitric oxide synthase (iNOS), NF-κB, IκBα, and phosphorylated IκBα protein expressions. In silico approaches, including protein-protein interaction (PPI) network analysis and molecular docking, were employed to explore potential molecular mechanisms involving NF-κB signaling pathways.

Treatment with QCT significantly reduced the secretion of IL-6 (96%) and TNF-α (87%), as well as NO production (42%), in a dose-dependent manner. Western blot results demonstrated a marked reduction in iNOS expression and inhibition of NF-κB activation through reduced phosphorylation of IκBα following QCT treatment. Molecular docking indicated a strong binding affinity between QCT and IKKβ, suggesting inhibition of the NF-κB pathway.

The findings indicated QCT to exert potent anti-inflammatory effects in LPS-stimulated BV2 cells by modulating key proteins involved in the NF-κB signaling pathway. Specifically, the docking results implied QCT’s direct interaction with the catalytic subunit IKKβ, inhibiting IκBα phosphorylation and subsequent NF-κB activation. The results have been found to be consistent with previous literature, reinforcing QCT's role in reducing neuroinflammation through specific molecular targets and pathways. Further in vivo studies are necessary to validate the findings.

Quercetin effectively suppressed neuroinflammation in microglial cells through inhibition of the NF-κB signaling pathway, reducing levels of critical pro-inflammatory mediators. The outcomes have highlighted the potential of quercetin as a preventive nutraceutical for neurodegenerative diseases, necessitating future in vivo investigations to confirm its therapeutic efficacy.

Several pathological conditions, including glaucoma, malignant brain tumors, and renal, gastric, and pancreatic carcinomas, are commonly associated with carbonic anhydrase type II (CA-II). Additionally, CA-II plays a critical role in regulating bicarbonate concentration in the eyes. The inhibition of CA-II reduces aqueous humor production and thus lowers intraocular pressure associated with glaucoma.

This study aimed to synthesize potent CA-II inhibitors, 5-nitro-1H-benzo[d]imidazole-2(3H)-thione (5NBIT) and acylhydrazone derivatives (1-13).

In this study, a new series of potent CA-II inhibitors, 5-nitro-1H-benzo[d]imidazole-2(3H)-thione (5NBIT) and acylhydrazone derivatives (1-13), were synthesized and characterized by IR, NMR, UV and mass spectroscopy and evaluated against bovine carbonic anhydrase-II (bCA-II).

Interestingly, most of the compounds showed better inhibition than the standard drug, acetazolamide (IC50: 18.2±0.51 µM), such as compounds 1 (IC50: 10.5±0.81 µM), 2 (IC50: 11.3±0.36 µM), 3 (IC50: 16.5±0.53 µM), 4 (IC50: 15.8±1.02 µM), 5 (IC50: 13.7±1.03 µM), and 9 (IC50: 12.2±1.03 µM). Among the synthesized compounds, compound 7 (IC50: 8.2±0.32 µM) exhibited the highest and compound 6 (IC50: 27.6±0.39 µM) showed the lowest inhibition. Structure-activity relationships suggest that the presence of nitro group on the phenyl ring contributed significantly to the overall inhibitory activity. Molecular docking of all the active compounds was performed to predict their binding behavior, which indicated good agreement between docking and experimental findings. Moreover, the MD simulation of compound 7 also showed excellent binding behavior and binding energy within the binding cavity of bCA-II.

These findings suggest that the synthesized 5NBIT and acylhydrazone derivatives exhibited potent CA-II inhibition, with several compounds outperforming the standard drug acetazolamide. These results provide valuable insights for the development of novel CA-II inhibitors with potential therapeutic applications in glaucoma and other related conditions.

Diffuse large B-cell lymphoma (DLBCL) pathogenesis is poorly understood, with limited causal evidence linking circulating inflammatory proteins (CIPs) and metabolites to disease risk. Observational studies face challenges from confounding and reverse causation, while existing Mendelian Randomization (MR) analyses lack bidirectional designs and multi-omics integration.

A bidirectional two-sample MR design was applied using inverse-variance weighting (IVW). Genetic instruments for 91 CIPs derived from Olink proteomic data (14,824 participants). DLBCL genetic associations (1,050 cases; 314,193 controls) were obtained from FinnGen (R10 release). Data for 1,091 blood metabolites and 309 metabolite ratios were sourced from the GWAS Catalog.

Ten CIPs exhibited causal effects on DLBCL. Risk-increasing proteins included: IL-10 (OR=1.46, 95%CI=1.05-2.03), TSLP (1.37,1.01-1.84), IL-17C (1.34,1.05-1.72), NRTN (1.30,1.02-1.66), OPG (1.29,1.01-1.66), and MCP1 (1.26,1.04-1.52). Protective proteins included: CD40 (0.82,0.67-1.00), CXCL9 (0.78,0.61-0.98), CD5 (0.77,0.61-0.97), and MCP3 (0.76,0.58-0.99). Reverse causation was absent for 7 proteins. Mediation analysis revealed 17.2% (p=0.048) of CD5’s protective effect was mediated by 1-methylhistidine.

These findings establish CIPs as causal factors in DLBCL pathogenesis and identify metabolite-mediated pathways as novel mechanistic links. The bidirectional design and multi-omics integration overcome key limitations of prior research, though statistical power for some mediation tests was limited by metabolite GWAS sample sizes.

Plasma inflammatory proteins causally influence DLBCL risk, partially mediated by metabolites. This underscores metabolite pathways as potential targets for therapeutic intervention.

Klotho is a multifunctional protein with anti-aging properties that plays a role in regulating vitamin D and phosphate metabolism. Sarcopenia is characterized by the loss of muscle mass and strength and is an important public health concern due to its negative effects on health. The aim of this study was to investigate the association between α-Klotho levels and the frequency of sarcopenia in a diverse population.

This study analyzed data from 1,250 participants in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. Participants were divided into four subgroups based on serum α-Klotho levels. Sarcopenia was assessed using skeletal muscle index and handgrip strength measurements. Multivariable logistic regression analysis was used to determine the association between serum α-Klotho levels and sarcopenia.

There was a significant difference in serum α-Klotho levels between patients with sarcopenia and patients without sarcopenia. In an unadjusted multivariable logistic regression model, higher α-Klotho serum levels were associated with a lower risk of sarcopenia (p < 0.05). This trend was maintained in the partially adjusted model, indicating that higher levels of α-Klotho were associated with a lower risk of sarcopenia. However, the fully adjusted model did not show significance.

Several factors significantly influence the relationship between serum α-Klotho levels and sarcopenia, including sex, ethnicity, alcohol consumption, body mass index (BMI), vitamin D levels, and disease status. Our findings indicate that the risk of sarcopenia is elevated in individuals within the lowest quartile of serum α-Klotho levels. Furthermore, a negative correlation exists between α-Klotho levels and grip strength, observed in both the overall sample and the aging-related subgroup. These results highlight the necessity for further investigation into the complex interplay between α-Klotho and grip strength, particularly in the context of sarcopenia associated with renal disease.

Serum α-Klotho levels in different populations are negatively correlated with the risk of sarcopenia, suggesting that α-Klotho may be involved in the occurrence and development of sarcopenia. Therefore, measuring α-Klotho levels in clinical practice may be a valuable diagnostic tool to identify individuals at high risk of developing sarcopenia.

Hepatocellular Carcinoma (HCC) exhibits high recurrence rates, particularly when accompanied by Microvascular Invasion (MVI). We identified MVI-related biomarkers and established a prognostic model for personalized HCC treatment.

Data were downloaded from The Cancer Genome Atlas (TCGA) and HCCDB databases. Key radiomics features were identified using the support vector machine-recursive feature elimination (SVM-RFE) algorithm, and differential expression analysis was performed with DESeq2. This was followed by functional enrichment analysis using the clusterProfiler package. Through univariate and Lasso regression analyses, we constructed a robust RiskScore model to effectively stratify HCC patients into distinct risk groups based on the median RiskScore value. The model prediction performance was evaluated using ROC curves and Kaplan-Meier (KM) analysis. We used the CIBERSORT algorithm to characterize immune cell infiltration patterns and conducted GSEA to identify differentially activated pathways between the risk groups.

Radiomic analysis revealed four significant features strongly associated with MVI, enabling the construction of a nomogram model with robust classification performance (AUC = 0.742). Subsequent analysis identified 241 overlapping MVI-related Differentially Expressed Genes (DEGs) enriched in critical tumor proliferation and invasion pathways. A 10-gene RiskScore model was developed, demonstrating excellent prognostic discrimination in training and validation cohorts. CIBERSORT analysis revealed significant correlations between specific immune cell infiltration and the 10 genes. GSEA analysis showed significant enrichment of cell cycle regulation pathways in the high-risk group, suggesting their important role in MVI.

The RiskScore was established using MVI-related features for prognosis assessment in HCC.

Our findings provided novel biomarkers and a theoretical basis for the early diagnosis and personalized treatment of HCC.

To identify the critical genes, biological mechanisms, and signaling pathways involved in the therapeutic effects of quercetin on diabetic foot ulcers using network pharmacology and molecular docking approaches.

We identified pathological targets of diabetic foot ulcers (DFU) from GeneCards, OMIM, and TTD, and pharmacological targets of quercetin from STP, TCMSP, and PharmMapper. Intersection analysis revealed potential therapeutic targets. Core targets were determined via GO/KEGG enrichment, PPI network construction, and Cytoscape screening algorithms (Degree, Closeness, Betweenness). Molecular docking and dynamics simulations assessed quercetin-core target interactions and binding affinity.

After screening and intersecting the targets of quercetin and diabetic foot ulcers, 236 genes related to quercetin's anti-diabetic foot ulcer effects were identified, with six key genes emerging as critical: SRC, TP53, MAPK1, JUN, HSP90AA1, and AKT1. Enrichment analysis suggested that quercetin may modulate inflammatory imbalance(HSP90AA1), immunosuppression(JUN), and oxidative stress(SRC, TP53, MAPK1, and AKT1) during diabetic foot ulcer progression.

The relationship between these core targets and biological pathways in diabetic foot ulcers requires further experimental validation. Notably, molecular docking and dynamics simulation results confirmed strong binding affinity between quercetin and the core targets, supporting their potential therapeutic relevance.

Quercetin exerts anti-diabetic foot ulcer effects by regulating SRC, TP53, MAPK1, JUN, HSP90AA1, and AKT1. These hub genes may serve as promising candidates for future therapeutic interventions in diabetic foot ulcers.

Chronic Renal Failure (CRF) is a progressive disease that severely affects patients' quality of life, but its current treatment options remain limited. This study explores the potential mechanism of Eriobotryae Folium (EF) in treating CRF by targeting ferroptosis.

Active compounds and targets of EF were identified through multiple databases (TCMSP, SwissTargetPrediction, UniProt, GeneCards, DrugBank). Using Cytoscape and STRING, both a compound-target network and a PPI network were generated. GO and KEGG analyses were conducted to explore relevant biological functions and pathways. The binding affinity and stability between critical compounds and target proteins were investigated through molecular docking and Molecular Dynamics (MD) simulations.

Eighteen active compounds and 366 targets of EF were identified, along with 1,267 CRF-related and 1,673 ferroptosis-related targets, with 40 overlapping genes. PPI analysis highlighted AKT1, EGFR, HIF1A, SRC, and ESR1 as key targets. The KEGG analysis indicated MAPK and HIF-1 pathways as major regulatory pathways. Molecular docking suggested quercetin, ellagic acid, and oleanolic acid as potential active compounds, with EGFR and SRC as promising targets. MD simulations confirmed strong and stable binding, especially for EGFR-ellagic acid (-21.38 kcal/mol) and EGFR-oleanolic acid (-24.02 kcal/mol).

This study suggests that EF treats CRF by targeting ferroptosis-related pathways and key proteins, such as EGFR and AKT1. MAPK and HIF-1 signaling pathways further substantiate its significant role in disease regulation.

EF may regulate ferroptosis through multiple targets and pathways, offering potential therapeutic benefits for CRF. The findings offer foundational insights for subsequent research and therapeutic development.

Diabetes mellitus, a chronic metabolic disorder characterized by elevated blood glucose levels, has emerged as a significant global health burden. Chronic inflammation and insulin resistance are central to the pathogenesis of non-insulin-dependent (type 2) diabetes mellitus. PTGS2 (prostaglandin-endoperoxide synthase 2) has been implicated in inflammatory pathways associated with diabetic complications, making it a potential therapeutic target.

Advanced computational methodologies were employed to identify potential natural compounds with anti-diabetic activity. Techniques included network pharmacology to establish compound-target-pathway relationships and in silico molecular docking to evaluate binding affinity and interaction profiles of selected phytochemicals with PTGS2.

PTGS2 and its downstream prostaglandin pathways were strongly associated with diabetic inflammation and insulin resistance. Molecular docking identified Corytuberine and Nuciferine as having high binding affinities with PTGS2. Network pharmacology analysis confirmed Nuciferine’s connection to PTGS2, supporting its role as a bioactive agent targeting diabetes-related inflammatory processes.

The findings suggest that PTGS2 contributes to the progression of insulin resistance and chronic inflammation in type 2 diabetes. Targeting this enzyme with bioactive compounds such as Nuciferine may offer therapeutic benefits. However, translational studies and clinical trials are essential to validate these computational predictions and assess safety and efficacy in vivo.

Nuciferine exhibits promising potential in modulating PTGS2 activity and improving insulin sensitivity. Continued research and clinical validation are needed to confirm its efficacy and support the development of novel anti-diabetic therapies targeting inflammatory pathways.

Chemotherapy remains essential despite advances in immunotherapy, radiotherapy, and biological therapy. However, the wide range of chemical drugs is limited by a narrow therapeutic index, low selectivity, and the development of resistance. In this regard, new high-efficiency drugs are in extremely high demand. The indazole moiety, a scaffold found in many biologically active compounds, was selected for use in new drug design.

Six new indazole derivatives were synthesized via Suzuki-Miyaura coupling starting from bromoindazole. Their antiviral (against influenza A and SARS-CoV-2), antibacterial (against M. tuberculosis), and antiproliferative activities (against neuroblastoma, glioma, leukemia cell lines) were evaluated in vitro. Acute toxicity was assessed in mice of both sexes via single intragastric administration, with toxicometric parameters and pathomorphological changes studied.

6-(1H-pyrazol-4-yl)-1H-indazole (8) suppressed the reproduction of the influenza virus at non-toxic doses to the MDCK cells and showed cytotoxicity against cancer cell lines, with an IC50 between 4 and 14 µM. However, it exhibited significant acute toxicity in mice (LD50 40 mg/kg), causing systemic organ damage.

Derivative 8 demonstrated promising antiviral and antiproliferative activities but exhibited considerable acute toxicity in vivo. The antiviral efficacy, although lower than oseltamivir, is meaningful and justifies further optimization and investigation. Its antibacterial activity against M. tuberculosis adds to its potential as a multifunctional agent.

While derivative 8 has shown potential as an antiviral and anticancer agent, its high toxicity highlights the need for further studies to define a safe and effective therapeutic window. Overall, the indazole scaffold remains a valuable platform for the development of new therapeutic compounds.

This paper provides a comprehensive review examining the application of copper radionuclides, particularly ⁶⁴Cu, in the diagnosis and potential therapy of various brain diseases.

Two researchers conducted an independent search of the PubMed and Web of Science databases for original research articles published in English. Following a screening process based on titles and abstracts, 42 publications reporting the use of copper radionuclides for diagnosing or treating brain diseases were selected for this review.

The analysis revealed that several copper isotopes, namely 60 Cu, 61 Cu, 62 Cu, ⁶⁴Cu, and ⁶⁷Cu, have been explored for diagnostic or therapeutic purposes in conditions including Alzheimer’s disease, Wilson’s disease, brain tumors, and traumatic brain injury. The isotopes 60 Cu, 61 Cu, and 62 Cu were primarily associated with diagnostic uses. In contrast, ⁶⁴Cu and ⁶⁷Cu were identified as having potential for both diagnosis and therapy (theranostic). Furthermore, the availability of ⁶⁴Cu was noted to be better compared to ⁶⁷Cu.

⁶⁴Cu radionuclides are frequently employed in imaging techniques for brain pathologies. While their role in radiographic applications is prominent, the therapeutic potential of ⁶⁴Cu is currently underdeveloped, and current evidence is primarily derived from preclinical studies, highlighting the critical need for clinical trials to validate ⁶⁴Cu’s efficacy and safety as a theranostic agent in neurological conditions.

⁶⁴Cu holds significant potential for both diagnosis and therapy of various brain diseases. Continued research and development in this area are crucial to unlock its full therapeutic potential and improve patient outcomes.

Idiopathic pulmonary fibrosis (IPF) is a kind of interstitial lung disease with a poor prognosis. Even though genome-wide association studies (GWAS) have identified numerous loci linked to IPF risk, the underlying causal genes and biological processes are still mostly unknown.

The IPF GWAS summary data included 4,125 cases, 20,464 controls from five cohorts. The weight file and related files for transcriptome association studies (TWAS) of plasma protein, multi-tissues, cross-tissue, and single-cell were obtained from Zhang’s study, Mancuso lab, GTExV8 database, and Thompson’s study, respectively. We conducted TWAS employing functional Summary-based Imputation (FUSION) from four levels, which were plasma protein, multiple tissues, cross-tissue, and single cell. Conditional and joint (COJO) analysis and multi-marker analysis of genomic annotation (MAGMA) analysis were used to validate the above results. Summary-data-based Mendelian randomization (SMR) and Bayesian co-localization analysis were utilized to explain the causal association between selected genes and the risk of IPF.

A total of 12, 361, 1187, and 72 genes were calculated from the four dimensions of TWAS. TOLLIP, GCHFR, ZNF318 TALDO1, CD151, and AP4M1 were selected by intersecting the results of the four sets of genes. GCHFR, TALDO1, CD151, and AP4M1 were verified by COJO analysis and MAGMA analysis. SMR and colocalization analyses identified GCHFR as the most significant gene for IPF.

We have applied the TWAS approach to identify novel therapeutic targets for IPF in multiple dimensions. Further biological testing will be required in future studies to validate our findings.

In summary, we carried out an extensive TWAS that integrated four dimensions: plasma protein, multiple tissues, cross-tissue, and single cell. GCHFR was identified as the most significant gene for IPF in this study.

Cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC) are major gynecological malignancies, causing significant cancer-related deaths in women. Current treatments yield poor outcomes, with a 5-year survival rate of only 17%. Identifying new biomarkers and therapeutic targets is crucial for improving prognosis and guiding personalized treatments.

We analyzed TCEAL2 expression using data from The Cancer Genome Atlas (TCGA) across various cancers, including CESC. We explored its correlation with clinical features, prognosis, immune infiltration, MSI, mRNAsi, and drug sensitivity. TCEAL2 expression was validated in GSE9750 datasets and CESC cell lines using qRT-PCR.

TCEAL2 expression was significantly dysregulated in CESC. Elevated TCEAL2 levels correlated with poor clinical outcomes, including advanced pathological M stage (p = 0.009), initial treatment failure (p = 0.0098), and reduced overall survival (OS) (p = 0.013). TCEAL2 was an independent predictor of unfavorable OS (p = 0.032). It was associated with key pathways such as calcium signaling, oxidative phosphorylation, and Wnt signaling. TCEAL2 also correlated with immune cell infiltration, MSI, and mRNAsi. Notably, TCEAL2 levels inversely correlated with sensitivity to several drugs, including CAY10603 and SB-223133.

The results suggest that TCEAL2 plays a significant role in CESC progression and its tumor microenvironment. Its correlation with immune infiltration and drug sensitivity highlights its potential as a prognostic biomarker and therapeutic target. Future studies should focus on elucidating the molecular mechanisms and validating their clinical utility.

TCEAL2 is a potential prognostic biomarker and therapeutic target in CESC. Further research is needed to explore its role and clinical applications.

Sodium Selenite (NaSe) is a molecule with various biological activities. Bone fractures and osteoporotic diseases are increasingly common health issues, prompting the search for alternative treatments. Therefore, the purpose of this study was to examine the antioxidant and osteogenic properties of NaSe.

The experiments were conducted using the hFOB1.19 osteoblast cell line. The MTT assay was used to assess the effects of NaSe on cell viability, while cytotoxicity was evaluated with Lactate Dehydrogenase (LDH) assays. Osteogenic differentiation was assessed by alizarin red staining, and Alkaline Phosphatase (ALP) activity and intracellular Reactive Oxygen Species (ROS) levels were also analyzed.

The results showed that NaSe significantly enhanced cell viability in a dose-dependent manner at low doses (0.01-1μM), with the most effective dose being 1μM (p<0.05). LDH activity remained similar to the control within the 0.01-1μM range but increased significantly at higher concentrations (5-50 μM) in both 24- and 48-hour experiments (p<0.05). NaSe reduced intracellular ROS levels significantly between 0.01-1 μM, with 1 μM being the most effective concentration (p<0.05). The highest ALP activity was observed at 0.1 μM NaSe (p < 0.05), and calcium deposition increased in a concentration-dependent manner (p<0.05). The most effective dose for enhancing mineralization was 0.1 μM (p<0.05).

This study demonstrates that NaSe has antioxidant and osteogenic effects at low doses in hFOB cells. These positive effects suggest that NaSe could be a promising candidate for in-vitro, in-vivo, and clinical trials, providing hope for new treatments for bone diseases.

One of the most effective osteoanabolic drugs for treating osteoporosis is romosozumab, which was developed as a consequence of growing knowledge of the Wnt signaling system. This review explored how romosozumab affects the bone mineral density (BMD) in osteoporotic patients.

Up until January 2024, PubMed, Web of Science, and Scopus were reviewed for any randomized controlled trials (RCTs) evaluating the impact of osteoporotic treatment with romosozumab on BMD changes and bone metabolism markers in primary osteoporosis patients. Pooled Hedges’ g indices, which were consistently used across all included studies to measure standardized mean differences, were computed along with their corresponding 95% confidence intervals using either a random-effects or fixed-effects model.

Out of the 1855 papers, 24 RCTs met the inclusion criteria. Patients with osteoporosis who received romosozumab for a period of time demonstrated an augmentation in their lumbar spine BMD. The study findings indicated that the total hip and femoral neck BMD demonstrated significant enhancement in 22 (out of 23) and 19 (out of 21) studies, respectively.

In patients with osteoporosis, romosozumab could markedly increase the total hip, lumbar spine, and femoral neck BMD. This finding could be verified by measuring bone turnover indicators such as PINP, TRACP-5b, and CTX.

Low back pain (LBP) and sciatica are among the most prevalent musculoskeletal disorders, leading to significant disability and an economic burden. Neurotrophic factors, including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and glial cell-derived neurotrophic factor (GDNF), play critical roles in pain modulation and neuronal function. While NGF-targeting monoclonal antibodies have shown potential in treating chronic pain, their efficacy and safety remain under debate. This study employs Mendelian Randomization (MR) to assess the causal relationships between NGF, BDNF, GDNF, and the risk of LBP and sciatica.

We conducted a two-sample MR analysis using genetic instruments for NGF, BDNF, and GDNF. LBP and sciatica data were obtained from FinnGen. The inverse variance weighted (IVW) method was applied as the primary causal estimation, with the weighted median (WM) and MR-Egger regression used for sensitivity analyses. Reverse MR was performed to evaluate bidirectional causality. Furthermore, we used expression quantitative trait loci (eQTLs) within 50 kb of each gene locus as genetic instruments for NGF regulation, ensuring that the genetic variants used directly influence neurotrophic factor expression.

MR analysis revealed a significant causal association between NGF and an increased risk of LBP (OR = 1.121, 95% CI 1.021-1.230, p = 0.016) and sciatica (OR = 1.158, 95% CI 1.034-1.296, p = 0.010), while BDNF and GDNF showed no significant associations with pain outcomes. Sensitivity analyses confirmed the robustness of the NGF findings, with no evidence of horizontal pleiotropy or heterogeneity. Reverse MR analysis showed no significant causal effect of LBP or sciatica on NGF levels (p > 0.05), ruling out reverse causality. Additionally, we investigated the NGF-eQTL, which captures genetically regulated NGF expression, and found a significant association between the NGF-eQTL and LBP (OR = 1.040, 95% CI 1.010-1.070, p = 0.007). Unlike external NGF measurements, the NGF-eQTL minimizes environmental confounding and reverse causation, providing stronger genetic evidence supporting NGF as a therapeutic target for LBP.

Our findings provide strong genetic evidence that nerve growth factor (NGF) plays a causal role in the development of low back pain and sciatica, supporting NGF inhibition as a promising therapeutic strategy. These results align with clinical observations where anti-NGF monoclonal antibodies demonstrated pain-relieving effects, though safety concerns remain. In contrast, no causal associations were observed for BDNF or GDNF, underscoring the specificity of NGF in peripheral pain sensitization. The study demonstrates the value of Mendelian Randomization in minimizing confounding and reverse causation, thereby strengthening causal inference. Future work should focus on pharmacogenomic predictors to identify patients most likely to benefit from NGF-targeted interventions while minimizing adverse effects.

This study provides genetic evidence that NGF plays a causal role in LBP and sciatica, reinforcing its potential as a therapeutic target. However, BDNF and GDNF were not significantly associated with pain outcomes, suggesting distinct mechanisms of pain modulation. While clinical trials of anti-NGF monoclonal antibodies have demonstrated efficacy in pain reduction, concerns about adverse effects, such as joint degeneration, habe limited their widespread clinical use. Future research should explore genetic predictors of anti-NGF therapy response to optimize treatment strategies for LBP and related musculoskeletal pain disorders.

Many medications associated with an increased risk of dementia do not have adequate warning labels, leading to a significant underestimation of their potential dangers. This study aims to leverage the FAERS database to identify drugs strongly linked to dementia and to examine the relationship between these drugs using Mendelian randomization techniques. The ultimate goal is to mitigate the risk of developing dementia.

We utilized the FAERS database to identify medications significantly associated with dementia cases. The DrugBank, OpenTargets, and STITCH databases were employed to pinpoint the target genes of these drugs. We then conducted Mendelian randomization analysis to explore the correlation between the expression of drug target genes and the incidence of dementia. Additionally, a time-to-onset analysis assessed the temporal relationships of drug ingestions. Furthermore, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Protein-Protein Interaction Network (PPI) analyses were performed to investigate the molecular pathways linked to target genes related to drugs associated with dementia.

A total of 28,139 dementia events were recorded in the FAERS database. Our Mendelian randomization analysis revealed a significant association between the expression of all identified drug target genes and dementia in both blood and brain tissues. Specifically, we identified nine drug target genes with significant correlations, implicating quetiapine, clozapine, valproic acid, alendronate, and digoxin as being strongly associated with dementia, which could provide insight into areas of clinical concern regarding dementia occurrence.

The adverse event data sourced from the FAERS database indicate that certain medications are associated with an increased risk of developing dementia, a finding corroborated by our Mendelian randomization analysis. Establishing a comprehensive monitoring and risk assessment program is crucial for identifying high-risk individuals and facilitating informed medication choices, thereby potentially reducing the incidence of dementia.