Diabetes is associated with a higher burden and heterogeneous phenotypes of plaque calcification, which may influence plaque stability and cardiovascular risk. This review examines diabetic plaque calcification as a dynamic process driven by hyperglycemia and other metabolic disturbances through downstream mechanisms including inflammation, apoptosis, matrix vesicles, and osteogenic transdifferentiation. It highlights the importance of multidimensional imaging assessment beyond calcification burden and discusses current therapeutic limitations and future research directions.
Neurons were long thought to depend primarily on glucose metabolism for ATP production. However, recent findings from three laboratories show neurons metabolise long-chain fatty acids as alternative fuel. Here, we highlight emerging evidence on the neutral lipid lipase DDHD2 and mechanisms enabling fatty acid mobilisation and oxidation in neurons. These advances reshape our understanding of neuronal bioenergetics and reveal an unexpected flexibility in how the brain can be fuelled.
GLP1 receptor agonists (GLP-1RAs) have transformed obesity treatment, but their impact on neuropsychiatric outcomes remains poorly understood. We conducted an observational study of 63,215 patients with preexisting neuropsychiatric conditions and evaluated 24 incident neuropsychiatric outcomes following treatment initiation. In propensity-matched analyses, semaglutide was associated with broadly lower neuropsychiatric event risk over two years compared with metformin, SGLT2 inhibitors, and DPP-4 inhibitors. Within the semaglutide-treated cohort, higher attained dose during the first two years after treatment initiation ("pre-landmark period") was associated with significantly lower incidence during the subsequent two years ("post-landmark period") of substance-related disorders (P < 0.001), mood disorders (P < 0.001), anxiety- and stress-related disorders (P < 0.001), central nervous system (CNS) atrophies (P < 0.001), neuromuscular disorders (P = 0.013), eating/sleep/behavioral disorders (P = 0.022), and personality/impulse-control disorders (P = 0.028). Consistent with prior clinical trials, the post-landmark incidence of dementia or CNS degenerative diseases was similar between the high-dose and low-dose semaglutide cohorts (P = 0.15). For most neuropsychiatric diagnoses, post-landmark incidence was strongly associated with the maximum attained dose. In contrast, incident cognitive symptoms and speech/language symptoms were more closely associated with weight loss (p < 0.001 and p < 0.003, respectively). Bulk and single-cell transcriptomic analyses identified low-level, regionally restricted GLP1R transcript signals in central and peripheral nervous system tissues, providing hypothesis-generating context for future experimental investigation. Together, these findings support an association between semaglutide exposure and multiple neuropsychiatric outcomes, and motivate prospective mechanistic and clinical studies.
Incretin-based therapies are increasingly used for obesity management, raising debate about whether they could challenge or replace metabolic bariatric surgery (MBS). Here, we compare evidence for both treatments, focusing on effectiveness, limitations and costs. We also explore how obesity care pathways may evolve and highlight key evidence gaps that must be addressed to define the future roles of incretin-based therapies and MBS in obesity management.
Sotagliflozin (SOTA), a dual sodium-glucose cotransporter (SGLT)1/2 inhibitor, improves cardiovascular outcomes in patients with diabetes and heart failure, yet the metabolic mechanisms underlying these benefits remain incompletely defined. As a model of type 2 diabetes, db/db mice were treated with SOTA (5 mg/kg/day) in drinking water for 4 weeks. Cardiac metabolism was assessed using LC-MS/MS, cardiac function by echocardiography, and susceptibility to ischemia/reperfusion injury in Langendorff-perfused hearts. Systemic metabolism was characterised by plasma biochemical profiling and 1H NMR spectroscopy of peripheral tissues. db/db mice exhibited obesity, hyperglycaemia, hyperinsulinaemia, and diastolic dysfunction, alongside perturbed cardiac and systemic metabolism. SOTA treatment improved hyperglycaemia, ventricular function and cardiac metabolomic profile without correcting obesity or insulin resistance. In the heart, SOTA partially restored glycolytic intermediates and improved bioenergetics, whereas systemic metabolic abnormalities largely persisted. These findings suggest dual SGLT1/2 inhibition induces selective cardiac metabolic remodelling in diabetic cardiomyopathy independent of global metabolic correction.
Metabolically dysfunction-associated steatotic liver disease (MASLD) constitutes a major health burden. Whether a multidomain profile of modifiable health, as captured by Life’s Crucial 9 (LC9), is associated with major complications in MASLD, and which plasma proteins underlie these associations, remains unclear. We evaluated LC9 in 59,433 individuals with MASLD, including 6,354 with plasma proteomic data. During a median follow-up of 13.8 years, participants in the highest versus lowest LC9 tertile had lower risks of major adverse cardiovascular events (HR 0.62), major adverse liver outcomes (HR 0.62), chronic kidney disease (HR 0.54), chronic respiratory disease (HR 0.63), all-cause mortality (HR 0.67), and cardiovascular mortality (HR 0.55). LC9 modestly improved discrimination for incident complications, but not materially for mortality. Proteomic analyses identified candidate mediators shared across outcomes, including FABP4 and HAVCR1. Our findings suggest LC9 provides a multidomain framework for MASLD risk stratification, offering candidate protein signatures for future mechanistic evaluation.
Toll-like receptor 2 (TLR2) is an innate immune receptor linked to obesity primarily via NF-κB activation. Using a mouse model of overnutrition and in vitro TLR2 stimulation of human peripheral blood mononuclear cells, we show that lipids, advanced glycation end products, and low-density lipoproteins extend TLR2 signaling beyond NF-κB to promote Type I IFN production and signaling, establishing the relevance of this pathway to human obesity. This response was abolished by pharmacologic inhibition of the receptor for advanced glycation end products, which recognizes glycated proteins and lipids. In vivo dietary reversal, metformin, and tirzepatide each reduced diet-induced inflammation, but differed in their metabolic effects: dietary reversal reduced weight gain and LDL, tirzepatide reduced weight without lowering LDL, and metformin exerted anti-inflammatory effects independent of weight or LDL. These findings identify TLR2-Type I IFN signaling as a feature of diet-induced inflammation and highlight the diverse immunomodulatory effects of weight-management therapies.
The liver is the principal organ responsible for maintaining systemic glucose homeostasis through the integrated regulation of gluconeogenesis, glycogenolysis, glycogenesis, and glycolysis. As fasting progresses and hepatic glycogen stores decline, gluconeogenesis becomes the dominant source of endogenous glucose production required to preserve euglycemia. This review summarizes the regulation of gluconeogenesis and discusses the clinical manifestations, diagnostic implications, and therapeutic relevance of gluconeogenic dysfunction across diverse disease states.
Reproductive success requires coordinated regulation of metabolism and inflammation across the ovary, uterus, and placenta. CD36 is a lipid transporter and innate immune receptor that couples fatty acid handling to lipid-inflammation crosstalk. We synthesize mechanistic evidence on how CD36 regulates oocyte competence, endometrial receptivity, and signaling at the maternal-fetal interface, and how its dysregulation contributes to gestational diabetes, preeclampsia, and pregnancy loss, suggesting CD36 as a therapeutic target.
Paraoxonases (PONs) are a family of three isozymes, PON1, PON2, and PON3, with lactonase and esterase enzymatic activities. These enzymes have been implicated in the pathophysiology of numerous disorders, including cancer, atherosclerosis, liver diseases, neurodegenerative conditions, and toxicities. Specifically, alterations in PONs, such as changes in gene expression, mRNA levels, protein abundance, and enzymatic activity, have been associated with a range of pathological conditions. PONs are primarily linked to these disorders through their antioxidant and detoxifying functions, although additional, yet unidentified, mechanisms may also contribute. A growing body of evidence indicates that modulating PON levels or activity of PONs may confer therapeutic benefit in the prevention, management, and treatment of certain diseases. Promising strategies include enzyme replacement therapy, drug repurposing, and genetic engineering techniques aimed at restoring or enhancing PON function. Moreover, PONs’ level and activity can be influenced by life-style factors and the microbiome, offering additional avenues for intervention. In this review, we propose that the modulation of PONs holds therapeutic and preventive potential, and we discuss the current and emerging strategies by which this may be achieved.
The upregulation of cyclooxygenase-2 (COX-2) and the subsequent production of prostaglandin E2 (PGE2) in synovial tissue are hallmarks of autoimmune arthritis, including rheumatoid arthritis (RA). While glucosamine (GlcN) derivatives modulate RA symptoms, their specific anti-inflammatory mechanisms in synovial fibroblasts (SFBs) are poorly understood. In this study, we evaluated the anti-inflammatory efficacy of various GlcN derivatives: glucosamine hydrochloride (GlcN-HCl), glucosamine sulfate (GlcN-S), glucosaminate (GlcNA), and N-acetylglucosamine (GlcNAc). GlcN-HCl and GlcN-S inhibited IL-1β-induced PGE2 release and the expression of COX-2 at both protein and mRNA levels, whereas GlcNA and GlcNAc exhibited no such inhibitory activity. Structure-activity relationship analysis using GlcN-HCl epimers revealed that whereas the C-4 epimer, galactosamine hydrochloride (GalN-HCl), retained potent anti-inflammatory effects, the C-2 epimer, mannosamine hydrochloride (ManN-HCl), showed significantly diminished bioactivity, highlighting the critical role of the C-2 stereochemical configuration in modulating inflammatory responses. Mechanistically, we demonstrated that GlcN-HCl-mediated COX-2 suppression occurs via epigenetic silencing rather than mRNA destabilization. GlcN-HCl treatment significantly reduced the enrichment of active chromatin marks, H3K27ac and H3K4me3, at the COX-2 promoter, whereas mRNA stability remained unaffected. Given that metabolic dysregulation is intrinsically linked to inflammatory pathogenesis, we characterized the metabolic profile of GlcN-HCl-treated SFBs. We found that GlcN-HCl triggers metabolic reprogramming of the polyol pathway by modulating the expression of AKR1B1 and sorbitol dehydrogenase (SORD), resulting in elevated intracellular sorbitol levels. Pharmacological inhibition of AKR1B1 effectively abrogated the anti-inflammatory effects of GlcN-HCl, indicating that polyol pathway activation is essential for its efficacy. We confirmed the evolutionary conservation of these findings in human SFBs, demonstrating the translational relevance of the GlcN-HCl-mediated metabolic and epigenetic axis. Our findings demonstrate that GlcN-HCl induces metabolic reprogramming of the polyol pathway in synovial fibroblasts, facilitating the epigenetic silencing of inflammatory mediators. This metabolic-epigenetic axis suggests a mechanistic rationale for pharmacological metabolic intervention in RA, shifting the therapeutic paradigm toward targeted reprogramming of synovial fibroblast metabolism.
Advances in artificial intelligence are transforming metabolic research, with predictive AI offering a growing capacity to integrate complex data and, in appropriate settings, anticipate disease trajectories or treatment responses. In this Comment, we discuss how AI tools can augment, rather than replace, traditional discovery approaches, highlight key challenges around data quality, bias, and interpretability, and outline future directions for productive collaboration between computational and experimental metabolism research.
CD59 is known as a membrane-bound regulator of the complement system that prevents the formation of the membrane attack complex on host cells. Here we report the metabolic consequences of CD59a knockout (KO) in mice fed a high-fat diet (HFD). Mice lacking CD59a were protected from the development of insulin resistance, glucose intolerance, hyperinsulinemia, obesity, and fatty liver. Mutants fed an HFD had elevated adiponectin levels and reduced leptin levels in plasma. Data from metabolic cages suggested decreased appetite and an increase in voluntary wheel activity in mutants. Liver transcriptome analysis showed a marked decrease of inflammatory and fibrotic pathways in CD59a KO mice on an HFD, and plasma and liver metabolomics were remarkably similar, indicating close correspondence between systemic and hepatic metabolic profiles. In conclusion, we uncover a noncanonical role of CD59a in the development of diet-induced insulin resistance, hyperinsulinemia, glucose intolerance, and obesity.
Phenyl sulfate (PS), a gut microbiota-derived metabolite implicated in the pathogenesis of diabetic kidney disease, is generated through microbial conversion of dietary tyrosine to phenol, followed by hepatic sulfation via SULT1A1. We developed an oral tyrosine challenge test (OTyCT) to phenotype individual PS-producing capacity. Forty-eight healthy adults underwent a standardized tyrosine load with serial plasma PS levels measured over 48 h using LC-MS. OTyCT revealed substantial interindividual variability of PS production independent of baseline PS levels, highlighting marked heterogeneity in host-microbiome metabolic interactions. Sixteen participants in the highest tertile of the incremental area under the curve of PS were defined as high-PS producers. High PS producers exhibited distinct gut microbial signatures despite comparable abundances of known phenol-biosynthetic genes and host SULT1A1 genotypes. These findings suggest that susceptibility to PS-related complications may vary according to gut microbial profiles, supporting OTyCT as a practical tool for metabolic phenotyping and microbiome-informed precision nutrition. Clinical Trial registry name and registration number: Identification of P-Cresyl Sulfate Producer Phenotype by Oral Tyrosine Challenge Test: Interactions Among Diet, Gut Microbiota, and Host Genome, NCT04204174.
Ultra-processed foods (UPFs) dominate diets in high-income countries and pose health risks beyond nutrient composition. Controlled trials show UPF-rich diets increase energy intake and weight gain. Mechanisms include high energy density, disrupted food matrices, faster eating rates, additives affecting gut, and hyper-palatable formulations. Observational evidence associates higher UPF intake with obesity, cardiovascular disease, type 2 diabetes and all-cause mortality. This Comment outlines evidence and policy strategies to reduce UPF exposure.
Despite intensive glycemic control, diabetic cardiomyopathy (DCM) often progresses due to hyperglycemic memory (HGM), yet the specific cardiac cells perpetuating this injury remain unknown. To address this, we performed single-nucleus RNA sequencing (snRNA-seq) on hearts from an HGM rat model. Our analysis of 86,120 nuclei revealed HGM-specific inflammatory and epigenetic reprogramming signatures. Fibroblasts emerged as potential mediators, appearing to drive extracellular matrix remodeling via upregulated LAMININ and COLLAGEN signaling. We uncovered a distinct HGM-specific fibroblast subpopulation characterized by oxidative stress and H3K27 demethylation. Integrative analysis prioritized Fmo2 as a key pathogenic candidate, which was further supported via Mendelian randomization and clinical data as a putative causal gene. This study suggests that a pathogenic Fmo2+ fibroblast subpopulation may act as a pathological “memory carrier,” providing novel mechanistic insights and proposing exploratory therapeutic avenues for HGM-induced cardiac damage beyond glycemic control.
Despite the lipid-rich nature of the brain, defining the role of lipid metabolism in neurodegenerative disease and targeting lipid metabolic pathways for disease modification are in their infancy. In Parkinson’s disease, Lewy body dementia, and other synucleinopathies, disease-associated forms of α-synuclein (αS) alter fatty acid (FA) metabolism, increasing monounsaturated FA-containing lipids. This disequilibrium in membrane fatty acyl composition results in aberrant αS:membrane interactions. We report treating PD patient neurons with myristic acid (C14:0) induces lipid metabolism modifications correcting abnormal PD-associated membrane composition and reversing PD-relevant phenotypes. C14:0 conditioning reduced Lewy-like αS inclusions; reduced abnormal pSer129 αS; corrected excess αS at membranes; and restored native αS tetramer:monomer homeostasis. Using nuclear magnetic resonance, we established C14:0 as correcting abnormal αS vesicle membranes dwell time in vitro, correlating with less pathogenic αS aggregation. Mechanistically, C14:0 rescued PD neuron phenotypes through remodeling the PD-associated lipidome, eliciting beneficial effects by increasing shorter, saturated fatty acyl-lipids.
MASH is a leading cause of liver transplantation. Here, we investigated formoterol, a long-acting β2 adrenergic receptor agonist (LABA), in MASH. Mice treated with a high-fat diet (HFD) for sixteen weeks developed liver steatosis and were treated with formoterol or vehicle for four weeks. Steatosis largely resolved following formoterol treatment. To investigate mechanism, we evaluated mitochondrial biogenesis and found in HFD mice treated with formoterol versus vehicle that: PGC1α levels and electron transport chain components were significantly higher; mitochondrial number was increased; and lipids were decreased. Human HepaRG liver cells were then exposed to free fatty acids and/or formoterol. Formoterol attenuated lipid accumulation and increased ATP-linked basal and maximal respiration. Finally, a retrospective analysis of 59,644 patients with MASH showed that patients taking LABAs had fewer complications of advanced liver disease and lower mortality. Together, these data raise the possibility that LABAs, especially formoterol, could be a novel MASH treatment.
Chronic elevations in interleukin-6 (IL6) signaling have been shown to exacerbate features of cardiometabolic disease. A common variant in the IL6 promoter (location -174 G/C, identifier rs1800795) is associated with increased circulating IL6, and increased cardiometabolic disease incidence in some populations. This study's objective was to isolate the impact of this gene variant on cardiometabolic responses to metabolic stress, using knock-in mice with a GG wildtype or variant CC genotype for the murine homolog of rs1800795. Male and female IL6 variant CC mice on a high fat diet exhibited enhanced systemic IL6 levels but similar weight gain, energy expenditure, adipose tissue inflammation, glucose homeostasis, and cardiac function relative to control GG mice. Sex differences in the effect of the IL6 variant on cardiomyocyte dimensions were observed, with male variant mice exhibiting smaller cardiomyocyte volume, and female variant mice exhibiting larger cardiomyocyte volume with smaller raw heart mass relative to control GG mice. These findings suggest that, in a controlled experimental setting, the IL6 promoter variant (-174 G/C) does not increase susceptibility to cardiometabolic disease. Further work is required to understand the mechanistic link between this IL6 variant and associated increased cardiometabolic risk observed in population studies.
