Association between serum vitamin D levels and lipid profiles: a cross-sectional analysis

Abstract Vitamin D is an essential nutrient that plays a crucial role in calcium homeostasis and bone health. Recent research suggests that vitamin D may also have an impact on lipid metabolism, specifically the level of circulating lipids in the blood. We aim to investigate it role among healthy participate. We conducted a cross-sectional study of 15,600 patients who were referred to the laboratories of university hospitals. We measured the serum levels of Vitamin D as well as triglycerides, total cholesterol, LDL, and HDL using ELISA. We found that the mean serum level of Vitamin D was 40.31 ± 20.79 ng/mL. Of the participants, 16.7% had a serum level of Vitamin D less than 20 ng/mL, 57.7% had a level between 21 and 40 ng/mL, and 13.5% had a level between 41 and 60 ng/mL. Additionally, 12.2% had a level greater than 60 ng/mL. We performed a one-way analysis of variance and found that as the serum level of Vitamin D increased, the mean LDL level decreased significantly. Our study provides evidence of a significant relationship between serum levels of Vitamin D and LDL levels in patients. The findings suggest that vitamin D status may play a role in regulating lipid metabolism and may have implications for the prevention and treatment of cardiovascular disease. Further research is needed to elucidate the underlying mechanisms of this relationship and to determine optimal levels of vitamin D intake for maintaining lipid profiles. Introduction Recently, due to the multiple effects of vitamin D on health, its status in different individuals has become a growing research topic1. The classic effects of vitamin D are mediated by its active metabolite, 1,25-dihydroxy vitamin D, which enables the absorption of calcium in the intestines, maintenance of adequate phosphate levels for bone mineralization, bone growth, and remodeling2. The biological effects of vitamin D are regulated by vitamin D receptors present in other tissues that are not related to calcium metabolism3. Various studies have shown that vitamin D can be stored in adipose tissue4. Adipose tissue has the potential to accumulate a significant amount of vitamin D, particularly when fat mass expands(such as in overweight and obesity)5. It has been demonstrated that obese individuals have lower circulating concentrations of (OH)D25 compared to non-obese individuals. However, it can be said that body fat mass and percentage of body fat are strong predictors of vitamin D status in different individuals6. Initial studies proposed a hypothetical mechanism suggesting that increased vitamin D in circulation with obesity decreases hepatic synthesis of (OH)D25 through a negative feedback mechanism, leading to a decrease in serum (OH)D257. Assessing vitamin D status is reflected by measuring its metabolite in circulation compared to the active form. However, the prevalence of deficiency or sufficiency of serum (OH)D25 varies greatly depending on the criteria used to define it, including population, season, dietary habits, ethnicity, physical activity, and age range8. In general, dyslipidemia refers to an imbalance in the levels of blood lipids, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c)9. This disorder is recognized as a risk factor for the development of atherosclerosis-related diseases such as coronary heart disease, ischemic cerebrovascular disease, and peripheral vascular disease10. Various factors, such as aging, increased intake of fats, especially saturated and trans fats, and decreased intake of antioxidant-rich foods like fruits and vegetables, play a role in its etiology11. Vitamin D has multiple roles in addition to its role in regulating calcium homeostasis and contributes to maintaining human health. Recent years have seen an upward trend in vitamin D deficiency. The primary source of vitamin D is sunlight exposure, and certain protein-rich foods also contain vitamin D. However, it should be noted that dietary intake alone may not meet individuals’ vitamin D needs. Observational studies have shown that low serum vitamin D levels are an independent risk factor for hypertension and cardiovascular diseases12. Vitamin D is a fat-soluble hormone that is naturally synthesized in the body through subcutaneous synthesis upon exposure to sunlight. This vitamin plays a crucial role in maintaining the health of bones, muscles, and also prevents various diseases such as cancer, diabetes, cardiovascular diseases, and autoimmune diseases13. Based on available evidence, vitamin D deficiency is directly associated with mortality in patients with cardiovascular diseases (CVD), and improving the vitamin D status has been reported to reduce the risk of myocardial infarction and stroke through multiple studies14. Dyslipidemia is one of the major risk factors for developing CVD, and significant associations have been found between serum vitamin D levels and lipid profiles according to conducted studies15. Although multiple mechanisms have been proposed to explain the effects of vitamin D on lipid profiles, the impact of this vitamin on blood lipid levels is still not clear16. Proposed mechanisms suggest that vitamin D may directly affect serum lipid profiles, including triglycerides, total cholesterol, and LDL cholesterol, by increasing the production of bile salts and reducing the activity of lecithin-cholesterol acyltransferase, as well as indirectly through its influence on calcium absorption, resulting in decreased fat absorption and increased synthesis of hepatic bile acids from cholesterol17. Considering the vital role mentioned for serum vitamin D levels, it can be inferred that improving the serum vitamin D level may have a significant role in improving associated conditions such as hyperlipidemia in affected individuals. Therefore, we aim to investigate the relationship between vitamin D levels and blood lipid levels in this study. Patients We confirm that all methods were carried out in accordance with relevant guidelines and regulations, and that all experimental protocols were approved by the Institutional Review Board (IRB) of the Tehran Islamic Azad University of Medical Sciences. Informed consent was obtained from all subjects and/or their legal guardian(s). In this research data from healthy patients were collected and we confirm that Cardiovascular diseases and metabolic diseases such as liver and kidney diseases, as well as autoimmune patients and patients using vitamins, were excluded from this study. Methods This is a descriptive, cross-sectional study conducted on people who visited the

Novel equations estimate long-term risk from cardiovascular-kidney-metabolic syndrome

November 29, 2023 3 min read Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: The new AHA PREVENT equations are designed to predict long-term absolute risk tied to CV-kidney-metabolic syndrome. An online calculator to estimate benefit of specific preventive therapies is in development. PHILADELPHIA — A speaker unveiled the American Heart Association’s new PREVENT equations to evaluate 10- and 30-year absolute risk associated with cardiovascular-kidney-metabolic syndrome. Details on the PREVENT equations were presented at the AHA Scientific Sessions and simultaneously published in Circulation. Sadiya Sana Khan “The current guidelines for primary prevention released in 2019 offer several recommendations focusing on risk assessment of cardiovascular disease for U.S. adults. This framework … is to calculate risk for U.S. adults aged 40 to 79 years using the pooled cohort equations or the [atherosclerotic] CVD risk calculator to identify individuals who are at high risk. Now, this risk-based framework continues to be the foundation of how we move forward for prevention, but there are significant limitations in 2023 with the [pooled cohort equation] model,” Sadiya Sana Khan, MD, MSc, FACC, FAHA, associate professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, said during a press conference. “First, they were developed only in Black and white adults in a relatively small sample, so they may not be generalizable to the diverse U.S. population. They begin at age 40 and so can’t be used in younger adults when we know the burden of [cardiovascular-kidney-metabolic disease] is increasing, particularly in young adulthood. Third, they relied on historical data from the ’80s and ’90s, and the population-level burden of risk factors has changed, as have treatments to address these gaps. The [cardiovascular-kidney-metabolic] working group on risk prediction, co-led by myself and Josef Coresh, MD, PhD, FAHA, developed the AHA predicting risk of CVD events, or the AHA PREVENT, equations.” As Healio previously reported, the AHA coined the term “cardiovascular-kidney-metabolic syndrome” to highlight the ties between metabolic and renal risk factors and CVD risk. The PREVENT equations were developed using real-world contemporary datasets including more than 6 million adults and includes HF risk in addition to risk for MI and stroke; omit race from CVD clinical care algorithms; include kidney function on top of traditional CVD risk factors for heart disease; and include components such as social determinants of health, blood glucose and kidney function, when clinically available. “A key conceptual advance in the PREVENT equations is this endorsement of the life course perspective of prediction and prevention,” Khan said during the press conference. “Importantly, this framework highlights the upstream drivers or social determinants of health that are critical to the determinants or [cardiovascular-kidney-metabolic] factors and lead to subclinical disease and disease manifestations.” With use at age 30 years, the PREVENT equations would enable 10- and 30-year total CV risk estimates and aid clinical decision-making in terms of intervention strategy based on predicted risk and expected benefit, Khan said. “We are developing an online calculator that will support clinicians to start these conversations with patients to guide holistic and patient-centered preventive care,” Khan said during the press conference. “The amount of benefit of a specific therapy is directly related to that predicted risk. … This will help us guide if, when and which therapies should be considered and allow us to move beyond statins as a solo approach for prevention. It’s not a question of replacing statins, but ‘statins and?’” Khan said. “We need to take the long view to target upstream social determinants of health. As we know those are upstream of the drivers and determinants of disease as we think and move forward in how we can optimize [cardiovascular-kidney-metabolic] health for everyone in the U.S. population.” References: Published by: Sources/Disclosures Collapse Source: Khan SS. A confluence of risk: Navigating the intersection of cardiovascular, kidney and metabolic health. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia. Disclosures: Khan reports no relevant financial disclosures. Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio American Heart Association

FDA clears blood-based biomarker lab test for traumatic brain injury

November 29, 2023 1 min read Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio The FDA has cleared a traumatic brain injury blood test for commercial availability, paving the way for its distribution to hospitals in the United States. According to a release from Abbott, the test will run on the company’s Alinity i laboratory instrument, which aims to provide clinicians with a rapid, objective way to assess mild traumatic brain injury (TBI) or concussion in individuals. The FDA has cleared a novel blood-based biomarker test to assess traumatic brain injury, allowing for its distribution to health care centers across the U.S. Image: Adobe Stock Alinity i can be employed within 12 hours of a suspected TBI. The test, which involves blood drawn from an arm, measures two biomarkers that, in elevated concentrations, are highly indicative of brain injury, Abbott said in the release. Results can be achieved within 18 minutes to help clinicians assess concussion and triage patients. A negative test would enable health care professionals to rule out a CT scan, thereby eliminating longer wait times for treatment, per the release. For those who sustain TBI, effects are variable from a few days post-injury or may be permanent, and individuals are more likely to sustain one or more TBI after the first instance. Misdiagnosis or lack of diagnosis can worsen short- and long-term outcomes; therefore, tools that enable rapid evaluation TBI or concussion are essential to proper treatment. “Now that this test will be widely available in labs across the country, medical centers will be able to offer an objective blood test that can aid in concussion assessment,” Beth McQuiston, MD, medical director in Abbott’s diagnostics business, said in the release. “That’s great news for both doctors and people who are trying to find out if they have suffered a traumatic brain injury.” Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio

Studying a propionic acidaemia mouse model reveals epigenetic mechanisms in the heart

We show how a build-up of propionyl-CoA in a mouse model of propionic acidaemia produces histone modifications in the heart. The transcriptional responses included genes implicated in contractile dysfunction. Notably, female mice are more severely affected, owing to a protective effect of β-alanine in males, a therapeutically important finding. This is a preview of subscription content, access via your institution Access options Access through your institution Change institution Buy or subscribe /* style specs start */ style{display:none!important}.LiveAreaSection-193358632 *{align-content:stretch;align-items:stretch;align-self:auto;animation-delay:0s;animation-direction:normal;animation-duration:0s;animation-fill-mode:none;animation-iteration-count:1;animation-name:none;animation-play-state:running;animation-timing-function:ease;azimuth:center;backface-visibility:visible;background-attachment:scroll;background-blend-mode:normal;background-clip:borderBox;background-color:transparent;background-image:none;background-origin:paddingBox;background-position:0 0;background-repeat:repeat;background-size:auto auto;block-size:auto;border-block-end-color:currentcolor;border-block-end-style:none;border-block-end-width:medium;border-block-start-color:currentcolor;border-block-start-style:none;border-block-start-width:medium;border-bottom-color:currentcolor;border-bottom-left-radius:0;border-bottom-right-radius:0;border-bottom-style:none;border-bottom-width:medium;border-collapse:separate;border-image-outset:0s;border-image-repeat:stretch;border-image-slice:100%;border-image-source:none;border-image-width:1;border-inline-end-color:currentcolor;border-inline-end-style:none;border-inline-end-width:medium;border-inline-start-color:currentcolor;border-inline-start-style:none;border-inline-start-width:medium;border-left-color:currentcolor;border-left-style:none;border-left-width:medium;border-right-color:currentcolor;border-right-style:none;border-right-width:medium;border-spacing:0;border-top-color:currentcolor;border-top-left-radius:0;border-top-right-radius:0;border-top-style:none;border-top-width:medium;bottom:auto;box-decoration-break:slice;box-shadow:none;box-sizing:border-box;break-after:auto;break-before:auto;break-inside:auto;caption-side:top;caret-color:auto;clear:none;clip:auto;clip-path:none;color:initial;column-count:auto;column-fill:balance;column-gap:normal;column-rule-color:currentcolor;column-rule-style:none;column-rule-width:medium;column-span:none;column-width:auto;content:normal;counter-increment:none;counter-reset:none;cursor:auto;display:inline;empty-cells:show;filter:none;flex-basis:auto;flex-direction:row;flex-grow:0;flex-shrink:1;flex-wrap:nowrap;float:none;font-family:initial;font-feature-settings:normal;font-kerning:auto;font-language-override:normal;font-size:medium;font-size-adjust:none;font-stretch:normal;font-style:normal;font-synthesis:weight style;font-variant:normal;font-variant-alternates:normal;font-variant-caps:normal;font-variant-east-asian:normal;font-variant-ligatures:normal;font-variant-numeric:normal;font-variant-position:normal;font-weight:400;grid-auto-columns:auto;grid-auto-flow:row;grid-auto-rows:auto;grid-column-end:auto;grid-column-gap:0;grid-column-start:auto;grid-row-end:auto;grid-row-gap:0;grid-row-start:auto;grid-template-areas:none;grid-template-columns:none;grid-template-rows:none;height:auto;hyphens:manual;image-orientation:0deg;image-rendering:auto;image-resolution:1dppx;ime-mode:auto;inline-size:auto;isolation:auto;justify-content:flexStart;left:auto;letter-spacing:normal;line-break:auto;line-height:normal;list-style-image:none;list-style-position:outside;list-style-type:disc;margin-block-end:0;margin-block-start:0;margin-bottom:0;margin-inline-end:0;margin-inline-start:0;margin-left:0;margin-right:0;margin-top:0;mask-clip:borderBox;mask-composite:add;mask-image:none;mask-mode:matchSource;mask-origin:borderBox;mask-position:0 0;mask-repeat:repeat;mask-size:auto;mask-type:luminance;max-height:none;max-width:none;min-block-size:0;min-height:0;min-inline-size:0;min-width:0;mix-blend-mode:normal;object-fit:fill;object-position:50% 50%;offset-block-end:auto;offset-block-start:auto;offset-inline-end:auto;offset-inline-start:auto;opacity:1;order:0;orphans:2;outline-color:initial;outline-offset:0;outline-style:none;outline-width:medium;overflow:visible;overflow-wrap:normal;overflow-x:visible;overflow-y:visible;padding-block-end:0;padding-block-start:0;padding-bottom:0;padding-inline-end:0;padding-inline-start:0;padding-left:0;padding-right:0;padding-top:0;page-break-after:auto;page-break-before:auto;page-break-inside:auto;perspective:none;perspective-origin:50% 50%;pointer-events:auto;position:static;quotes:initial;resize:none;right:auto;ruby-align:spaceAround;ruby-merge:separate;ruby-position:over;scroll-behavior:auto;scroll-snap-coordinate:none;scroll-snap-destination:0 0;scroll-snap-points-x:none;scroll-snap-points-y:none;scroll-snap-type:none;shape-image-threshold:0;shape-margin:0;shape-outside:none;tab-size:8;table-layout:auto;text-align:initial;text-align-last:auto;text-combine-upright:none;text-decoration-color:currentcolor;text-decoration-line:none;text-decoration-style:solid;text-emphasis-color:currentcolor;text-emphasis-position:over right;text-emphasis-style:none;text-indent:0;text-justify:auto;text-orientation:mixed;text-overflow:clip;text-rendering:auto;text-shadow:none;text-transform:none;text-underline-position:auto;top:auto;touch-action:auto;transform:none;transform-box:borderBox;transform-origin:50% 50%0;transform-style:flat;transition-delay:0s;transition-duration:0s;transition-property:all;transition-timing-function:ease;vertical-align:baseline;visibility:visible;white-space:normal;widows:2;width:auto;will-change:auto;word-break:normal;word-spacing:normal;word-wrap:normal;writing-mode:horizontalTb;z-index:auto;-webkit-appearance:none;-moz-appearance:none;-ms-appearance:none;appearance:none;margin:0}.LiveAreaSection-193358632{width:100%}.LiveAreaSection-193358632 .login-option-buybox{display:block;width:100%;font-size:17px;line-height:30px;color:#222;padding-top:30px;font-family:Harding,Palatino,serif}.LiveAreaSection-193358632 .additional-access-options{display:block;font-weight:700;font-size:17px;line-height:30px;color:#222;font-family:Harding,Palatino,serif}.LiveAreaSection-193358632 .additional-login>li:not(:first-child)::before{transform:translateY(-50%);content:””;height:1rem;position:absolute;top:50%;left:0;border-left:2px solid #999}.LiveAreaSection-193358632 .additional-login>li:not(:first-child){padding-left:10px}.LiveAreaSection-193358632 .additional-login>li{display:inline-block;position:relative;vertical-align:middle;padding-right:10px}.BuyBoxSection-683559780{display:flex;flex-wrap:wrap;flex:1;flex-direction:row-reverse;margin:-30px -15px 0}.BuyBoxSection-683559780 .box-inner{width:100%;height:100%}.BuyBoxSection-683559780 .readcube-buybox{background-color:#f3f3f3;flex-shrink:1;flex-grow:1;flex-basis:255px;background-clip:content-box;padding:0 15px;margin-top:30px}.BuyBoxSection-683559780 .subscribe-buybox{background-color:#f3f3f3;flex-shrink:1;flex-grow:4;flex-basis:300px;background-clip:content-box;padding:0 15px;margin-top:30px}.BuyBoxSection-683559780 .subscribe-buybox-nature-plus{background-color:#f3f3f3;flex-shrink:1;flex-grow:4;flex-basis:100%;background-clip:content-box;padding:0 15px;margin-top:30px}.BuyBoxSection-683559780 .title-readcube,.BuyBoxSection-683559780 .title-buybox{display:block;margin:0;margin-right:10%;margin-left:10%;font-size:24px;line-height:32px;color:#222;padding-top:30px;text-align:center;font-family:Harding,Palatino,serif}.BuyBoxSection-683559780 .title-asia-buybox{display:block;margin:0;margin-right:5%;margin-left:5%;font-size:24px;line-height:32px;color:#222;padding-top:30px;text-align:center;font-family:Harding,Palatino,serif}.BuyBoxSection-683559780 .asia-link{color:#069;cursor:pointer;text-decoration:none;font-size:1.05em;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:1.05em6}.BuyBoxSection-683559780 .access-readcube{display:block;margin:0;margin-right:10%;margin-left:10%;font-size:14px;color:#222;padding-top:10px;text-align:center;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:20px}.BuyBoxSection-683559780 .access-asia-buybox{display:block;margin:0;margin-right:5%;margin-left:5%;font-size:14px;color:#222;padding-top:10px;text-align:center;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:20px}.BuyBoxSection-683559780 .access-buybox{display:block;margin:0;margin-right:10%;margin-left:10%;font-size:14px;color:#222;opacity:.8px;padding-top:10px;text-align:center;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:20px}.BuyBoxSection-683559780 .price-buybox{display:block;font-size:30px;color:#222;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;padding-top:30px;text-align:center}.BuyBoxSection-683559780 .price-buybox-to{display:block;font-size:30px;color:#222;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;text-align:center}.BuyBoxSection-683559780 .price-info-text{font-size:16px;padding-right:10px;color:#222;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif}.BuyBoxSection-683559780 .price-value{font-size:30px;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif}.BuyBoxSection-683559780 .price-per-period{font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif}.BuyBoxSection-683559780 .price-from{font-size:14px;padding-right:10px;color:#222;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:20px}.BuyBoxSection-683559780 .issue-buybox{display:block;font-size:13px;text-align:center;color:#222;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:19px}.BuyBoxSection-683559780 .no-price-buybox{display:block;font-size:13px;line-height:18px;text-align:center;padding-right:10%;padding-left:10%;padding-bottom:20px;padding-top:30px;color:#222;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif}.BuyBoxSection-683559780 .vat-buybox{display:block;margin-top:5px;margin-right:20%;margin-left:20%;font-size:11px;color:#222;padding-top:10px;padding-bottom:15px;text-align:center;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:17px}.BuyBoxSection-683559780 .tax-buybox{display:block;width:100%;color:#222;padding:20px 16px;text-align:center;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;line-height:NaNpx}.BuyBoxSection-683559780 .button-container{display:flex;padding-right:20px;padding-left:20px;justify-content:center}.BuyBoxSection-683559780 .button-container>*{flex:1px}.BuyBoxSection-683559780 .button-container>a:hover,.Button-1078489254:hover,.Button-2496381730:hover{text-decoration:none}.BuyBoxSection-683559780 .readcube-button{background:#fff;margin-top:30px}.BuyBoxSection-683559780 .button-asia{background:#069;border:1px solid #069;border-radius:0;cursor:pointer;display:block;padding:9px;outline:0;text-align:center;text-decoration:none;min-width:80px;margin-top:75px}.BuyBoxSection-683559780 .button-label-asia,.ButtonLabel-3296148077,.ButtonLabel-1651148777{display:block;color:#fff;font-size:17px;line-height:20px;font-family:-apple-system,BlinkMacSystemFont,”Segoe UI”,Roboto,Oxygen-Sans,Ubuntu,Cantarell,”Helvetica Neue”,sans-serif;text-align:center;text-decoration:none;cursor:pointer}.Button-1078489254,.Button-2496381730{background:#069;border:1px solid #069;border-radius:0;cursor:pointer;display:block;padding:9px;outline:0;text-align:center;text-decoration:none;min-width:80px;max-width:320px;margin-top:10px}.Button-1078489254 .readcube-label,.Button-2496381730 .readcube-label{color:#069} /* style specs end */ Subscribe to this journal Receive 12 digital issues and online access to articles $119.00 per year only $9.92 per issue Learn more Rent or buy this article Prices vary by article type from$1.95 to$39.95 Learn more Prices may be subject to local taxes which are calculated during checkout Additional access options: Log in Learn about institutional subscriptions Read our FAQs Contact customer support Fig. 1: Sex-dependent changes in histone modifications in the hypomorphic mouse model of PA. References Richard, E., Pérez, B., Pérez-Cerdá, C. & Desviat, L. R. Understanding molecular mechanisms in propionic acidemia and investigated therapeutic strategies. Expert Opin. Orphan Drugs 3, 1427–1438 (2015). This review presents an overview of propionic acidemia. Article CAS Google Scholar Kebede, A. F. et al. Histone propionylation is a mark of active chromatin. Nat. Struct. Mol. Biol. 24, 1048–1056 (2017). This paper reports histone propionylation in vivo. Article CAS PubMed Google Scholar He, W., Wang, Y., Xie, E. J., Barry, M. A. & Zhang, G.-F. Metabolic perturbations mediated by propionyl-CoA accumulation in organs of mouse model of propionic acidemia. Mol. Gen. Metab. 134, 257–266 (2021). This review discusses the metabolic changes in propionic acidemia. Article CAS Google Scholar Guenzel, A. J. et al. Generation of a hypomorphic model of propionic acidemia amenable to gene therapy testing. Mol. Ther. 21, 1316–1323 (2013). This paper introduces the hypomorphic mouse model of PA. Article CAS PubMed PubMed Central Google Scholar Gillette, T. G. & Hill, J. A. Readers, writers, and erasers: chromatin as the whiteboard of heart disease. Circ. Res. 116, 1245–1253 (2015). The review discusses the role of changes in chromatin structure in cardiac disease. Article CAS PubMed PubMed Central Google Scholar Download references Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This is a summary of: Park, K. C. et al. Disrupted propionate metabolism evokes transcriptional changes in the heart by increasing histone acetylation and propionylation. Nat. Cardiovas. Res. https://doi.org/10.1038/s44161-023-00365-0 (2023). Rights and permissions Reprints and Permissions About this article Cite this article Studying a propionic acidaemia mouse model reveals epigenetic mechanisms in the heart. Nat Cardiovasc Res (2023). https://doi.org/10.1038/s44161-023-00371-2 Download citation Published: 29 November 2023 DOI: https://doi.org/10.1038/s44161-023-00371-2 Share this article Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

Mangoceuticals Selects TRYBE Labs as its Nationwide Blood Collection and Testing Services Provider

TRYBE Labs to provide MangoRx customers with turnkey at-home blood collection services and solutions Dallas, Texas, Nov. 29, 2023 (GLOBE NEWSWIRE) — Mangoceuticals, Inc. (NASDAQ: MGRX) (“MangoRx” or the “Company”), a company focused on developing, marketing, and selling a variety of men’s health and wellness products via a secure telemedicine platform, including its uniquely formulated hair growth product branded ‘GROW’ and erectile dysfunction (ED) drug branded “Mango,” today announced that it has selected TRYBE Labs to provide its customers with a minimally invasive FDA approved at-home blood collection device and testing services as the Company seeks to further expand its product lines requiring blood tests and results reviewed by physicians. Using innovative, FDA approved at-home blood collection technology, TRYBE Labs is a CLIA certified and Joint Commission accredited laboratory that provides a direct-to-consumer product which includes an easy-to-use collection kit, full range of testing, and physician-read results for male health and performance evaluation – including hormone, thyroid and vitamin levels. “As we have been continuously working to bring additional pharmaceutical based products and solutions to market, the requirement for our physicians to review up-to-date blood work and results has become paramount,” said Jacob Cohen, MangoRx’s co-founder and CEO. “TRYBE Labs offers a unique, innovative, convenient, and minimally invasive approach for blood collection and testing along with fast result turnaround times (in as little as 72 hours) for patients across the United States. What makes our partnership that much greater is that TRYBE Labs and MangoRx are completely aligned with our respective approaches in being disruptive in our industries and we are thrilled to work with them and their team on this endeavor.” TRYBE Labs will also be joining the Company as one of their affiliate marketing partners to further create awareness and drive sales of MangoRx’s men’s health and wellness related products through its own direct-to-consumer marketing efforts. “TRYBE Labs was built by men, for men,” said Lewis Scalione, Founding Partner, TRYBE Labs. “We know many men are hesitant to seek medical care and that they may struggle with the perceived stigma that comes with low energy or suboptimal performance – at the gym or in the intimate moments of their lives. By putting the power of information and cutting-edge technology directly into their hands, we are making healthcare more accessible to all who need it.” About MangoRxMangoRx is focused on developing a variety of men’s health and wellness products and services via a secure telemedicine platform. To date, the Company has identified men’s wellness telemedicine services and products as a growing sector and especially related to the area of erectile dysfunction (ED) and hair growth. Interested consumers can use MangoRx’s telemedicine platform for a smooth medical prescription that is exclusively compounded for each individual. Orders will then be reviewed by a physician and, if approved, fulfilled and discreetly shipped through MangoRx’s partner compounding pharmacy and right to the patient’s doorstep. To learn more about MangoRx’s mission and other products, please visit www.MangoRx.com or on social media @Mango.Rx. About TRYBE LabsTRYBE Labs is the only FDA-approved, at-home collection and testing service on the market today that is designed specifically for men. With an interactive online portal for monitoring, scoring and tracking of results, TRYBE Labs is delivering the future of men’s health today. Visit trybelabs.us. Cautionary Note Regarding Forward-Looking Statements Certain statements made in this press release contain forward-looking information within the meaning of applicable securities laws, including within the meaning of the Private Securities Litigation Reform Act of 1995 (“forward-looking statements”). These forward-looking statements represent the Company’s current expectations or beliefs concerning future events and can generally be identified using statements that include words such as “estimate,” “expects,” “project,” “believe,” “anticipate,” “intend,” “plan,” “foresee,” “forecast,” “likely,” “will,” “target” or similar words or phrases. These forward-looking statements are subject to risks, uncertainties and other factors, many of which are outside of the Company’s control which could cause actual results to differ materially from the results expressed or implied in the forward-looking statements, including, but not limited to; our ability to obtain additional funding and generate revenues to support our operations; risks associated with our ED product which have not been, and will not be, approved by the U.S. Food and Drug Administration (“FDA”) and have not had the benefit of the FDA’s clinical trial protocol which seeks to prevent the possibility of serious patient injury and death; risks that the FDA may determine that the compounding of our planned products does not fall within the exemption from the Federal Food, Drug, and Cosmetic Act (“FFDCA Act”) provided by Section 503A; risks associated with related party relationships and agreements; the effect of data security breaches, malicious code and/or hackers; competition and our ability to create a well-known brand name; changes in consumer tastes and preferences; material changes and/or terminations of our relationships with key parties; significant product returns from customers, product liability, recalls and litigation associated with tainted products or products found to cause health issues; our ability to innovate, expand our offerings and compete against competitors which may have greater resources; our significant reliance on related party transactions; the projected size of the potential market for our technologies and products; risks related to the fact that our Chairman and Chief Executive Officer, Jacob D. Cohen and President, Jonathan Arango, combined have majority voting control over the Company; risks related to the significant number of shares in the public float, our share volume, the effect of sales of a significant number of shares in the marketplace, and the fact that the majority of our shareholders paid less for their shares than the public offering price of our common stock in our recent initial public offering; the fact that we have a significant number of outstanding warrants to purchase shares of common stock at $1.00 per share, the resale of which underlying shares have been registered under the Securities Act of 1933, as amended; our ability to build and maintain our brand; cybersecurity, information systems and fraud risks and problems with

Nascent Biotech Granted Japanese Patent for Crossing Blood-Brain Barrier

NORTH PALM BEACH, FL / ACCESSWIRE / November 29, 2023 / Nascent Biotech, Inc. (OTC:NBIO) (“Nascent Biotech”, “Nascent”, or the “Company”), a clinical-stage biotechnology Company pioneering the development of monoclonal antibodies targeting treatment of various cancers and viral infections, is pleased to announce the Company has been issued a “Method-of-Use” patent from the Japanese Patent Office (“JPO”) for its primary asset, Pritumumab (“PTB”). Specifically, the patent approval is related to PTB’s capacity to cross through the Blood-Brain Barrier (“BBB”). The patent allowance recognizes PTB’s ability to act as a monotherapy, as well as its potential to act as a conjugate, bringing other therapies across the BBB. In basic terms, the blood-brain barrier is a semipermeable border of endothelial cells that act as a filtering mechanism for the capillaries that carry blood to the brain and spinal cord tissue, blocking the passage of certain substances from the circulatory system into the brain. Nascent’s senior management recognizes this patent approval as a significant event elevating the Company’s value proposition. The approval strengthens the Company’s intellectual property position, both in general and by providing protection that extends internationally. “This patent further validates the value of PTB as a unique biotechnology asset,” remarked Nascent CEO, Sean Carrick. “It also extends our IP footprint internationally, opening up new market potential, expanding the upside value proposition of PTB commercially. We look forward to providing further highlights and updates related to this as well as our progress in Phase 2 clinical research.” About Nascent Biotech Nascent Biotech, Inc. (OTCQB: NBIO) is a clinical-stage biotech company pioneering the development of monoclonal antibodies to be used in the treatment of various cancers and viral infections, helping people worldwide. Its products are not yet commercially available. The Company’s lead candidate, Pritumumab (PTB), is a monoclonal Antibody (Mab) that is being studied in Phase I clinical trials for the treatment of Brain Cancer. For further information please visit our website www.nascentbiotech.com. Forward Looking Safe Harbor Statement Statements in this press release about our future expectations constitute ‘forward-looking statements’ within the meaning of Section 27A of the Securities Act of 1933, Section 21E of the Securities Exchange Act of 1934 and as that term is defined in the Private Litigation Reform Act of 1995. Such forward-looking statements involve risks and uncertainties and are subject to change at any time and our actual results could differ materially from expected results. These risks and uncertainties include, without limitation, Nascent Biotech Inc’s ability to target the medical professionals; Nascent Biotech Inc’s ability to raise capital; as well as other risks. Additional information about these and other factors may be described in the Nascent Biotech Inc’s Form 10, filed on May 2, 2015, and future subsequent filings with the Securities and Exchange Commission. The Company undertakes no obligation to update or release any revisions to these forward-looking statements to reflect events or circumstances after the date of this statement or to reflect the occurrence of unanticipated events, except as required by law. Corporate ContactSean Carrick | CEO | Nascent Biotech, Inc.sean.carrick@nascentbiotech.com Public RelationsEDM Media, LLChttps://edm.media(800) 301-7883 SOURCE: Nascent Biotech Inc. View source version on accesswire.com:https://www.accesswire.com/810821/nascent-biotech-granted-japanese-patent-for-crossing-blood-brain-barrier

Vittoria Biotherapeutics Announces the Presentation of New Data Supporting the Company’s Platform at the 65th American Society of Hematology Annual Meeting

PHILADELPHIA, Nov. 29, 2023 (GLOBE NEWSWIRE) — Vittoria Biotherapeutics announced the presentations of abstracts authored by researchers at the University of Pennsylvania and a poster authored by the Company, at the upcoming 65th American Society of Hematology (ASH) Annual Meeting, taking place from December 9-12th, 2023, in San Diego, California. The presentations will showcase data from the laboratory of Marco Ruella, M.D., Vittoria’s Scientific Founder and Chair of the Scientific Advisory Board, who is an assistant professor of Medicine in the Perelman School of Medicine at the University of Pennsylvania (Penn) and Scientific Director of the Lymphoma Program at Penn Medicine’s Abramson Cancer Center. The oral presentations will include recent data generated at Penn with the Company’s Senza5™ platform, a technology exclusively licensed from Penn to Vittoria, along with additional pipeline technologies. By harnessing the fundamental biology of T cells, Senza5 is designed to engineer cell therapies with improved anti-tumor efficacy, stemness, potency, and durability through gene-edited CD5 knockout and a proprietary five-day manufacturing process. Oral and poster presentation abstracts to be presented at the meeting can be found below: Oral Presentations: Title: Disinhibition of T Cell Activation Via CD5 Knockout Is a Universal Strategy to Enhance Adoptive T Cell ImmunotherapiesSession: 703. Cellular Immunotherapies: Basic and Translational: Overcoming Challenges in CAR-T Therapies Through Biological InsightsPresenter: Ruchi P. Patel, M.S.Presentation Date and Time: Saturday, December 9th at 10:45 am PSTLocation: Room 6DE Title: Fratricide-Resistant Anti-CD2 Chimeric Antigen Receptor T-Cells with Endogenous CD2 Knockout Are Highly Effective Against T-Cell NeoplasmsSession: 703. Cellular Immunotherapies: Basic and Translational: Innovative T Cell Therapies for Unexplored Frontiers Presenter: Mathew G. Angelos, M.D., Ph.D.Presentation Date and Time: Monday, December 11th at 3:15 pm PSTLocation: Room 6DE Poster Presentation: Title: Senza5TM CART5: An Autologous CD5-Deleted Anti-CD5 CART Product with Enhanced Anti-T-Cell Lymphoma Activity Session: 703. Cellular Immunotherapies: Basic and Translational: Poster IIPresentation Date and Time: Sunday, December 10, 2023 at 6 pm PSTLocation: Halls G – H About Vittoria Biotherapeutics Vittoria Biotherapeutics, Inc., is developing novel CAR-T cell therapies that transcend the limitations of current cell therapies. Based on technology exclusively licensed from the University of Pennsylvania, the Company’s proprietary Senza5 platform unlocks the antitumor potential of engineered T cells and utilizes a five-day manufacturing process to maximize stemness, durability, and target cell cytotoxicity. By acting on the fundamental biology of T cells, Senza5 can be used to improve the efficacy of engineered T cell therapies with pipeline applications in oncology and autoimmune diseases. To learn more, visit vittoriabio.com and follow us on LinkedIn. Affiliations with the University of Pennsylvania Dr. Ruella is the scientific founder of, and an equity holder in, Vittoria Biotherapeutics. The University of Pennsylvania holds equity in Vittoria Biotherapeutics, has received sponsored research funding from Vittoria, has licensed certain intellectual property to Vittoria and may receive future funding and financial consideration based on development and commercialization of certain products by Vittoria. Dr. Ruella and Ruchi Patel are also paid consultants for Vittoria Biotherapeutics. Investor Contact Vittoria BiotherapeuticsNicholas A. Siciliano, Ph.D.Chief Executive Officer+1 215-600-1380 Media Contact LifeSci CommunicationsJason Braco, Ph.D.jbraco@lifescicomms.com+1 646-876-4932

Eradicating HIV Will Take Collaborative Action and a Commitment to Curb TB Infections

Newswise — Nov. 29, 2023 –The COVID-19 pandemic hampered progress in fighting tuberculosis infections worldwide. Diverted funds meant that one of the world’s leading infectious killers caused 1.3 million deaths in 2022. TB is also the leading cause of death among those with HIV /AIDS worldwide. In 2022, 167,000 people died of HIV-associated TB. This World AIDS Day, the Forum of International Respiratory Societies (FIRS), of which the American Thoracic Society is a founding member, calls on governments, health advocates, and non-government organizations to strengthen their response to AIDS and TB. This collaborative effort is necessary to help realize the World Health Organization’s goal of ending the AIDS epidemic by 2030. “People with latent TB who are living with HIV should have access to TB prevention therapy,” said American Thoracic Society (ATS) President M. Patricia Rivera, MD, ATSF. “Studies show that this therapy can reduce the chances of dying from TB and AIDS by nearly 40 percent.” ATS began in 1905 as the National Association for the Study and Prevention of Tuberculosis. Today, the ATS and other FIRS members, representing the world’s leading respiratory societies, are working to improve lung health globally. In the developing world, TB is often the first sign a person has HIV. Yet, about half of the people living with HIV and tuberculosis are unaware of their co-infection and, therefore, not receiving appropriate care that could prevent not only serious illness but death, according to WHO. Shortly after AIDS emerged, it fueled a global resurgence of TB that continues in many low- and middle-income countries. In 2022, the WHO reported that the largest number of new TB cases were in WHO’s Southeast Asia Region (46 percent), followed by the African Region (23 percent) and the Western Pacific (18 percent). According to the Centers for Disease Control and Prevention, HIV infection is the greatest risk factor for progressing from latent to active TB. HIV increases the risk of other infectious respiratory diseases, including Pneumocystis jirovecii pneumonia and bacterial pneumonia, both of which can be life threatening. Education, prevention strategies, and new medicines, particularly antiretroviral therapies, have reduced the number of AIDS-related deaths by 69 percent since the peak in 2004. Still, the WHO estimates that in 2022, an estimated 39 million people were living with AIDS, 1.5 million of them children. FIRS believes a global response to HIV/AIDS can be strengthened by: Increasing awareness of the continuing global threat of HIV-related disease and its link to TB and other respiratory diseases. Improving the health outcomes of people living with HIV through patient care and research into better prevention, early diagnosis, and effective treatment strategies for both HIV and TB, including rapid diagnosis and treatment for multidrug-resistant TB that is harder to cure. Reducing the incidence and severity of HIV-related disease by strengthening mother-to-child transmission prevention programs and increasing the early use of antiretroviral therapy. Improving HIV education in at-risk communities to reduce the incidence of new HIV infections. Reducing HIV-related health disparities and inequities. “The good news is that antiretroviral therapies work, and TB is preventable and curable,” Dr. Rivera said. “These two facts, along with the millions of lives that we can save, should be motivation enough to ensure that these medical advances are available to everyone.”

Blood Glucose Test Strips Market to Reach $17.7 Billion by 2030, Says Coherent Market Insights

Burlingame, Nov. 29, 2023 (GLOBE NEWSWIRE) — According to Coherent Market Insights, The global blood glucose test strips market was valued at US$ 10.7 Billion in 2023 and is forecast to reach a value of US$ 17.7 Billin by 2030 at a CAGR of 7.4% between 2023 and 2030. Blood Glucose test strips are used to test for the presence of glucose in the blood. Glucose is a sugar found in the blood and used by the body for energy. Test strips are usually made of paper or plastic and have a special coating that reacts with glucose. The strip changes color when it comes into contact with glucose. This change can be read on a meter calibrated to show blood glucose levels.Test strips are an important part of diabetes treatment. They allow people with diabetes to check their blood sugar levels at home and make sure they are staying within their target range. Test strips can also be used to check for ketones, which are a sign your body isn’t getting enough insulin. Hence, there is increasing demand for blood glucose test strips across the globe Request Sample Copy of this Report @ https://www.coherentmarketinsights.com/insight/request-sample/6124 Market Statistics: The global blood glucose test strips market is estimated to account for US$ 10.7 Bn in terms of value by the end of 2023. Market Drivers: Increasing prevalence of diabetes is expected to propel the growth of the global blood glucose test strips market during the forecast period. For instance, according to fact sheet published by International Diabetes Federation in November 2022, stated that in 2021, 537 million adults (1 in 10) were living with diabetes. That number is expected to increase to 643 million by 2030 and 783 million by 2045. Morevoer, it also stated that lmost one in two adults (44%) with diabetes remains undiagnosed (240 million). The majority suffer from type 2 diabetes.More than three-quarters of diabetics live in low- and middle-income countries. Market Opportunities: Healthcare has advanced significantly in developing countries, with the increase in government funding, patient awareness, and increasing disposable income, people have increased access to healthcare facilities, which may fuel the blood glucose monitoring market in the forecast period. Historically speaking, blood glucose monitoring in the developing world has followed the patterns of the industrialized world with a lapse in time, which varies from place to place. The rising trend in the prevalence of diabetes, in both developed and developing countries, may help the diabetes care market to grow, in turn, driving the self-blood glucose monitoring and continuous glucose monitoring market. Rapidly transforming healthcare in developing countries and the need for better diagnostics technology give wide opportunities to the players in the blood glucose monitoring market. Buy this Complete Business Research Report @ https://www.coherentmarketinsights.com/insight/buy-now/6124 Market Trends: Increasing demand for demand for point-of-care testing across the globe is one of the key trends expected to augment the growth of the global blood glucose test strips market. Point-of-care testing enables rapid on-site blood level analysis without the need for glucose processing in a lab, providing actual, timely results. The benefits of this approach, which include convenience, faster response times, and immediate adjustments to diabetes management strategies, are multiple. The popularity of point-of-care tests stems from their ability to provide quick and accurate results. Market Restraints: The more significant technology trends in the emergence, like patch pump and glucose sensing lens, are expected to take place in the near future. Scientists have designed a smart contact lens to measure the wearer’s blood sugar, without using a needle, which is expected to change the scenario of the blood glucose monitoring market gradually, this is expected to hamper growth of the global blood glucose test strips market in near future. For instance, GlucoTrack is a non-invasive intermittent glucose monitoring device for home-use. The sensor is placed on the ear lobe and display the reading on the device. These devices eliminates the need of test strip and it may capture the market share of glucometer market Competitive Landscape: Major players operating in the global Blood Glucose Test Strips market include Abbott, F. Hoffmann-La Roche Ltd, Johnson & Johnson, ARKRAY, Inc., Ascensia Diabetes Care Holdings AG, AgaMatrix, Bionime Corporation, ACON Laboratories, Inc., MEDISANA GMBH, Tividia Health, Inc., Rossmax International Ltd, among others. Ask for Customization @ https://www.coherentmarketinsights.com/insight/request-customization/6124 Detailed Segmentation: Global Blood Glucose Test Strip Market, By Material Type: Thin Film Electrochemical Films Thick Film Electrochemical Films Optical strips Global Blood Glucose Test Strip Market, By Technology: Glucose Oxidase Glucose Dehydrogenase Global Blood Glucose Test Strip Market, By Application: Type I Diabetes Type II Diabetes Global Blood Glucose Test Strip Market, By End User: Hospitals Home Care Settings Diagnostic Laboratories Others (Research and Academic Institutions, etc.) Global Blood Glucose Test Strip Market, By Geography: North America U.S. Canada Latin America Brazil Mexico Rest of Latin America Europe Germany U.K. Spain France Italy Russia Rest of Europe Asia Pacific China India Japan Australia South Korea Rest of Asia Pacific Middle East & Africa South Africa GCC Countries Rest of Middle East & Africa Find more related trending reports below: Diabetes Monitoring Devices Market, by Product Type (Self-Glucose Monitoring Devices, and Continuous Glucose Monitoring Devices), by Indication (Type-I Diabetes, Type-II Diabetes, and Gestational Diabetes), by Approach (Invasive and Non-invasive), by End User (Hospitals, Clinics, Ambulatory Surgical Centers, Home Care Centers, and Self-Care), and by Region – Global Trends, and Forecast to 2025 Continuous Glucose Monitoring Devices Market, By Component (Sensors, Transmitters, and Receivers), By End User (Hospitals, Home care, and Others), By Region (North America, Latin America, Europe, Middle East & Africa, and Asia Pacific) Non-Invasive Blood Glucose Monitoring Devices Market, By Technology (Optical, Transdermal, Enzymatic, and Others), By Modality (Wearable, and Non-wearable), By End User (Hospitals, Home Care Settings, and Clinics), and By Region (North America, Latin America, Europe, Asia Pacific, Middle East, and Africa) – Size, Share, Outlook and Opportunity Analysis 2018-2026 Glucose Sensor Market, by Product Type (Non-invasive (Optical Sensors and Transdermal Sensors), Invasive (Intravenous Implantable, Micro Dialysis, and Subcutaneous Sensor), and

Persistent CMV pneumonitis in HIV infection: a case report

A 39-year-old male was hospitalized for one month at an outside hospital with acute respiratory failure which required high flow oxygen supplementation. He was diagnosed with HIV with a CD4 cell count of 36 cells/µL. His risk factors included sex with men and women. Patient was not vaccinated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was also diagnosed with CMV DNAemia of 200,000 copies/mL in plasma and presumed Pneumocystis jirovecii (PJP) pneumonia given consistent imaging findings and a positive beta-D-glucan result. Sputum Pneumocystis Calcofluor white smear was negative, and the patient deferred bronchoscopy. He was treated for CMV DNAemia with intravenous ganciclovir for 3–4 weeks before transitioning to oral valganciclovir. He was also treated for PJP pneumonia with steroids and trimethoprim-sulfamethoxazole until developing hyperkalemia and transitioned to pentamidine to complete treatment. He was started on antiretroviral therapy (ART) with bictegravir/emtricitabine/tenofovir alafenamide. He was discharged on ART, valganciclovir, and prophylactic dapsone for PJP pneumonia prevention. Fig. 1 Coronal CT image shows bilateral peri-broncho-vascular nodules and ground glass opacities Full size image Four months after discharge from the outside hospital, the patient presented to the emergency department in the summer of 2022 with a dry cough for 3 weeks accompanied by intermittent fever, chills, night sweats, dysphagia, and diarrhea. He also had unintentional weight loss of 15 pounds over the last month. He had not been taking his medications for the last month and had been lost to follow up. Patient was raised in Mexico, but had no other recent travel, animal exposures, or current partners. On physical examination, his temperature was 37.8 C°, heart rate of 128 beats per minute, and a respiration rate of 26 breaths per minute with pulse oxygenation of 94%. The patient was diaphoretic but in no acute distress. Other findings were notable for oropharyngeal white patches, bilateral coarse breath sounds, and multiple flesh colored umbilicated papules on the left thorax. The exam was negative for hepatosplenomegaly or lymphadenopathy. On admission, chest x-ray revealed an ill-defined focal hazy opacity of the right lateral middle lung with a computerized tomography (CT) scan subsequently showing extensive areas of bilateral tree-in-bud infiltrate with scattered ground glass and consolidative opacities (Figs. 1, 2 and 3). Labs confirmed advanced HIV with CD4 of 6 cells/µL and a HIV viral load of > 800,000 copies/mL. He was found to be positive for SARS-CoV-2 by polymerase chain reaction (PCR). Plasma CMV PCR was elevated at 3.9 million copies/mL. Fig. 2 Axial CT image demonstrates nodules in peripheral aspects of right upper and left upper lobes Full size image Coronavirus disease 2019 (COVID-19) treatment was deferred as the patient presented with subacute symptoms for several weeks prior to arrival without initial hypoxemia. The patient was started on empiric typical and atypical bacterial pneumonia treatment with vancomycin, cefepime, and doxycycline. He also started PJP treatment with trimethoprim-sulfamethoxazole. Additionally, the patient was started on fluconazole for presumed Candida esophagitis. However, during his admission, the patient developed worsening oxygen requirements and persistent fevers. CT angiogram did not show evidence of pulmonary embolism. C-reactive protein was elevated at 1.7 mg/dL and ferritin was 4,003 ng/mL. Bronchoalveolar lavage (BAL) was performed including viral culture which was positive for CMV. SARS-CoV-2 specific testing was not performed on the BAL fluid, and it is not routinely recovered from the cell lines used for viral culture at the reference laboratory. AFB culture was also performed on the BAL which later grew Mycobacterium avium complex (MAC). Transbronchial biopsies taken demonstrated pneumonitis with numerous enlarged, virally infected cells with both cytoplasmic and large nuclear inclusions. These findings were diagnostic of CMV pneumonitis (Fig. 4). Immunostaining confirmed numerous, scattered positive cells for CMV (Fig. 4B and D) whereas stains for acid fast bacilli and fungi were negative. The patient was initiated on intravenous ganciclovir for CMV pneumonitis. Dilated ophthalmologic exam did not reveal retinitis. The patient’s fevers, dyspnea, and cough resolved over the next seven days, and he was transitioned to oral valganciclovir. Of note, the MAC isolated on BAL was not treated due to patient’s improvement on other therapy. Fig. 3 Axial CT image demonstrates nodules and consolidative opacities in right middle lobe and posterior left lung base Full size image Fig. 4 Histopathologic and immunohistochemical evaluation of transbronchial biopsy. A) Fragment of lung tissue with scattered enlarged cells (small arrowheads) with cytologic features diagnostic for CMV infection in a background of pneumonitis (100x magnification, H&E). B) Immunohistochemical confirmation using antibodies to CMV that are binding to enlarged cells (strong nuclear staining) scattered throughout the biopsy (100x magnification, CMV IHC). C) Multiple enlarged cells (arrowheads), some with characteristic nuclear inclusions in a background of reactive and inflamed lung parenchyma (400x magnification, H&E). D) CMV immunohistochemical staining with strong positivity in the nuclei and scattered positivity in the cytoplasm of the same cells (400x magnification, CMV IHC) Full size image The patient was prescribed a 21-day course of valganciclovir. At outpatient follow up, he reported doing well and was finishing his CMV therapy. On that visit, he was reinitiated on ART with abacavir/dolutegravir/lamivudine. He presented again 2 months after initial presentation with dyspnea and fevers, requiring readmission to the hospital. A repeat CT revealed resolution of the majority of nodular opacities and residual ground glass opacities (Fig. 5), but his CMV PCR showed a plasma level of 5 million copies/mL. Patient’s SARS-CoV-2 by PCR testing was persistently positive, which seemed to indicate inability to clear the virus versus a continued active infection. He was briefly treated with intravenous foscarnet given initial concern for ganciclovir resistance; however, the mutational analysis for ganciclovir, cidofovir, and foscarnet resistance was negative with codons 457–630 of UL97 gene and codons 393–1000 of UL54 gene sequencing. Repeat CD4 was < 10 cells/µL and HIV viral load was 6 million copies/mL concerning for non-adherence to ART. The patient was switched back to intravenous ganciclovir and then to oral valganciclovir with symptomatic improvement. Fig. 5 Coronal CT image obtained 3 months later with resolution of majority of the nodular opacities with