1 6669 104 URIC ACID IN METABOLIC SYNDROME: DOES URIC ACID HAVE A DEFINITIVE ROLE? INCREASED SERUM URIC ACID (SUA) LEVELS ARE COMMONLY SEEN IN PATIENTS WITH METABOLIC SYNDROME AND ARE WIDELY ACCEPTED AS RISK FACTORS FOR HYPERTENSION, GOUT, NON-ALCOHOLIC FATTY LIVER DISEASE, CHRONIC KIDNEY DISEASE (CKD), AND CARDIOVASCULAR DISEASES. ALTHOUGH SOME AMBIGUITY FOR THE EXACT ROLE OF URIC ACID (UA) IN THESE DISEASES IS STILL PRESENT, SEVERAL PATHOPHYSIOLOGICAL MECHANISMS HAVE BEEN IDENTIFIED SUCH AS INCREASED OXIDATIVE STRESS, INFLAMMATION, AND APOPTOSIS. ACCUMULATING EVIDENCE IN GENOMICS ENLIGHTENS GENETIC VARIABILITIES AND SOME EPIGENETIC CHANGES THAT CAN CONTRIBUTE TO HYPERURICEMIA. HERE WE DISCUSS THE ROLE OF UA WITHIN METABOLISM AND THE CONSEQUENCES OF ASYMPTOMATIC HYPERURICEMIA WHILE PROVIDING NEWFOUND EVIDENCE FOR THE ASSOCIATIONS BETWEEN UA AND GUT MICROBIOTA AND VITAMIN D. INCREASED SUA LEVELS AND BENEFICIAL EFFECTS OF LOWERING SUA LEVELS NEED TO BE ELUCIDATED MORE TO UNDERSTAND ITS COMPLICATED FUNCTION WITHIN DIFFERENT METABOLIC PATHWAYS AND SET OPTIMAL TARGET LEVELS FOR SUA FOR REDUCING RISKS FOR METABOLIC AND CARDIOVASCULAR DISEASES. 2022 2 537 31 ASYMPTOMATIC HYPERURICEMIA: IS IT REALLY ASYMPTOMATIC? PURPOSE OF REVIEW: HYPERURICEMIA IS HIGHLY PREVALENT, AFFECTING APPROXIMATELY 38 MILLION INDIVIDUALS IN THE UNITED STATES. HOWEVER, THE SIGNIFICANCE OF ASYMPTOMATIC HYPERURICEMIA - HYPERURICEMIA IN THE ABSENCE OF GOUT - CONTINUES TO BE DEBATED. RECENT FINDINGS: ASYMPTOMATIC HYPERURICEMIA RESULTS IN MONOSODIUM URATE CRYSTAL DEPOSITION IN TISSUES, WHICH MAY PROMOTE CHRONIC INFLAMMATION. INTRACELLULARLY, HYPERURICEMIA INHIBITS THE MASTER REGULATOR ADENOSINE MONOPHOSPHATE (AMP)-ASSOCIATED PROTEIN KINASE AND MAY CONDITION INNATE IMMUNE RESPONSES THROUGH DURABLE EPIGENETIC MODIFICATIONS. AT THE POPULATION LEVEL, ASYMPTOMATIC HYPERURICEMIA IS ASSOCIATED WITH MULTIPLE COMORBIDITIES, INCLUDING HYPERTENSION, CHRONIC KIDNEY DISEASE, CORONARY ARTERY DISEASE, AND DIABETES; LIMITATIONS OF THESE STUDIES INCLUDE THAT MOST ARE RETROSPECTIVE AND SOME DO NOT RIGOROUSLY DISTINGUISH BETWEEN ASYMPTOMATIC HYPERURICEMIA AND GOUT. TREATMENT STUDIES SUGGEST THAT URATE LOWERING MAY REDUCE THE RISK OF INCIDENCE OR PROGRESSION OF SOME OF THESE COMORBIDITIES; UNFORTUNATELY, MANY OF THESE TREATMENT STUDIES ARE SMALL OR FLAWED, AND NOT ALL STUDY RESULTS ARE CONSISTENT. SUMMARY: ACCUMULATING EVIDENCE SUGGESTS THAT ASYMPTOMATIC HYPERURICEMIA CONTRIBUTES TO THE COMORBIDITIES WITH WHICH IT ASSOCIATES AND THAT PROPER ASYMPTOMATIC HYPERURICEMIA TREATMENT MAY REDUCE FUTURE RISK. ADDITIONAL PROSPECTIVE TRIALS ARE NEEDED TO DEFINITELY ESTABLISH CAUSALITY AND SUPPORT DECISION-MAKING AS TO WHETHER, AND WHICH PATIENTS WITH ASYMPTOMATIC HYPERURICEMIA WOULD WARRANT URATE-LOWERING TREATMENT. 2020 3 3701 28 INFLAMMATORY RESPONSE TO REGULATED CELL DEATH IN GOUT AND ITS FUNCTIONAL IMPLICATIONS. GOUT, A CHRONIC INFLAMMATORY ARTHRITIS DISEASE, IS CHARACTERIZED BY HYPERURICEMIA AND CAUSED BY INTERACTIONS BETWEEN GENETIC, EPIGENETIC, AND METABOLIC FACTORS. ACUTE GOUT SYMPTOMS ARE TRIGGERED BY THE INFLAMMATORY RESPONSE TO MONOSODIUM URATE CRYSTALS, WHICH IS MEDIATED BY THE INNATE IMMUNE SYSTEM AND IMMUNE CELLS (E.G., MACROPHAGES AND NEUTROPHILS), THE NACHT, LRR, AND PYD DOMAINS-CONTAINING PROTEIN 3 (NLRP3) INFLAMMASOME ACTIVATION, AND PRO-INFLAMMATORY CYTOKINE (E.G., IL-1BETA) RELEASE. RECENT STUDIES HAVE INDICATED THAT THE MULTIPLE PROGRAMMED CELL DEATH PATHWAYS INVOLVED IN THE INFLAMMATORY RESPONSE INCLUDE PYROPTOSIS, NETOSIS, NECROPTOSIS, AND APOPTOSIS, WHICH INITIATE INFLAMMATORY REACTIONS. IN THIS REVIEW, WE EXPLORE THE CORRELATION AND INTERACTIONS AMONG THESE FACTORS AND THEIR ROLES IN THE PATHOGENESIS OF GOUT TO PROVIDE FUTURE RESEARCH DIRECTIONS AND POSSIBILITIES FOR IDENTIFYING POTENTIAL NOVEL THERAPEUTIC TARGETS AND ENHANCING OUR UNDERSTANDING OF GOUT PATHOGENESIS. 2022 4 1183 29 CONVERGING RELATIONSHIPS OF OBESITY AND HYPERURICEMIA WITH SPECIAL REFERENCE TO METABOLIC DISORDERS AND PLAUSIBLE THERAPEUTIC IMPLICATIONS. BACKGROUND: OBESITY AND HYPERURICEMIA MUTUALLY INFLUENCE METABOLIC SYNDROME. THIS STUDY DISCUSSES THE METABOLIC RELATIONSHIPS BETWEEN OBESITY AND HYPERURICEMIA IN TERMS OF PATHOPHYSIOLOGY, COMPLICATIONS, AND TREATMENTS. METHODS: WE SEARCHED FOR PRECLINICAL OR CLINICAL STUDIES ON THE PATHOPHYSIOLOGY, COMPLICATIONS, AND THERAPY OF OBESITY AND HYPERURICEMIA ON THE PUBMED DATABASE. RESULTS: IN THIS SYSTEMIC REVIEW, WE SUMMARIZED OUR SEARCHING RESULTS ON TOPICS OF PATHOPHYSIOLOGY, COMPLICATIONS AND THERAPEUTIC STRATEGY. IN PATHOPHYSIOLOGY, WE FIRSTLY INTRODUCE GENETIC VARIATIONS FOR OBESITY, HYPERURICEMIA AND THEIR RELATIONSHIPS BY GENETIC STUDIES. SECONDLY, WE TALK ABOUT THE EPIGENETIC INFLUENCES ON OBESITY AND HYPERURICEMIA. THIRDLY, WE DESCRIBE THE CENTRAL METABOLIC REGULATION AND THE ROLE OF HYPERURICEMIA. THEN, WE REFER TO THE CHARACTER OF ADIPOSE TISSUE INFLAMMATION AND OXIDATIVE STRESS IN THE OBESITY AND HYPERURICEMIA. IN THE LAST PART OF THIS TOPIC, WE REVIEWED THE CRITICAL LINKS OF GUT MICROBIOTA IN THE OBESITY AND HYPERURICEMIA. IN THE FOLLOWING PART, WE REVIEW THE PATHOPHYSIOLOGY OF MAJOR COMPLICATIONS IN OBESITY AND HYPERURICEMIA INCLUDING INSULIN RESISTANCE AND TYPE 2 DIABETES MELLITUS, CHRONIC KIDNEY DISEASE, CARDIOVASCULAR DISEASES, AND CANCERS. FINALLY, WE RECAPITULATE THE THERAPEUTIC STRATEGIES ESPECIALLY THE NOVEL PHARMACEUTIC INTERVENTIONS FOR OBESITY AND HYPERURICEMIA, WHICH CONCURRENTLY SHOW THE MUTUAL METABOLIC INFLUENCES BETWEEN TWO DISEASES. CONCLUSION: THE DATA REVIEWED HERE DELINEATE THE METABOLIC RELATIONSHIPS BETWEEN OBESITY AND HYPERURICEMIA, AND PROVIDE A COMPREHENSIVE OVERVIEW OF THE THERAPEUTIC TARGETS FOR THE MANAGEMENT OF METABOLIC SYNDROMES. 2020 5 6667 36 URATE-INDUCED IMMUNE PROGRAMMING: CONSEQUENCES FOR GOUTY ARTHRITIS AND HYPERURICEMIA. TRAINED IMMUNITY IS A PROCESS IN WHICH INNATE IMMUNE CELLS UNDERGO FUNCTIONAL REPROGRAMMING IN RESPONSE TO PATHOGENS OR DAMAGE-ASSOCIATED MOLECULES LEADING TO AN ENHANCED NON-SPECIFIC IMMUNE RESPONSE TO SUBSEQUENT STIMULATION. WHILE THIS CAPACITY TO RESPOND MORE STRONGLY TO STIMULI IS BENEFICIAL FOR HOST DEFENSE, IN SOME CIRCUMSTANCES IT CAN LEAD TO MALADAPTIVE PROGRAMMING AND CHRONIC INFLAMMATION. GOUT IS CHARACTERIZED BY PERSISTENT LOW-GRADE INFLAMMATION AND IS ASSOCIATED WITH AN INCREASED NUMBER OF COMORBIDITIES. HYPERURICEMIA IS THE MAIN RISK FACTOR FOR GOUT AND IS LINKED TO THE DEVELOPMENT OF COMORBIDITIES. SEVERAL EXPERIMENTAL STUDIES HAVE SHOWN THAT URATE CAN MECHANISTICALLY ALTER THE INFLAMMATORY CAPACITY OF MYELOID CELLS, WHILE OBSERVATIONAL STUDIES HAVE INDICATED AN ASSOCIATION OF HYPERURICEMIA TO A WIDE SPECTRUM OF COMMON ADULT INFLAMMATORY DISEASES. IN THIS REVIEW, WE ARGUE THAT HYPERURICEMIA IS A MAIN CULPRIT IN THE DEVELOPMENT OF THE LONG-TERM SYSTEMIC INFLAMMATION SEEN IN GOUT. WE REVISIT EXISTING EVIDENCE FOR URATE-INDUCED TRANSCRIPTIONAL AND EPIGENETIC REPROGRAMMING THAT COULD LEAD TO AN ALTERED FUNCTIONAL STATE OF CIRCULATING MONOCYTES CONSISTING IN ENHANCED RESPONSIVENESS AND MALADAPTIVE IMMUNE RESPONSES. BY DISCUSSING SPECIFIC FUNCTIONAL ADAPTATIONS OF MONOCYTES AND MACROPHAGES INDUCED BY SOLUBLE URATE OR MONOSODIUM URATE CRYSTALS AND THEIR CONTRIBUTION TO INFLAMMATION IN VITRO AND IN VIVO, WE FURTHER ENFORCE THAT URATE IS A METABOLITE THAT CAN INDUCE INNATE IMMUNE MEMORY AND WE DISCUSS FUTURE RESEARCH AND POSSIBLE NEW THERAPEUTIC APPROACHES FOR GOUT AND ITS COMORBIDITIES. 2020 6 6891 19 [SIGNAL RECEPTORS OF CONGENITAL IMMUNITY: A NEW MOLECULAR TARGET FOR DIAGNOSTICS AND TREATMENT OF INFLAMMATORY DISEASES]. THE DISCOVERY OF SIGNAL RECEPTORS OF CONGENITAL IMMUNITY (SIGNAL PRR) NOT ONLY PROVIDED A NOVEL VIEW OF BASIC ASPECTS OF PATHOGENESIS OF CHRONIC INFLAMMATORY DISEASES BUT ALSO CREATED A BASIS FOR THE DEVELOPMENT OF ADDITIONAL DIAGNOSTIC CRITERIA FOR THESE PATHOLOGIES AND NEW PHARMACEUTICALS FOR THEIR TREATMENT. REDUCED EXPRESSION AND FUNCTION OF PRR DUE TO MUTATIONS/POLYMORPHISMS OR EPIGENETIC DISTURBANCES OF REGULATION CAN BE REGARDED AS IMMUNODEFICIENT CONDITIONS MANIFEST AS SEVERE INFECTIOUS INFLAMMATORY DISEASES. IN CONTRAST, EXCESSIVE EXPRESSION AND ACTIVATION OF PRR AS A RULE LEADS TO CHRONIC AUTOINFLAMMATORY, AUTOIMMUNE, AND ATOPIC DISEASES INVOLVING ADAPTIVE IMMUNITY AND AGGRESSION AGAINST OWN TISSUES AND CELLS. ASSESSMENT OF CERTAIN MUTATIONS IN PRR GENES, THEIR EXPRESSION AND ACTIVATION PROVIDES A POWERFUL TOOL FOR IN-DEPTH DIAGNOSTICS OF INFLAMMATORY DISEASES. SIMULTANEOUSLY, NEW LINES OF IMMUNOSTIMULATING AND ANTI-INFLAMMATORY THERAPY ARE DEVELOPED BASED ON THE KNOWLEDGE OF MOLECULAR PHYSIOLOGY OF PRR WITH THE USE OF SYNTHETIC AGONISTS AND ANTAGONISTS OF SIGNAL PRR. 2011 7 5760 31 SOLUBLE URIC ACID PRIMES TLR-INDUCED PROINFLAMMATORY CYTOKINE PRODUCTION BY HUMAN PRIMARY CELLS VIA INHIBITION OF IL-1RA. OBJECTIVES: THE STUDY OF THE PROINFLAMMATORY ROLE OF URIC ACID HAS FOCUSED ON THE EFFECTS OF ITS CRYSTALS OF MONOSODIUM URATE (MSU). HOWEVER, LITTLE IS KNOWN WHETHER URIC ACID ITSELF CAN DIRECTLY HAVE PROINFLAMMATORY EFFECTS. IN THIS STUDY, WE INVESTIGATE THE PRIMING EFFECTS OF URIC ACID EXPOSURE ON THE CYTOKINE PRODUCTION OF PRIMARY HUMAN CELLS UPON STIMULATION WITH GOUT-RELATED STIMULI. METHODS: PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMCS) WERE HARVESTED FROM PATIENTS WITH GOUT AND HEALTHY VOLUNTEERS. CELLS WERE PRETREATED WITH OR WITHOUT URIC ACID IN SOLUBLE FORM FOR 24 H AND THEN STIMULATED FOR 24 H WITH TOLL-LIKE RECEPTOR (TLR)2 OR TLR4 LIGANDS IN THE PRESENCE OR ABSENCE OF MSU CRYSTALS. CYTOKINE PRODUCTION WAS MEASURED BY ELISA; MRNA LEVELS WERE ASSESSED USING QPCR. RESULTS: THE PRODUCTION OF INTERLEUKIN (IL)-1BETA AND IL-6 WAS HIGHER IN PATIENTS COMPARED WITH CONTROLS AND THIS CORRELATED WITH SERUM URATE LEVELS. PROINFLAMMATORY CYTOKINE PRODUCTION WAS SIGNIFICANTLY POTENTIATED WHEN CELLS FROM HEALTHY SUBJECTS WERE PRETREATED WITH URIC ACID. SURPRISINGLY, THIS WAS ASSOCIATED WITH A SIGNIFICANT DOWNREGULATION OF THE ANTI-INFLAMMATORY CYTOKINE IL-1 RECEPTOR ANTAGONIST (IL-1RA). THIS EFFECT WAS SPECIFIC TO STIMULATION BY URIC ACID AND WAS EXERTED AT THE LEVEL OF GENE TRANSCRIPTION. EPIGENETIC REPROGRAMMING AT THE LEVEL OF HISTONE METHYLATION BY URIC ACID WAS INVOLVED IN THIS EFFECT. CONCLUSIONS: IN THIS STUDY WE DEMONSTRATE A MECHANISM THROUGH WHICH HIGH CONCENTRATIONS OF URIC ACID (UP TO 50 MG/DL) INFLUENCE INFLAMMATORY RESPONSES BY FACILITATING IL-1BETA PRODUCTION IN PBMCS. WE SHOW THAT A MECHANISM FOR THE AMPLIFICATION OF IL-1BETA CONSISTS IN THE DOWNREGULATION OF IL-1RA AND THAT THIS EFFECT COULD BE EXERTED VIA EPIGENETIC MECHANISMS SUCH AS HISTONE METHYLATION. HYPERURICAEMIA CAUSES A SHIFT IN THE IL-1BETA/IL-1RA BALANCE PRODUCED BY PBMCS AFTER EXPOSURE TO MSU CRYSTALS AND TLR-MEDIATED STIMULI, AND THIS PHENOMENON IS LIKELY TO REINFORCE THE ENHANCED STATE OF CHRONIC INFLAMMATION. 2016 8 6725 36 VITAMIN D: NOT JUST BONE METABOLISM BUT A KEY PLAYER IN CARDIOVASCULAR DISEASES. VITAMIN D IS THE FIRST ITEM OF DRUG EXPENDITURE FOR THE TREATMENT OF OSTEOPOROSIS. ITS DEFICIENCY IS A CONDITION THAT AFFECTS NOT ONLY OLDER INDIVIDUALS BUT ALSO YOUNG PEOPLE. RECENTLY, THE SCIENTIFIC COMMUNITY HAS FOCUSED ITS ATTENTION ON THE POSSIBLE ROLE OF VITAMIN D IN THE DEVELOPMENT OF SEVERAL CHRONIC DISEASES SUCH AS CARDIOVASCULAR AND METABOLIC DISEASES. THIS REVIEW AIMS TO HIGHLIGHT THE POSSIBLE ROLE OF VITAMIN D IN CARDIOVASCULAR AND METABOLIC DISEASES. IN PARTICULAR, HERE WE EXAMINE (1) THE ROLE OF VITAMIN D IN DIABETES MELLITUS, METABOLIC SYNDROME, AND OBESITY, AND ITS INFLUENCE ON INSULIN SECRETION; (2) ITS ROLE IN ATHEROSCLEROSIS, IN WHICH CHRONIC VITAMIN D DEFICIENCY, LOWER THAN 20 NG/ML (50 NMOL/L), HAS EMERGED AMONG THE NEW RISK FACTORS; (3) THE ROLE OF VITAMIN D IN ESSENTIAL HYPERTENSION, IN WHICH LOW PLASMA LEVELS OF VITAMIN D HAVE BEEN ASSOCIATED WITH BOTH AN INCREASE IN THE PREVALENCE OF HYPERTENSION AND DIASTOLIC HYPERTENSION; (4) THE ROLE OF VITAMIN D IN PERIPHERAL ARTERIOPATHIES AND ANEURYSMAL PATHOLOGY, REPORTING THAT PATIENTS WITH PERIPHERAL ARTERY DISEASES HAD LOWER VITAMIN D VALUES THAN NON-SUFFERING PAD CONTROLS; (5) THE GENETIC AND EPIGENETIC ROLE OF VITAMIN D, HIGHLIGHTING ITS TRANSCRIPTIONAL REGULATION CAPACITY; AND (6) THE ROLE OF VITAMIN D IN CARDIAC REMODELING AND DISEASE. DESPITE THE MANY OBSERVATIONAL STUDIES AND META-ANALYSES SUPPORTING THE CRITICAL ROLE OF VITAMIN D IN CARDIOVASCULAR PHYSIOPATHOLOGY, CLINICAL TRIALS DESIGNED TO EVALUATE THE SPECIFIC ROLE OF VITAMIN D IN CARDIOVASCULAR DISEASE ARE SCARCE. THE CHARACTERIZATION OF THE IMPORTANCE OF VITAMIN D AS A MARKER OF PATHOLOGY SHOULD REPRESENT A FUTURE RESEARCH CHALLENGE. 2021 9 6259 26 THE MOLECULAR MECHANISMS BY WHICH VITAMIN D PREVENTS INSULIN RESISTANCE AND ASSOCIATED DISORDERS. NUMEROUS STUDIES HAVE SHOWN THAT VITAMIN D DEFICIENCY IS VERY COMMON IN MODERN SOCIETIES AND IS PERCEIVED AS AN IMPORTANT RISK FACTOR IN THE DEVELOPMENT OF INSULIN RESISTANCE AND RELATED DISEASES SUCH AS OBESITY AND TYPE 2 DIABETES (T2DM). WHILE IT IS GENERALLY ACCEPTED THAT VITAMIN D IS A REGULATOR OF BONE HOMEOSTASIS, ITS ABILITY TO COUNTERACT INSULIN RESISTANCE IS SUBJECT TO DEBATE. THE GOAL OF THIS COMMUNICATION IS TO REVIEW THE MOLECULAR MECHANISM BY WHICH VITAMIN D REDUCES INSULIN RESISTANCE AND RELATED COMPLICATIONS. THE UNIVERSITY LIBRARY, PUBMED, AND GOOGLE SCHOLAR WERE SEARCHED TO FIND RELEVANT STUDIES TO BE SUMMARIZED IN THIS REVIEW ARTICLE. INSULIN RESISTANCE IS ACCOMPANIED BY CHRONIC HYPERGLYCAEMIA AND INFLAMMATION. RECENT STUDIES HAVE SHOWN THAT VITAMIN D EXHIBITS INDIRECT ANTIOXIDATIVE PROPERTIES AND PARTICIPATES IN THE MAINTENANCE OF NORMAL RESTING ROS LEVEL. APPEALINGLY, VITAMIN D REDUCES INFLAMMATION AND REGULATES CA(2+) LEVEL IN MANY CELL TYPES. THEREFORE, THE BENEFICIAL ACTIONS OF VITAMIN D INCLUDE DIMINISHED INSULIN RESISTANCE WHICH IS OBSERVED AS AN IMPROVEMENT OF GLUCOSE AND LIPID METABOLISM IN INSULIN-SENSITIVE TISSUES. 2020 10 1388 28 DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE: NON-INVASIVE ASSESSMENT OF CARDIOVASCULAR RISK. THE PREVALENCE AND BURDEN OF DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE ON GLOBAL HEALTH AND SOCIOECONOMIC DEVELOPMENT IS ALREADY HEAVY AND STILL RISING. DIABETES MELLITUS BY ITSELF IS LINKED TO ADVERSE CARDIOVASCULAR EVENTS, AND THE PRESENCE OF CONCOMITANT CHRONIC KIDNEY DISEASE FURTHER AMPLIFIES CARDIOVASCULAR RISK. THE CULMINATION OF TRADITIONAL (MALE GENDER, SMOKING, ADVANCED AGE, OBESITY, ARTERIAL HYPERTENSION AND DYSLIPIDEMIA) AND NON-TRADITIONAL RISK FACTORS (ANEMIA, INFLAMMATION, PROTEINURIA, VOLUME OVERLOAD, MINERAL METABOLISM ABNORMALITIES, OXIDATIVE STRESS, ETC.) CONTRIBUTES TO ADVANCED ATHEROSCLEROSIS AND INCREASED CARDIOVASCULAR RISK. TO DECREASE THE MORBIDITY AND MORTALITY OF THESE PATIENTS DUE TO CARDIOVASCULAR CAUSES, TIMELY AND EFFICIENT CARDIOVASCULAR RISK ASSESSMENT IS OF HUGE IMPORTANCE. CARDIOVASCULAR RISK ASSESSMENT CAN BE BASED ON LABORATORY PARAMETERS, IMAGING TECHNIQUES, ARTERIAL STIFFNESS PARAMETERS, ANKLE-BRACHIAL INDEX AND 24 H BLOOD PRESSURE MEASUREMENTS. NEWER METHODS INCLUDE EPIGENETIC MARKERS, SOLUBLE ADHESION MOLECULES, CYTOKINES AND MARKERS OF OXIDATIVE STRESS. IN THIS REVIEW, THE AUTHORS PRESENT SEVERAL NON-INVASIVE METHODS OF CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE. 2021 11 3793 33 INTERLEUKIN-22 IN ALCOHOLIC HEPATITIS AND BEYOND. ALCOHOLIC HEPATITIS (AH) IS A CLINICAL SYNDROME CHARACTERIZED BY JAUNDICE AND PROGRESSIVE INFLAMMATORY LIVER INJURY IN PATIENTS WITH A HISTORY OF PROLONGED PERIODS OF EXCESS ALCOHOL CONSUMPTION AND RECENT HEAVY ALCOHOL ABUSE. SEVERE AH IS A LIFE-THREATENING FORM OF ALCOHOL-ASSOCIATED LIVER DISEASE WITH A HIGH SHORT-TERM MORTALITY RATE AROUND 30-50% AT ONE MONTH FROM THE INITIAL PRESENTATION. A LARGE NUMBER OF PRO-INFLAMMATORY MEDIATORS, METABOLIC PATHWAYS, TRANSCRIPTIONAL FACTORS AND EPIGENETIC FACTORS HAVE BEEN SUGGESTED TO BE ASSOCIATED WITH THE DEVELOPMENT AND PROGRESSION OF AH. SEVERAL FACTORS MAY CONTRIBUTE TO LIVER FAILURE AND MORTALITY IN PATIENTS WITH SEVERE AH INCLUDING HEPATOCYTE DEATH, INFLAMMATION, AND IMPAIRED LIVER REGENERATION. ALTHOUGH THE PATHOGENESES OF AH HAVE BEEN EXTENSIVELY INVESTIGATED AND MANY THERAPEUTIC TARGETS HAVE BEEN IDENTIFIED OVER THE LAST FIVE DECADES, NO NEW DRUGS FOR AH HAVE BEEN SUCCESSFULLY DEVELOPED. IN THIS REVIEW, WE DISCUSS INTERLEUKIN-22 (IL-22) BIOLOGY AND ITS ROLES OF ANTI-APOPTOSIS, ANTI-FIBROSIS, ANTI-OXIDATION, ANTI-BACTERIAL INFECTION AND REGENERATIVE STIMULATION IN PROTECTING AGAINST LIVER INJURY IN MANY PRECLINICAL MODELS INCLUDING SEVERAL RECENTLY DEVELOPED MODELS SUCH AS CHRONIC-PLUS-BINGE ETHANOL FEEDING, ACUTE-ON-CHRONIC LIVER FAILURE, C-X-C MOTIF CHEMOKINE LIGAND 1 PLUS HIGH-FAT DIET-INDUCED NONALCOHOLIC STEATOHEPATITIS. FINALLY, CLINICAL TRIALS OF IL-22 FOR THE TREATMENT OF AH ARE ALSO DISCUSSED, WHICH SHOWED SOME PROMISING BENEFITS FOR AH PATIENTS. 2020 12 6067 36 THE DIABETES MELLITUS-ATHEROSCLEROSIS CONNECTION: THE ROLE OF LIPID AND GLUCOSE METABOLISM AND CHRONIC INFLAMMATION. DIABETES MELLITUS COMPRISES A GROUP OF CARBOHYDRATE METABOLISM DISORDERS THAT SHARE A COMMON MAIN FEATURE OF CHRONIC HYPERGLYCEMIA THAT RESULTS FROM DEFECTS OF INSULIN SECRETION, INSULIN ACTION, OR BOTH. INSULIN IS AN IMPORTANT ANABOLIC HORMONE, AND ITS DEFICIENCY LEADS TO VARIOUS METABOLIC ABNORMALITIES IN PROTEINS, LIPIDS, AND CARBOHYDRATES. ATHEROSCLEROSIS DEVELOPS AS A RESULT OF A MULTISTEP PROCESS ULTIMATELY LEADING TO CARDIOVASCULAR DISEASE ASSOCIATED WITH HIGH MORBIDITY AND MORTALITY. ALTERATION OF LIPID METABOLISM IS A RISK FACTOR AND CHARACTERISTIC FEATURE OF ATHEROSCLEROSIS. POSSIBLE LINKS BETWEEN THE TWO CHRONIC DISORDERS DEPENDING ON ALTERED METABOLIC PATHWAYS HAVE BEEN INVESTIGATED IN NUMEROUS STUDIES. IT WAS SHOWN THAT BOTH TYPES OF DIABETES MELLITUS CAN ACTUALLY INDUCE ATHEROSCLEROSIS DEVELOPMENT OR FURTHER ACCELERATE ITS PROGRESSION. ELEVATED GLUCOSE LEVEL, DYSLIPIDEMIA, AND OTHER METABOLIC ALTERATIONS THAT ACCOMPANY THE DISEASE DEVELOPMENT ARE TIGHTLY INVOLVED IN THE PATHOGENESIS OF ATHEROSCLEROSIS AT ALMOST EVERY STEP OF THE ATHEROGENIC PROCESS. CHRONIC INFLAMMATION IS CURRENTLY CONSIDERED AS ONE OF THE KEY FACTORS IN ATHEROSCLEROSIS DEVELOPMENT AND IS PRESENT STARTING FROM THE EARLIEST STAGES OF THE PATHOLOGY INITIATION. IT MAY ALSO BE REGARDED AS ONE OF THE POSSIBLE LINKS BETWEEN ATHEROSCLEROSIS AND DIABETES MELLITUS. HOWEVER, THE DATA AVAILABLE SO FAR DO NOT ALLOW FOR DEVELOPING EFFECTIVE ANTI-INFLAMMATORY THERAPEUTIC STRATEGIES THAT WOULD STOP ATHEROSCLEROTIC LESION PROGRESSION OR INDUCE LESION REDUCTION. IN THIS REVIEW, WE SUMMARIZE THE MAIN ASPECTS OF DIABETES MELLITUS THAT POSSIBLY AFFECT THE ATHEROGENIC PROCESS AND ITS RELATIONSHIP WITH CHRONIC INFLAMMATION. WE ALSO DISCUSS THE ESTABLISHED PATHOPHYSIOLOGICAL FEATURES THAT LINK ATHEROSCLEROSIS AND DIABETES MELLITUS, SUCH AS OXIDATIVE STRESS, ALTERED PROTEIN KINASE SIGNALING, AND THE ROLE OF CERTAIN MIRNA AND EPIGENETIC MODIFICATIONS. 2020 13 5558 34 ROLE OF GUT MICROBIOTA IN THE AETIOLOGY OF OBESITY: PROPOSED MECHANISMS AND REVIEW OF THE LITERATURE. THE AETIOLOGY OF OBESITY HAS BEEN ATTRIBUTED TO SEVERAL FACTORS (ENVIRONMENTAL, DIETARY, LIFESTYLE, HOST, AND GENETIC FACTORS); HOWEVER NONE OF THESE FULLY EXPLAIN THE INCREASE IN THE PREVALENCE OF OBESITY WORLDWIDE. GUT MICROBIOTA LOCATED AT THE INTERFACE OF HOST AND ENVIRONMENT IN THE GUT ARE A NEW AREA OF RESEARCH BEING EXPLORED TO EXPLAIN THE EXCESS ACCUMULATION OF ENERGY IN OBESE INDIVIDUALS AND MAY BE A POTENTIAL TARGET FOR THERAPEUTIC MANIPULATION TO REDUCE HOST ENERGY STORAGE. SEVERAL MECHANISMS HAVE BEEN SUGGESTED TO EXPLAIN THE ROLE OF GUT MICROBIOTA IN THE AETIOLOGY OF OBESITY SUCH AS SHORT CHAIN FATTY ACID PRODUCTION, STIMULATION OF HORMONES, CHRONIC LOW-GRADE INFLAMMATION, LIPOPROTEIN AND BILE ACID METABOLISM, AND INCREASED ENDOCANNABINOID RECEPTOR SYSTEM TONE. HOWEVER, EVIDENCE FROM ANIMAL AND HUMAN STUDIES CLEARLY INDICATES CONTROVERSIES IN DETERMINING THE CAUSE OR EFFECT RELATIONSHIP BETWEEN THE GUT MICROBIOTA AND OBESITY. METAGENOMICS BASED STUDIES INDICATE THAT FUNCTIONALITY RATHER THAN THE COMPOSITION OF GUT MICROBIOTA MAY BE IMPORTANT. FURTHER MECHANISTIC STUDIES CONTROLLING FOR ENVIRONMENTAL AND EPIGENETIC FACTORS ARE THEREFORE REQUIRED TO HELP UNRAVEL OBESITY PATHOGENESIS. 2016 14 6342 32 THE ROLE OF EPIGENETIC REGULATOR SIRT1 IN BALANCING THE HOMEOSTASIS AND PREVENTING THE FORMATION OF SPECIFIC "SOIL" OF METABOLIC DISORDERS AND RELATED CANCERS. SIRT1 WAS DISCOVERED IN 1979 BUT GROWING INTEREST IN THIS PROTEIN OCCURRED ONLY 20 YEARS LATER WHEN ITS OVEREXPRESSION WAS REPORTED TO PROLONG THE LIFESPAN OF YEAST. SINCE THEN, SEVERAL STUDIES HAVE SHOWN THE BENEFITS OF ITS INCREASED EXPRESSION IN PREVENTING OR DELAYING OF MANY DISEASES. SIRT1, AS A HISTONE DEACETYLASE, IS AN EPIGENETIC REGULATOR BUT IT HAS WIDE RANGE OF NON-HISTONE TARGETS WHICH ARE INVOLVED IN METABOLISM, ENERGY SENSING PATHWAYS, CIRCADIAN MACHINERY AND IN INFLAMMATORY REGULATION. DISTURBANCES IN THESE INTERCONNECTED PROCESSES CAUSE DIFFERENT DISEASES, HOWEVER IT SEEMS THEY HAVE COMMON ROOTS IN UNBALANCED INFLAMMATORY PROCESSES AND LOWER LEVEL OR INACTIVATION OF SIRT1. SIRT1 INACTIVATION WAS IMPLICATED IN CORONAVIRUS DISEASE (COVID-19) SEVERITY AS WELL AND ITS LOW LEVEL COUNTED AS A PREDICTOR OF UNCONTROLLED COVID-19. SEVERAL OTHER DISEASES SUCH AS METABOLIC DISEASE, OBESITY, DIABETES, ALZHEIMER'S DISEASE, CARDIOVASCULAR DISEASE OR DEPRESSION ARE RELATED TO CHRONIC INFLAMMATION AND SIMILARLY SHOW DECREASED SIRT1 LEVEL. IT HAS RECENTLY BEEN KNOWN THAT SIRT1 IS INDUCIBLE BY CALORIE RESTRICTION/PROPER DIET, PHYSICAL ACTIVITY AND APPROPRIATE EMOTIONAL STATE. INDEED, A HEALTHIER METABOLIC STATE BELONGS TO HIGHER LEVEL OF SIRT1 EXPRESSION. THESE SUGGEST THAT APPROPRIATE LIFESTYLE AS NON-PHARMACOLOGICAL TREATMENT MAY BE A BENEFICIAL TOOL IN THE PREVENTION OF INFLAMMATION OR METABOLIC DISTURBANCE-RELATED DISEASES AS WELL AS COULD BE A PART OF THE COMPLEMENTARY THERAPY IN MEDICAL PRACTICE TO REACH BETTER THERAPEUTIC RESPONSE AND QUALITY OF LIFE. WE AIMED IN THIS REVIEW TO LINK THE BENEFICIAL EFFECT OF SIRT1 WITH THOSE DISEASES, WHERE ITS LEVEL DECREASED. MOREOVER, WE AIMED TO COLLECT EVIDENCES OF INTERVENTIONS OR TREATMENTS, WHICH INCREASE SIRT1 EXPRESSION AND THUS, OPEN THE POSSIBILITY TO USE THEM AS PREVENTIVE OR COMPLEMENTARY THERAPIES IN MEDICAL PRACTICE. 2022 15 4152 37 MECHANISTIC INSIGHTS INTO THE PLEIOTROPIC EFFECTS OF BUTYRATE AS A POTENTIAL THERAPEUTIC AGENT ON NAFLD MANAGEMENT: A SYSTEMATIC REVIEW. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS ONE OF THE MOST COMMON CHRONIC DISEASES WORLDWIDE. AS A MULTIFACETED DISEASE, NAFLD'S PATHOGENESIS IS NOT ENTIRELY UNDERSTOOD, BUT RECENT EVIDENCE REVEALS THAT GUT MICROBIOTA PLAYS A SIGNIFICANT ROLE IN ITS PROGRESSION. BUTYRATE, A GUT MICROBIOTA METABOLITE, HAS BEEN REPORTED TO HAVE HEPATO-PROTECTIVE EFFECTS IN NAFLD ANIMAL MODELS. THE PURPOSE OF THIS SYSTEMATIC REVIEW IS TO DETERMINE HOW BUTYRATE AFFECTS THE RISK FACTORS FOR NAFLD. SEARCHES WERE CONDUCTED USING RELEVANT KEYWORDS IN ELECTRONIC DATABASES UP TO MARCH 2022. ACCORDING TO THE EVIDENCE PRESENTED IN THIS STUDY, BUTYRATE CONTRIBUTES TO A WIDE VARIETY OF BIOLOGICAL PROCESSES IN THE GUT-LIVER AXIS. ITS BENEFICIAL PROPERTIES INCLUDE IMPROVING INTESTINAL HOMEOSTASIS AND LIVER HEALTH AS WELL AS ANTI-INFLAMMATORY, METABOLISM REGULATORY AND ANTI-OXIDATIVE EFFECTS. THESE EFFECTS MAY BE ATTRIBUTED TO BUTYRATE'S ABILITY TO REGULATE GENE EXPRESSION AS AN EPIGENETIC MODULATOR AND TRIGGER CELLULAR RESPONSES AS A SIGNALLING MOLECULE. HOWEVER, THE EXACT UNDERLYING MECHANISMS REMAIN UNCLEAR. HUMAN TRIALS HAVE NOT BEEN PERFORMED ON THE EFFECT OF BUTYRATE ON NAFLD, SO THERE ARE CONCERNS ABOUT WHETHER THE RESULTS OF ANIMAL STUDIES CAN BE TRANSLATED TO HUMANS. THIS REVIEW SUMMARISES THE CURRENT KNOWLEDGE ABOUT THE PROPERTIES OF BUTYRATE, PARTICULARLY ITS POTENTIAL EFFECTS AND MECHANISMS ON LIVER HEALTH AND NAFLD MANAGEMENT. 2022 16 5391 29 REDOX-RELATED BIOMARKERS IN HUMAN CARDIOVASCULAR DISEASE - CLASSICAL FOOTPRINTS AND BEYOND. GLOBAL EPIDEMIOLOGICAL STUDIES SHOW THAT CHRONIC NON-COMMUNICABLE DISEASES SUCH AS ATHEROSCLEROSIS AND METABOLIC DISORDERS REPRESENT THE LEADING CAUSE OF PREMATURE MORTALITY AND MORBIDITY. CARDIOVASCULAR DISEASE SUCH AS ISCHEMIC HEART DISEASE IS A MAJOR CONTRIBUTOR TO THE GLOBAL BURDEN OF DISEASE AND THE SOCIOECONOMIC HEALTH COSTS. CLINICAL AND EPIDEMIOLOGICAL DATA SHOW AN ASSOCIATION OF TYPICAL OXIDATIVE STRESS MARKERS SUCH AS LIPID PEROXIDATION PRODUCTS, 3-NITROTYROSINE OR OXIDIZED DNA/RNA BASES WITH ALL MAJOR CARDIOVASCULAR DISEASES. THIS SUPPORTS THE CONCEPT THAT THE FORMATION OF REACTIVE OXYGEN AND NITROGEN SPECIES BY VARIOUS SOURCES (NADPH OXIDASES, XANTHINE OXIDASE AND MITOCHONDRIAL RESPIRATORY CHAIN) REPRESENTS A HALLMARK OF THE LEADING CARDIOVASCULAR COMORBIDITIES SUCH AS HYPERLIPIDEMIA, HYPERTENSION AND DIABETES. THESE REACTIVE OXYGEN AND NITROGEN SPECIES CAN LEAD TO OXIDATIVE DAMAGE BUT ALSO ADVERSE REDOX SIGNALING AT THE LEVEL OF KINASES, CALCIUM HANDLING, INFLAMMATION, EPIGENETIC CONTROL, CIRCADIAN CLOCK AND PROTEASOMAL SYSTEM. THE IN VIVO FOOTPRINTS OF THESE ADVERSE PROCESSES (REDOX BIOMARKERS) ARE DISCUSSED IN THE PRESENT REVIEW WITH FOCUS ON THEIR CLINICAL RELEVANCE, WHEREAS THE DETAILS OF THEIR MECHANISMS OF FORMATION AND TECHNICAL ASPECTS OF THEIR DETECTION ARE ONLY BRIEFLY MENTIONED. THE MAJOR CATEGORIES OF REDOX BIOMARKERS ARE SUMMARIZED AND EXPLAINED ON THE BASIS OF SUITABLE EXAMPLES. ALSO THE POTENTIAL PROGNOSTIC VALUE OF REDOX BIOMARKERS IS CRITICALLY DISCUSSED TO UNDERSTAND WHAT KIND OF INFORMATION THEY CAN PROVIDE BUT ALSO WHAT THEY CANNOT ACHIEVE. 2021 17 6353 25 THE ROLE OF GENETIC AND EPIGENETIC REGULATION IN INTESTINAL FIBROSIS IN INFLAMMATORY BOWEL DISEASE: A DESCENDING PROCESS OR A PROGRAMMED CONSEQUENCE? INFLAMMATORY BOWEL DISEASES (IBDS) ARE A GROUP OF CHRONIC DISEASES CHARACTERIZED BY RECURRING PERIODS OF EXACERBATION AND REMISSION. FIBROSIS OF THE INTESTINE IS ONE OF THE MOST COMMON COMPLICATIONS OF IBD. BASED ON CURRENT ANALYSES, IT IS EVIDENT THAT GENETIC FACTORS AND MECHANISMS, AS WELL AS EPIGENETIC FACTORS, PLAY A ROLE IN THE INDUCTION AND PROGRESSION OF INTESTINAL FIBROSIS IN IBD. KEY GENETIC FACTORS AND MECHANISMS THAT APPEAR TO BE SIGNIFICANT INCLUDE NOD2, TGF-BETA, TLRS, IL23R, AND ATG16L1. DEOXYRIBONUCLEIC ACID (DNA) METHYLATION, HISTONE MODIFICATION, AND RIBONUCLEIC ACID (RNA) INTERFERENCE ARE THE PRIMARY EPIGENETIC MECHANISMS. GENETIC AND EPIGENETIC MECHANISMS, WHICH SEEM TO BE IMPORTANT IN THE PATHOPHYSIOLOGY AND PROGRESSION OF IBD, MAY POTENTIALLY BE USED IN TARGETED THERAPY IN THE FUTURE. THEREFORE, THE AIM OF THIS STUDY WAS TO GATHER AND DISCUSS SELECTED MECHANISMS AND GENETIC FACTORS, AS WELL AS EPIGENETIC FACTORS. 2023 18 2687 35 EVIDENCE OF EPIGENETIC ALTERATIONS IN THROMBOSIS AND COAGULATION: A SYSTEMATIC REVIEW. THROMBOSIS IN THE CONTEXT OF CARDIOVASCULAR DISEASE (CVD) AFFECTS MAINLY THE BLOOD VESSELS SUPPLYING THE HEART, BRAIN AND PERIPHERIES AND IT IS THE LEADING CAUSE OF DEATH WORLDWIDE. THE PATHOPHYSIOLOGICAL THROMBOTIC MECHANISMS ARE LARGELY UNKNOWN. HERITABILITY CONTRIBUTES TO A 30% OF THE INCIDENCE OF CVD. THE REMAINING VARIATION CAN BE EXPLAINED BY LIFE STYLE FACTORS SUCH AS SMOKING, DIETARY AND EXERCISE HABITS, ENVIRONMENTAL EXPOSURE TO TOXINS, AND DRUG USAGE AND OTHER COMORBIDITIES. EPIGENETIC VARIATION CAN BE ACQUIRED OR INHERITED AND CONSTITUTES AN INTERACTION BETWEEN GENES AND THE ENVIRONMENT. EPIGENETICS HAVE BEEN IMPLICATED IN ATHEROSCLEROSIS, ISCHEMIA/REPERFUSION DAMAGE AND THE CARDIOVASCULAR RESPONSE TO HYPOXIA. EPIGENETIC REGULATORS OF GENE EXPRESSION ARE MAINLY THE METHYLATION OF CPG ISLANDS, HISTONE POST TRANSLATIONAL MODIFICATIONS (PTMS) AND MICRORNAS (MIRNAS). THESE EPIGENETIC REGULATORS CONTROL GENE EXPRESSION EITHER THROUGH ACTIVATION OR SILENCING. EPIGENETIC CONTROL IS MOSTLY DYNAMIC AND CAN POTENTIALLY BE MANIPULATED TO PREVENT OR REVERSE THE UNCONTROLLED EXPRESSION OF GENES, A TRAIT THAT RENDERS THEM PUTATIVE THERAPEUTIC TARGETS. IN THE CURRENT REVIEW, WE SYSTEMATICALLY STUDIED AND PRESENT AVAILABLE DATA ON EPIGENETIC ALTERATIONS IMPLICATED IN THROMBOSIS DERIVED FROM HUMAN STUDIES. EVIDENCE OF EPIGENETIC ALTERATIONS IS OBSERVED IN SEVERAL THROMBOTIC DISEASES SUCH AS CORONARY ARTERY DISEASE AND CEREBROVASCULAR DISEASE, PREECLAMPSIA AND ANTIPHOSPHOLIPID SYNDROME. DIFFERENTIAL CPG METHYLATION AND SPECIFIC HISTONE PTMS THAT CONTROL TRANSCRIPTION OF PROTHROMBOTIC AND PROINFLAMMATORY GENES HAVE ALSO BEEN ASSOCIATED WITH PREDISPOSING FACTORS OF THROMBOSIS AND CVD, SUCH US SMOKING, AIR POLLUTION, HYPERTRIGLYCERIDEMIA, OCCUPATIONAL EXPOSURE TO PARTICULATE MATTER AND COMORBIDITIES INCLUDING CANCER, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND CHRONIC KIDNEY DISEASE. THESE CLINICAL OBSERVATIONS ARE FURTHER SUPPORTED BY IN VITRO EXPERIMENTS AND INDICATE THAT EPIGENETIC REGULATION AFFECTS THE PATHOPHYSIOLOGY OF THROMBOTIC DISORDERS WITH POTENTIAL DIAGNOSTIC OR THERAPEUTIC UTILITY. 2019 19 1900 29 ENERGY SENSING PATHWAYS: BRIDGING TYPE 2 DIABETES AND COLORECTAL CANCER? THE RECENTLY RAPID INCREASE OF OBESITY AND TYPE 2 DIABETES MELLITUS HAS CAUSED GREAT BURDEN TO OUR SOCIETY. A POSITIVE ASSOCIATION BETWEEN TYPE 2 DIABETES AND RISK OF COLORECTAL CANCER HAS BEEN REPORTED BY INCREASING EPIDEMIOLOGICAL STUDIES. THE MOLECULAR MECHANISM OF THIS CONNECTION REMAINS ELUSIVE. HOWEVER, TYPE 2 DIABETES MAY RESULT IN ABNORMAL CARBOHYDRATE AND LIPID METABOLISM, HIGH LEVELS OF CIRCULATING INSULIN, INSULIN GROWTH FACTOR-1, AND ADIPOCYTOKINES, AS WELL AS CHRONIC INFLAMMATION. ALL THESE FACTORS COULD LEAD TO THE ALTERATION OF ENERGY SENSING PATHWAYS SUCH AS THE AMP ACTIVATED KINASE (PRKA), MECHANISTIC (MAMMALIAN) TARGET OF RAPAMYCIN (MTOR), SIRT1, AND AUTOPHAGY SIGNALING PATHWAYS. THE RESULTED IMPAIRED SIRT1 AND AUTOPHAGY SIGNALING PATHWAY COULD INCREASE THE RISK OF GENE MUTATION AND CANCER GENESIS BY DECREASING GENETIC STABILITY AND DNA MISMATCH REPAIR. THE DYSREGULATED MTOR AND PRKA PATHWAY COULD REMODEL CELL METABOLISM DURING THE GROWTH AND METASTASIS OF CANCER IN ORDER FOR THE CANCER CELL TO SURVIVE THE UNFAVORABLE MICROENVIRONMENT SUCH AS HYPOXIA AND LOW BLOOD SUPPLY. MOREOVER, THESE PATHWAYS MAY BE COUPLING METABOLIC AND EPIGENETIC ALTERATIONS THAT ARE CENTRAL TO ONCOGENIC TRANSFORMATION. FURTHER RESEARCHES INCLUDING MOLECULAR PATHOLOGIC EPIDEMIOLOGIC STUDIES ARE WARRANTED TO BETTER ADDRESS THE PRECISE LINKS BETWEEN THESE TWO IMPORTANT DISEASES. 2017 20 4801 31 OBESITY AND INSULIN RESISTANCE: ASSOCIATIONS WITH CHRONIC INFLAMMATION, GENETIC AND EPIGENETIC FACTORS. BACKGROUND: OBESITY IS KNOWN TO BE A MULTIFACTORIAL DISEASE. IN ITS PATHOGENESIS, DIFFERENT FACTORS SUCH AS CHRONIC INFLAMMATION, OXIDATIVE STRESS, INSULIN RESISTANCE, GENETIC FACTORS, ENVIRONMENTAL EFFECTS, VEGETATIVE DISTURBANCE, AND UNBALANCED NUTRITION PLAY A SIGNIFICANT ROLE. METHODOLOGY: THIS STUDY DESCRIBES THE ASSOCIATION OF OBESITY AND INSULIN RESISTANCE WITH CHRONIC INFLAMMATION, GENETIC, AND EPIGENETIC FACTORS. PREVIOUS LITERATURE HAS BEEN REVIEWED TO EXPLAIN THE RELATION OF OBESITY WITH THOSE FACTORS INVOLVED IN CHRONIC LOW-GRADE INFLAMMATION AND INSULIN. RESULTS: OBESITY IS ASSOCIATED WITH A DECREASE IN GHRELIN SECRETION, ELEVATED PLASMA LEPTIN LEVELS, OXIDATIVE STRESS, INCREASED MACROPHAGE PHAGOCYTIC ACTIVITY, AND THE INDUCTION OF PROINFLAMMATORY SYNTHESIS OF CYTOKINES AND INTERFERON-GAMMA. OBESITY IS LINKED TO DECREASED LEVELS OF CYTOCHROME P450 (CYP) ENZYMES AND IMPAIRED DETOXIFICATION PROCESSES. DEFICIENCY OF VITAMINS AND MINERALS CAN ALSO PLAY A SIGNIFICANT ROLE IN THE DEVELOPMENT OF OXIDATIVE STRESS AND CHRONIC INFLAMMATION IN OBESITY. THERE IS EVIDENCE OF ASSOCIATIONS BETWEEN A GENETIC PREDISPOSITION TO OBESITY IN CHILDREN WITH ELEVATED LEVELS OF CERTAIN MIRNAS. CONCLUSION: THE PURPOSE OF THE PRESENT REVIEW IS AN ANALYSIS OF THE MULTIPLE FACTORS ASSOCIATED WITH OBESITY. 2021