Metabolism

Protein tyrosine phosphatases are crucial regulators of metabolism with specific roles in different tissues. To investigate hepatocyte-specific function of protein tyrosine phosphatase receptor type K (PTPRK), we generated mice carrying floxed Ptprk alleles and crossed them with Alb-Cre mice (Ptprk{Delta}Hep mice). Under chow feeding, Ptprk{Delta}Hepmice were largely comparable to littermate controls. In contrast, Ptprk{Delta}Hepmice fed a high-fat, high-fructose, high-cholesterol diet exhibited reduced steatosis, lower hepatic PPAR{gamma}, and blunted hepatocyte hypertrophy, accompanied by improved systemic insulin sensitivity, as assessed by hyperinsulinemic-euglycemic clamps. We identified PTPRK-interacting proteins enriched for metabolic functions associated with glycolysis and lipid biosynthesis using pull downs from primary hepatocyte lysates. In line with these findings, Ptprk{Delta}Hep mice developed fewer tumours than controls in an obesity and carcinogen-induced hepatocellular carcinoma (HCC) model. Our data show that under nutrient excess PTPRK is functionally engaged in hepatocytes to support PPAR{gamma}-linked steatotic growth, insulin resistance, and tumour initiation, highlighting PTPRK as a potential therapeutic target in MASLD-associated HCC.

Selectively bred diet-induced obesity-prone (DIO-P) rats have defective nutrient sensing prior to obesity onset. We hypothesized that glial inflammation in the arcuate nucleus (ARC) impairs hypothalamic responses to dietary clues, thereby promoting obesity development in genetically susceptible animals. This study established a timeline of inflammatory events in male and female DIO-P and diet-resistant (DR) rats fed either a low fat chow or exposed to a high energy diet (HED; 32% fat, 25% sucrose) for three days or four weeks. On chow diet, DIO-P rats of both sexes displayed elevated astrocyte density and increased expression of pro-inflammatory markers in the ARC, alongside reduced microglial content, compared to DR rats. Three days of HED transiently amplified most MBH pro-inflammatory markers in DIO-P rats. Four weeks of HED decreased GFAP expression in DIO-P rats while Iba1 density remained unchanged, whereas, DR rats showed a reduction in Iba1with no change in GFAP or cytokine expression. To determine whether mediobasal hypothalamus (MBH) astrocyte inflammation contributes to the development and maintenance of an obesity, astrocytic IKK{beta} was depleted before or after HED exposure. Prophylactic MBH astrocyte-specific IKK{beta} knockdown prevented subsequent body weight gain, improved glucose tolerance and decreased leptin levels in DIO-P rats to levels comparable to DR rats, with no effect in the latter. In contrast, MBH IKK{beta} astrocytic depletion in already obese DIO-P rats had no effect on energy homeostasis. Together, these findings validate the DIO-P rat as a polygenic model of obesity predisposition and demonstrate that preventing ARC astrogliosis is sufficient to HED-induced body weight gain and obesity development in genetically susceptible animals, highlighting MBH inflammation as a marker and driver of obesity predisposition. HighlightsO_LIChow-fed DIO-P rats present heightened ARC astrogliosis and cytokine expression preceding HED-induced obesity. C_LIO_LIInhibition of IKK{beta} in MBH astrocytes prevents DIO-P rats from becoming obese. C_LIO_LIOnce obese, inhibition of IKK{beta} in MBH astrocytes is not sufficient to reverse the obese phenotype. C_LI

Systemic inflammation is implicated in various diseases, yet its upstream determinants remain poorly examined. We conducted a large scale two-sample Mendelian randomisation (MR) study to systematically evaluate the potential causal effects of 3,213 molecular (metabolomic, proteomic), physiological and disease traits on circulating interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Genetic instruments were derived from genome wide association studies and analysed using inverse variance weighted (IVW), weighted median, and MR-Egger methods with multiple testing correction. Bidirectional MR was performed to assess reverse causation. After Bonferroni correction, evidence of potential causal effects was observed for 72 traits on CRP and 9 traits on IL-6. CRP was predominantly influenced by metabolomic traits, especially lipid and fatty acid measures. Genetically proxied adiposity (body mass index and obesity), triglyceride rich lipoproteins, glycoprotein acetyls (GlycA), and apolipoprotein E increased CRP levels, whereas HDL-related cholesterols, polyunsaturated fatty acids, and glutamine decreased CRP. Most associations were consistent across MR methods, supporting the robustness of these results. As expected, IL-6 had a large effect on CRP. IL-6 was influenced by primarily adiposity and HDL-related lipid measures, with generally smaller effect sizes and limited support across sensitivity analyses. Bidirectional analyses indicated little evidence that CRP directly drives metabolic traits when restricting to cis-acting instruments, whereas genetically proxied IL-6 signalling showed consistent downstream effects on HDL particle concentration and composition. Adiposity is a shared upstream determinant of both inflammatory biomarkers, with stronger and broader effects on CRP. These findings suggest that CRP acts as an integrated downstream readout of systemic inflammatory burden, whereas IL-6 reflects a more tightly regulated and context-dependent process. Our work clarifies traits that may causally influence systemic inflammation and highlights biological pathways linking inflammation to cardiometabolic and inflammatory diseases. By mapping upstream determinants of IL-6 and CRP, we also provide a resource to prioritise key drivers for mechanistic study and therapeutic targeting.

Background: The gluteus maximus (GM) is a major hip extensor essential for mobility and metabolic health. Most MRI studies rely on global measures, such as muscle volume or fat fraction, which can overlook spatially localised remodelling. Here, we integrate conventional volumetric and fat fraction metrics with 3D mesh-based shape phenotypes to provide a spatially resolved characterisation of GM morphology in relation to anthropometric, lifestyle, and cardiometabolic factors, with a focus on type 2 diabetes (T2D) and sex-specific effects. Methods: We analysed T1 Dixon MRI from UK Biobank participants to quantify GM muscle volume, fat fraction, and regional surface morphology using 3D meshes. Statistical parametric mapping was used to assess regional associations with anthropometric, lifestyle, and clinical variables Bi-directional causal mediation analyses were performed using GM volumetric and principal components (PCs) of shape variation. PCs were also tested for associations with prevalent and incident disease. Longitudinal changes in GM composition were evaluated in participants with repeated imaging evaluations. Results: GM muscle volume and fat fraction were strongly associated with age, adiposity, and physical activity. Shape analysis revealed spatially localised remodelling patterns not captured by global measures, with region-specific surface shrinkage linked to age, BMI, alcohol intake, grip strength, physical activity, frailty, osteoporosis, and cardiometabolic disease. T2D showed marked sex-differences, with regional shrinkage in men and relative expansion in women. PCA reduced high-dimensional shape variation into interpretable components. Mediation analyses indicated that T2D-related differences in GM morphology partly mediated increases in fat fraction, suggesting that disease effects manifest through spatially patterned shape changes rather than overall muscle size. PCs capturing variations in the central-upper posterior and anterior GM, differentiated between T2D cases from controls, and were associated with incident T2D risk (Men: PC6 HR per SD: 0.81 [0.70-0.95], false discovery rate (FDR)-adjusted p = 0.038, in left GM; 0.76 [0.65-0.88], p = 0.002, in right GM; women; PC5 HR = 1.32, [1.08-1.61], p = 0.032, in right GM). Conclusions: Integrated 3D quantification of GM composition and morphology provides spatially resolved biomarkers that go beyond muscle volume and fat fraction. By capturing region-specific GM remodelling, linked to anthropometric, lifestyle and cardiometabolic factors, this approach offers a more nuanced characterisation of muscle-fat phenotypes and enhances mechanistic insight and risk stratification in population-based imaging studies.

Background: The glucagon-like peptide-1 receptor (GLP1R) is a key regulator of glucose metabolism and appetite and a major therapeutic target for type 2 diabetes (T2D) and obesity. Genetic studies have implicated the GLP1R locus in both body mass index (BMI) and T2D, but it remains unclear whether their underlying genetic associations are the same. Methods: We analyzed 431,107 participants of genetically inferred European ancestry from the Million Veteran Program. Within 500 kb of GLP1R, we performed locus-wide linear regression models for BMI and logistic regression models for T2D, adjusted for age, sex, and 10 principal components. We identified primary and secondary BMI sentinel variants using conditional analyses and evaluated their associations with T2D. Bayesian fine-mapping was used to construct credible sets of GLP1R locus for BMI and T2D. Results: Conditioning on the primary sentinel variant rs12213929 (upstream of GLP1R, {beta} = 0.11; 95% CI 0.09-0.14; p = 1.94E-17), we identified a secondary variant (rs13216992, intron of GLP1R) independently associated with BMI ({beta} = 0.10; 95% CI 0.07-0.13; p = 7.88E-14). The two sentinel variants showed low linkage disequilibrium (r2 = 0.03). A two-variant allelic burden score (0-4; sum of the rs12213929 G-allele count and rs13216992 C-allele count) showed that participants with 4 risk alleles had 0.47 kg/m2 higher BMI than those with 0 risk alleles (95% CI 0.39-0.55; p < 2E-16). Both variants were associated with higher T2D risk, but with distinct patterns after BMI adjustment: the rs12213929-T2D association persisted after adjustment for BMI (OR = 1.02; 95% CI 1.01-1.03; p = 0.0004), whereas the rs13216992-T2D association was fully attenuated (OR = 1.00; 95% CI 0.99-1.01; p = 0.68). Fine-mapping identified a compact 95% BMI credible set of 17 variants and a broader 95% T2D credible set of 42 variants, with all BMI credible variants contained within the T2D set. Conclusions: The GLP1R locus harbors at least two independent BMI-associated variants that exhibit heterogeneous relationships with T2D: rs12213929 influences T2D risk partly through BMI-independent pathways, whereas rs13216992 appears to act predominantly via adiposity. These findings refine the genetic architecture at this key therapeutic target gene and provide a foundation for functional and pharmacogenomic studies to determine whether GLP1R variation can inform precision prevention and treatment of obesity and T2D.

{beta}2-Adrenergic receptor (Adr{beta}2) is the most abundant form of adrenergic receptors in skeletal muscle. Our previous studies have shown that the ventromedial hypothalamic nucleus (VMH) regulates metabolic benefits of exercise, potentially by skeletal muscle Adr{beta}2. Although a large body of literature has shown the importance of Adr{beta}2 on skeletal muscle physiology, it remains unexplored whether skeletal muscle Adr{beta}2 contributes to metabolic benefits of exercise, such as prevention of diet-induced obesity (DIO). Here, we generated mice lacking Adr{beta}2 in skeletal muscle cells (SKMAdr{beta}2) and tested whether SKMAdr{beta}2 is required for metabolic benefits of exercise on DIO. Deletion of SKMAdr{beta}2 completely abolished the induction of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (Pgc-1) in skeletal muscle by {beta}2-agonist, which is a potent activator of Pgc-1. Exercise upregulates Pgc-1, which regulates a broad range of skeletal muscle physiology, including hypertrophy and mitochondrial function. Deletion of SKMAdr{beta}2 hampers augmented Pgc-1 in skeletal muscle by a single bout of exercise. Intriguingly, we found that deletion of SKMAdr{beta}2 increased endurance capacity. Further, our data showed that body weight in DIO mice lacking SKMAdr{beta}2 is comparable to that of control DIO mice during exercise training, suggesting that deletion of SKMAdr{beta}2 did not affect the metabolic benefits of exercise in DIO. Collectively, our data indicate that SKMAdr{beta}2 contributes to exercise-induced transcriptional changes and endurance capacity, however, it is not required for exercise benefits on bodyweight in DIO mice.

Obesity affects millions of people worldwide and has serious complications such as cardiovascular disease and diabetes. Current treatments for obesity target proteins such as the receptors for glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP) and/or glucagon (GCG). These interventions have revolutionized the treatment of obesity and represent first-line pharmacotherapeutic strategies. One major weakness to these strategies is that once drug treatment stops, most patients are unable to maintain the new body weight setpoint, often gaining weight back rapidly. Thus, the identification of new therapies that focus on the ability to maintain homeostatic setpoint are necessary. The glucocorticoid receptor (GR) has been implicated in several pathways including reward-seeking, inflammation, stress and energy balance. Here, we investigated the effects of 30 days treatment with PT150 (40 mg/kg), a novel GR antagonist, alone and in combination with semaglutide (30 nmol/kg) on food intake, glucose homeostasis, body weight and setpoint maintenance using a C57Bl/6 diet-induced obesity (DIO) mouse model. We monitored food intake and body weight throughout treatment and after drug washout for 20 days to evaluate defended body weight maintenance (body weight setpoint). Our results indicate that treatment with PT150 alone does not significantly alter body weight but in combination with semaglutide it shows the most promising effects in body weight reduction and homeostatic setpoint maintenance. Together, these data suggest that PT150, a GR modulator, may be effective as a homeostatic setpoint modulator when combined with semaglutide.

Lactation is associated with a protective effect against breast and ovarian cancer as well as against cardiovascular diseases suggesting a systemic effect. Here, we show that the serum of lactating mice and breastfeeding mothers have targeted antineoplastic effects, while serum from virgin mice and matched post-partum but non-lactating women do not. The effect is specific to cancer cells expressing Pappalysin-A (PAPP-A), a target that is shared among diseases affected by breastfeeding. RNAseq revealed that lactating serum inhibits mitochondrial function and we found that PAPP-A alone lowers mitochondrial function, suggesting that lactation serum acts by exploiting the metabolic vulnerability of these cancer cells. Using serum proteomics, we identified corticotropin release factor (CRF) as being unique to serum of lactating women and we show that CRF alone mimics the mitochondrial and anti-tumorigenic effect of lactating serum. Blocking the CRF receptor, inhibits the protective effect of lactating serum. Since CRF has shown efficacy in the clinic in other settings, our findings raise the possibility to extend its use to mimic or enhance the protective effect of breastfeeding. SummaryWe show that the serum from lactating women has anti-cancer activity and used multi-omics approaches to identify corticotropin release factor as a peptide able to mimic the effect of lactating serum by targeting cells with low mitochondrial activity.

BackgroundVisceral adiposity is widely regarded as the pathogenic component of central obesity in cardiometabolic disease. However, emerging evidence suggests that abdominal subcutaneous adiposity may also confer metabolic risk in South Asian populations, although data in young, lean individuals are scarce. We investigated associations of MRI-measured abdominal subcutaneous adipose tissue (ASAT) and visceral adipose tissue (VAT) with cardiometabolic risk markers in young rural Indian adults. MethodsWe quantified ASAT and VAT using MRI in 590 participants (310 men) aged 18 years from the Pune Maternal Nutrition Study cohort. Sex-specific multiple regression models were used to examine associations with glucose-insulin indices, blood pressure, lipids, adipokines, and inflammatory markers. ResultsASAT showed broad and consistent associations with adverse cardiometabolic profiles, including higher 120-min glucose, dyslipidaemia, elevated blood pressure, leptin, CRP and leukocyte count, and lower insulin sensitivity and adiponectin, particularly in men; in women, ASAT was associated with most cardiometabolic risk markers except HDL-cholesterol. In contrast, VAT was associated with fewer risk markers and exhibited weaker, sex-specific patterns of association. Across outcomes, associations with ASAT were generally stronger than those observed for VAT. ConclusionsIn young, lean Indians, abdominal subcutaneous adiposity exhibits stronger associations with insulin resistance, dyslipidaemia and inflammation than visceral adiposity, challenging the prevailing VAT-centric paradigm derived largely from Western populations. These findings provide human evidence that the hierarchy of metabolic risk across abdominal fat depots is population-specific. This suggests genetic and early-life risk stratification, and supports early targeted preventive strategies. Research InsightsWhat is currently known about this topic? (max. 3 highlights, each < 100 characters) Indians have higher central obesity-adiposity than Europeans at similar BMI. Western data links VAT with cardiometabolic risk, while ASAT is protective. VAT & ASAT risk patterns vary across native and migrant South Asians. What is the key research question? (formatted as a question, < 100 characters) How do VAT and ASAT associate with cardiometabolic risk in lean rural Indian youth? What is new? (max. 3 highlights, each < 100 characters) ASAT shows stronger links with cardiometabolic risk than VAT in rural Indian youth. ASAT may contribute to high diabetes and CVD risk at low BMI in young Indians. How might this study influence clinical practice? (max. 1 highlight, < 100 characters) Early-life ASAT accumulation may raise later cardiometabolic risk, supporting early prevention strategies.

BackgroundEarly-life protein restriction is a risk factor for cardiovascular disease, yet the mechanisms underlying vascular dysfunction and therapeutic strategies remain poorly defined. Tauroursodeoxycholic acid (TUDCA) is a bile acid that inhibits endoplasmic reticulum (ER) stress and has therapeutic potential in metabolic diseases. We hypothesized that TUDCA exerts vasculoprotective effects in the setting of post-weaning protein restriction. MethodsPost-weaning male and female mice fed a normoprotein (14% protein) or protein-restricted (6% protein, isocaloric) diet for 105 days. In the last 15 days, mice received TUDCA (300 mg/kg/day) or vehicle. Vascular function was assessed in the thoracic aorta with or without perivascular adipose tissue (PVAT). mRNA expression and histological analyses were performed in aorta and PVAT. ResultsLong-term protein restriction resulted in endothelial dysfunction, vascular hypocontractility, and loss of the anticontractile effect of PVAT in males, but not females. These alterations were restored by TUDCA. In aorta, TUDCA normalized expression of eNOS and contractile phenotype-related genes -actin, SM22, Cav1.2 whereas, in the PVAT, TUDCA restored lipid content and expression of PRDM16, PPAR{gamma}, PGC1, leptin, and OB-Rb in protein-restricted mice. TUDCA attenuated fibrosis and ER stress markers while increased the bile acid receptor FXR expression in both tissues. Similar to TUDCA, ER stress inhibition with 4-phenylbutyric acid restored vascular and PVAT function in protein-restricted male mice. ConclusionsPost-weaning protein restriction induces vascular and PVAT dysfunction and fibrosis in males, associated with ER stress. TUDCA significantly attenuates these alterations, supporting its potential as a therapeutic strategy for vascular complications associated with early-life undernutrition.

Low-density lipoprotein cholesterol (LDL-C) is a well-established and modifiable risk factor for cardiovascular diseases (CVDs), which has been the leading cause of mortality among women and men in the United States since 1921. Despite research demonstrating sexually dimorphic symptom presentation of CVD, women remain underdiagnosed and undertreated for CVDs relative to men. Using genotype and phenotype data from the All of Us (AoU) Research Program, we examined sex-specific differences in LDL-C measurements, including baseline levels, statin treatment efficacy, age-related patterns, genome-wide association study (GWAS) results, and heritability between women and men. We find that the median LDL-C measurements of women are consistently higher than those of men across all age strata and that this difference is most apparent after 40 years of age. In addition, women are treated with statins at a lower rate than their male counterparts, and statins appear to be less effective in women--particularly Black women, who exhibited the highest median LDL-C levels while prescribed statins. Based on GWAS, genetic variants associated with LDL-C measurements differ between women and men, as do their effect sizes. Finally, heritability differs between sex, age, racial identity, and statin treatment groups. These findings indicate that current clinical intervals of LDL-C and pharmaceutical-based LDL-C modification approaches may not be equally appropriate across subgroups, with significant variation by sex and self-identified race. This highlights the need for sex-specific and population-informed strategies in both the treatment of LDL-C and genetic studies.

Class B scavenger receptors BI (SR-BI) and BII (SR-BII) internalize lipoproteins but also bind and internalize bacteria. Their roles in sepsis are unknown. We overexpressed human SR-BI and BII in the liver and kidney as well as bone marrow-derived macrophages, and then performed cecal ligation and puncture (CLP) surgery. SR-BI and BII transgenic mice had significantly worse survival compared to WT mice. 24 h after CLP, liver injury markers and histological damage were prominent in both SR-BI and BII transgenic mice, whereas kidney damage was similar. Systemic inflammatory cytokines were markedly increased in SR-BI and BII transgenic mice; parallel increases were seen in liver mRNA expression, not in the kidney. The highest degree of neutrophil infiltration was observed in the liver of SR-BI. Human SR-BI and BII dramatically decreased bacterial accumulation in the liver. Green fluorescence protein-labeled E. coli were efficiently phagocytosed in hepatic macrophages of SR-BI and BII transgenic mice; phagocytosis was more prominent in SR-BII transgenic mice. Finally, human SR-BI overexpression reduced systemic HDL-C level, eliminated adrenal cortex lipid droplets, and dampened the systemic increase of corticosterone after CLP. Supplementation with glucocorticoid and mineralocorticoid improved survival in SR-BI, but not SR-BII, transgenic mice after CLP. In summary, our findings suggest human SR-BI and BII overexpression contributes to higher mortality after CLP by excessive inflammatory response due to adrenal insufficiency (SR-BI) or hyperactive phagocytosis (SR-BII) in the liver.

Obesity, a global health crisis affecting 16% of the world population, is characterized by chronic inflammation that contributes to health complications such as type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD). Emerging evidence suggests that self-DNA released from dying cells aberrantly activates inflammatory responses during obesity. However, the role of extracellular deoxyribonucleases (DNASEs), which at steady state regulate abundance of extracellular self-DNA, remains poorly understood in this context. Here, we show that individuals with obesity exhibit elevated levels of circulating cell-free DNA (cfDNA) with a distinctive end-motif signature, anti-DNASE1L3 autoantibodies and a reduction in circulating DNASE activity. These cfDNA alterations correlate with the severity of obesity and can be corrected by therapeutic intervention such as bariatric surgery. Similarly, mice fed a high-fat diet (HFD) displayed increased cfDNA levels and decreased DNASE activity. Genetic deficiency of the extracellular nuclease DNASE1L3 in mice worsened HFD-induced metabolic complications, including glucose intolerance, insulin resistance, MASLD, and metabolic tissue inflammation. Conversely, targeted supplementation of DNASE1L3 in the liver using adeno-associated viral vectors protected obese mice from developing MASLD and liver inflammation. These findings uncover a novel role of DNASE1L3 in controlling obesity-associated inflammation and its potential therapeutic use for preventing metabolic disease.

Obesity-driven type 2 diabetes (T2D) is characterized by pathological alterations in visceral white adipose tissue (vWAT). While microRNAs (miRNAs) are key post-transcriptional regulators, comprehensive human vWAT profiling across metabolic states remains limited. This study characterized vWAT miRNA expression in lean, obese, and obese+T2D individuals to identify regulatory networks associated with metabolic failure. Deep miRNA sequencing was performed on vWAT samples from a discovery cohort, followed by validation via qPCR in an independent replication cohort. Differentially expressed miRNAs across the three groups were bioinformatically integrated with matched mRNA transcriptomic data to construct functional regulatory modules and identify enriched pathways underlying metabolic impairment. Several miRNAs exhibited robust and reproducible differential expression between obesity and obesity with T2D. Integrated miRNA-mRNA analyses revealed coherent regulatory modules involving inflammation, lipid metabolism, insulin signaling, and iron homeostasis. Specifically, miR-141-3p, miR-200b-3p, miR-15b-3p, miR-12136, and miR-585-3p showed consistent differential expression. Notably, miR-141-3p and miR-200b-3p were markedly upregulated and inversely associated with metabolic stress-related genes, including TF and FBXO32. Several miRNAs correlated with clinical markers of metabolic dysfunction, supporting their biomarker potential. By comparing lean, obese, and diabetic populations, this study provides a comprehensive characterization of the vWAT miRNA landscape and identifies specific miRNA-mRNA regulatory circuits that orchestrate the transition from healthy adiposity to pathological adipose tissue dysfunction. These findings pinpoint novel molecular drivers of type 2 diabetes progression and offer potential targets for therapeutic intervention in metabolic endocrine disorders.

Obesity alters systemic metabolism and immune function, yet how obesity and tumor progression regulate extracellular vesicle (EV) composition and function within the tumor microenvironment remains unclear. Using a preclinical model of diet-induced obesity (DIO) and triple-negative breast cancer (TNBC), we investigated how obesity and tumor stage shape the proteomic composition of EVs from visceral adipose tissue (VAT-EVs) and mammary tumors (tumor-EVs), and how these EVs regulate immune and tumor cell metabolism. Orthotopically transplanted metM-Wntlung tumors were classified as early ([~]0.5 cm3) or late ([~]1.0 cm3), and EV proteomes were analyzed by mass spectrometry. At early stages, tumor-EVs from DIO mice, compared with control lean mice, were depleted in immune-related proteins, whereas VAT-EVs were enriched in mitochondrial and fatty acid oxidation proteins. In contrast, at later stages, tumor-EVs from DIO mice were enriched in lipid metabolism and oxidative stress-associated proteins, while VAT-EVs exhibited loss of mitochondrial proteins consistent with metabolic dysfunction. Functionally, tumor-EVs and VAT-EVs differentially regulated CD8 T cell mitochondrial activity and cytokine production and induced distinct, stage-dependent metabolic reprogramming in non-aggressive epithelial-like (E-Wnt) versus mesenchymal-like (M-Wnt) tumor cells. These findings suggest that obesity and tumor progression dynamically reshapes EV cargo, enabling EV-mediated metabolic reprogramming that may contribute to immune suppression and TNBC progression.

PurposePortal hypertension, a major complication of chronic liver disease, leads to significant morbidity and mortality. While portal vein diameter measured on imaging has long been proposed as a non-invasive marker of portal hypertension, normative CT-based reference values and population-level associations remain incompletely characterized. Here, we aim to define contemporary reference values for portal vein diameter on clinically obtained CT and evaluate its associations with demographic, clinical, and imaging factors, as well as its diagnostic performance for portal hypertension. MethodsWe conducted a retrospective analysis of 20,225 clinically obtained CT scans at a single academic medical center. The main portal vein was automatically segmented using Total Segmentator, and maximum diameter extracted using the Vascular Modeling Toolkit. Associations with demographic and imaging factors were evaluated using linear mixed-effects models; prevalent liver disease and portal hypertension using logistic regression; risk of incident ascites and esophageal varices among participants with liver disease using Cox regression; and invasive hepatic venous pressures using correlation analysis and linear regression. ResultsThe mean portal vein diameter was 12.4 mm (95% CI, 12.37-12.45). Larger diameter was independently associated with male sex (+1.4 mm), higher BMI (+0.11 mm/kg/m2), greater height (+0.04 mm/cm), and older age (+0.05 mm/10 years) (all p <0.001), and was substantially larger on contrast-enhanced abdomen/pelvis CT (+2.4 mm, p <0.001). Each 1-mm increase in portal vein diameter was associated with higher odds of prevalent liver disease (OR 1.06; 95% CI, 1.04-1.08) and portal hypertension (OR 1.18; 95% CI, 1.12-1.28). Among individuals with liver disease, greater diameter predicted higher risk of incident esophageal varices (baseline diameter HR 1.50; 95% CI, 1.14-2.08) and ascites (HR per mm increase in diameter 1.06; 95% CI, 1.003-1.12). However, portal vein diameter demonstrated weak to no association with invasively measured hepatic venous pressures. ConclusionIn this large, EHR-linked imaging cohort, the mean portal vein diameter on CT was 12.4 mm and varied with demographic and imaging factors. Larger diameter was associated with liver disease, portal hypertension, and subsequent development of varices and ascites, supporting use of portal vein diameter as a pragmatic screening or enrichment tool within multimodal clinical frameworks. Key ResultsO_LIMean portal vein diameter on routine clinical CT was 12.4 mm (95% CI, 12.37-12.45) and varied with sex, height, BMI, exam type, contrast use, and clinical setting. C_LIO_LIEach 1-mm increase in portal vein diameter was associated with higher odds of prevalent liver disease (OR 1.06) and portal hypertension (OR 1.18). C_LIO_LIAmong individuals with liver disease, larger portal vein diameter predicted higher risk of incident esophageal varices and ascites, independent of demographic and imaging factors. C_LI

Uric acid (UA) is traditionally regarded as a metabolic risk marker; however, its dynamic behavior during glucose-lowering therapy remains incompletely understood. We compared UA responses to a modified traditional Japanese diet (MJDD) and the DPP-4 inhibitor alogliptin in patients with early-stage type 2 diabetes mellitus (T2DM). In this prospective observational study, drug-naive patients received MJDD (n=58) or alogliptin (n=52) monotherapy for 3 months. Changes ({Delta}) in serum UA were analyzed in relation to glycemic control, insulin resistance, adipose tissue insulin resistance (adipo-IR), and beta-cell function. Both interventions significantly reduced fasting blood glucose and HbA1c while paradoxically increasing serum UA and HOMA-B. Baseline UA was the primary determinant of {Delta}UA in both cohorts. MJDD significantly reduced body mass index, insulin, free fatty acids, HOMA-R, and adipo-IR, with effects most pronounced in subjects with baseline BMI >25. In contrast, alogliptin selectively reduced adipo-IR in leaner subjects (BMI <25). Across both treatments, {Delta}UA correlated positively with {Delta}HOMA-B and inversely with {Delta}HbA1c. Notably, during MJDD, {Delta}UA showed a paradoxical negative correlation with {Delta}BMI and {Delta}FBG, and a positive correlation with {Delta}FFA. Patients exhibiting the greatest UA increases demonstrated the most marked improvements in beta-cell function and, with MJDD, the greatest weight loss. These findings indicate that MJDD and alogliptin exert distinct metabolic effects in early T2DM, yet both link rising UA to enhanced beta-cell function, suggesting that UA may serve as a dynamic pharmacometabolic biomarker reflecting therapy-specific metabolic adaptation rather than metabolic deterioration.

The dual incretin receptor agonist tirzepatide improves {beta}-cell function in T2D patients, but the underlying mechanism remains unclear. This study aimed to elucidate the molecular pathway through which tirzepatide restores {beta}-cell functional improvement. High-fat diet (HFD)-fed C57BL/6J mice were treated with vehicle, a GIP analogue, semaglutide or tirzepatide. Tirzepatide significantly reduced body weight and improved glucose tolerance in HFD-fed mice without altering {beta}-cell mass, proliferation, or apoptosis. Instead, tirzepatide reversed {beta}-cell dedifferentiation, as indicated by reduced ALDH1A3 expression and restored levels of the identity transcription factors PDX1 and MAFA. Single-cell RNA sequencing (scRNA seq) and in vitro studies revealed that tirzepatide up-regulated FOXO1, reactivating the FOXO1-PDX1/MAFA axis. In T2D patients, tirzepatide improved glycemic control, reduced insulin demand, increased HOMA-{beta}, and decreased HOMA-IR. Improvement in HOMA-{beta} correlated positively with baseline insulin resistance. Hence, our study suggested that tirzepatide restores {beta}-cell function in T2D by reprogramming stressed {beta} cells and re-establishing {beta}-cell identity through FOXO1-dependent transcriptional reactivation. These findings provide a mechanistic basis for the superior efficacy of dual incretin receptor agonism in T2D management. ARTICLE HIGHLIGHTSO_LITirzepatide restores {beta} cell identity and function without altering {beta} cell mass in HFD induced diabetic mice. C_LIO_LITirzepatide reverses {beta}-cell dedifferentiation and restores key {beta}-cell transcription factors (PDX1, MAFA) through reactivation of the AKT-FOXO1 signaling pathway. C_LIO_LITirzepatide increases HOMA-{beta} and decreases HOMA-IR in T2D patients, and improvements in HOMA-{beta} positively correlate with baseline insulin resistance. C_LIO_LIThese results demonstrate that tirzepatides therapeutic benefits are not only metabolic but also involve direct restoration of {beta}-cell identity and function. This highlights {beta}-cell reprogramming as a novel therapeutic avenue, thus supporting the broader clinical adoption of dual incretin receptor agonists. C_LI

Obesity is a major contributor to cardiometabolic disease, and pharmacological therapies such as semaglutide are increasingly used to induce weight loss. However, the commonly used diet-induced obesity model in C57BL/6J mice is limited by relative resistance to weight gain in females, complicating the study of sex-specific effects. Here, we used leptin-deficient ob/ob mice, which develop severe early-onset obesity in both sexes, to investigate sex-specific responses to semaglutide on skeletal muscle mass, function, and mitochondrial metabolism. The ob/ob mice were treated daily with semaglutide or vehicle for three weeks, followed by assessments of body composition, muscle and organ mass, muscle contractile function, and mitochondrial efficiency. Semaglutide induced comparable reductions in body weight and food intake in both sexes but elicited distinct sex-specific changes in body composition. Male mice exhibited losses in both skeletal muscle and organ mass, whereas female mice preferentially lost fat and organ mass while preserving skeletal muscle. Despite these divergent structural adaptations, muscle force generation remained intact in both sexes. Collectively, these findings reveal pronounced sexual dimorphism in skeletal muscle and metabolic remodeling during pharmacologically induced weight loss, highlighting the importance of considering biological sex when evaluating the metabolic and therapeutic effects of anti-obesity interventions. Article HighlightO_LIC57BL/6J mice are limited by relative resistance to weight gain in females, complicating the study of sex-specific effects. So, we wanted to determine the sex-specific effect of semaglutide on skeletal muscle function, and mitochondrial metabolism in ob/ob mice. C_LIO_LIWe assessed body composition and ex-vivo muscle force following the treatment and found that the female ob/ob mice are protected from semaglutide-induced skeletal muscle mass loss. C_LIO_LIThese findings demonstrate sex-specific effects of semaglutide, highlighting the need to consider biological sex in GLP-1RA-based therapies. C_LI

ObjectiveBMI alone does not capture obesity-related health heterogeneity. The Edmonton Obesity Staging System (EOSS) grades obesity severity based on comorbidities and functional impairment, whereas the Lancet Commission Diagnostic Model for Obesity (DMO) distinguishes preclinical from clinical obesity based on organ dysfunction. We assessed whether both frameworks identify overlapping phenotypes and how they classify obesity severity. MethodsA modified EOSS and DMO were applied to the UK Biobank (N {approx} 411,000). Stage distributions, cross-classification, and the impact of combining BMI with fat distribution on obesity categorization were analyzed. ResultsAbout one quarter of participants were classified with obesity under both frameworks. Most were assigned to advanced stages, with high concordance for established disease. Differences were most pronounced in early stages: DMO captured a broader spectrum of mild/subclinical organ dysfunction, whereas EOSS emphasized established disease with prognostic relevance. Discrepancies reflected differences in operationalization of e.g. metabolic, cardiovascular, and mental health. Obesity thresholds influenced classification, with [~]50% reclassified when BMI was combined with different fat distribution parameters, highlighting sensitivity of early-stage assignment. ConclusionEOSS and DMO provide complementary perspectives on obesity severity. Integrating EOSSs prognostic granularity with DMOs multidimensional approach may improve risk stratification and identify individuals most suitable for intensive interventions. STUDY IMPORTANCEO_ST_ABSWhat is already known?C_ST_ABSO_LIBMI alone poorly reflects obesity-related health risk; comorbidities, organ dysfunction, and functional impairments are crucial for precise staging. C_LIO_LITwo major frameworks exist: EOSS focuses on prognostic severity, while DMO identifies early/preclinical obesity--but their agreement and clinical implications were unclear. C_LI What does this study add?O_LIDemonstrates that EOSS emphasizes established disease and prognostic severity, whereas DMO captures a broader spectrum of early or subclinical organ dysfunction, revealing distinct phenotypes within the same BMI-defined population. C_LIO_LIHighlights that combining BMI with anthropometric measures can reclassify up to [~]50% of individuals, illustrating the sensitivity of early-stage assignment to diagnostic thresholds. C_LI How might these results change the direction of research or the focus of clinical practice?O_LIIntegrating EOSSs prognostic detail with DMOs broad, multidimensional approach enables targeted intervention, helping clinicians prioritize patients for intensive obesity management or treatment. C_LIO_LIProvides evidence for harmonizing obesity classification beyond BMI, emphasizing the need for multidimensional assessment in both research cohorts and routine clinical practice. C_LI