Medical Bulletin 12/ July/ 2024

Here are the top medical news for the day:

New Guidelines for Healthcare Professionals on Muscle-Building Supplement Use

In a groundbreaking effort to mitigate the risks associated with muscle-building dietary supplement use among adolescents and young adults, a comprehensive set of guidelines has been introduced to assist healthcare professionals.

These guidelines, published in the Journal of Adolescent Health, focus on assessment and harm reduction strategies to better support young individuals engaged in the use of these readily available supplements.

Muscle-building dietary supplements, such as whey protein and creatine monohydrate, are commonly used by adolescents and young adults and are intended to enhance muscle mass, strength, and athletic performance. Despite their popularity, there has been a significant gap in guidance for health and mental health care professionals on how to assess and manage potential risks associated with their use. The new guidance aims to bridge this gap by providing detailed recommendations on assessment, nutritional evaluation, behavioural assessment, physical and mental health monitoring, harm reduction, and steroid use assessment.

“Given the risks involved, we highly recommend that all health and mental health care professionals ask their adolescent and young adult clients about muscle-building supplement use. This includes assessing the type, frequency, dose, and method of supplement use, as well as understanding the client’s motivations and knowledge about the supplements,” said Kyle T. Ganson, PhD, MSW, assistant professor and lead author of the guidance.

The authors advocate for comprehensive biopsychosocial assessments when muscle-building supplement use is reported by adolescent and young adult clients. “It is critical to assess for other behaviours aimed at altering appearance, weight, shape, strength, and performance, as well as body image issues and the presence of any eating disorder, body dysmorphic disorder, or muscle dysmorphia. Identifying adverse effects on physical, psychological, and social health, and ongoing monitoring, should be part of routine practice.”

A harm reduction approach is emphasized throughout the guidelines. “This approach includes open communication, understanding motivations, and psychoeducation. The goal is to provide strategies to reduce negative effects associated with the use of muscle-building supplements while acknowledging that abstinence may not be a realistic goal for all clients.”

Lastly, the guidelines addressed the need to assess for potential or current use of anabolic-androgenic steroids (AAS), given the connection between muscle-building supplement use and future AAS use. Healthcare professionals are encouraged to provide education on the potential harms of AAS and further strategies to reduce risks.

Reference: Kyle T. Ganson, Ph.D., M.S.W., Jason M. Nagata, M.D., M.Sc.; Adolescent and Young Adult Use of Muscle-Building Dietary Supplements: Guidance for Assessment and Harm Reduction Approaches to Mitigate Risks; Journal of Adolescent Health; Published: July 05, 2024; DOI: https://doi.org/10.1016/j.jadohealth.2024.05.027

Research Identifies Cause of Lupus and Possible Reversal Technique

Northwestern Medicine and Brigham and Women’s Hospital scientists have discovered a molecular defect that promotes the pathologic immune response in systemic lupus erythematosus (known as lupus) and show that reversing this defect may potentially reverse the disease.

The study was published in the journal Nature.

Lupus affects more than 5 million people worldwide. Until now, the causes of this disease were unclear. Lupus can lead to life-threatening damage to multiple organs, including the kidneys, brain, and heart. Existing treatments often fail to control the disease effectively and have unintended side effects, such as reducing the immune system’s ability to fight infections.

In the study, scientists discovered a new pathway that causes lupus. They found changes in multiple molecules in the blood of lupus patients. These changes lead to a lack of activation in a pathway controlled by the aryl hydrocarbon receptor (AHR), which usually helps cells respond to environmental pollutants, bacteria, or metabolites. When AHR is not properly activated, it results in too many immune cells called T peripheral helper cells, which promote the production of harmful autoantibodies that cause the disease.

To explore potential treatments, the researchers added AHR-activating molecules back into blood samples from lupus patients. This reprogrammed the harmful immune cells into Th22 cells, which may help heal the damage caused by lupus.

“Up until this point, all therapy for lupus is a blunt instrument. It’s broad immunosuppression. By identifying a cause for this disease, we have found a potential cure that will not have the side effects of current therapies. We’ve identified a fundamental imbalance in the immune responses that patients with lupus make, and we’ve defined specific mediators that can correct this imbalance to dampen the pathologic autoimmune response. We found that if we either activate the AHR pathway with small molecule activators or limit the pathologically excessive interferon in the blood, we can reduce the number of these disease-causing cells. If these effects are durable, this may be a potential cure,” said the authors.

Reference: Law, C., Wacleche, V.S., Cao, Y. et al. Interferon subverts an AHR–JUN axis to promote CXCL13+ T cells in lupus. Nature (2024). https://doi.org/10.1038/s41586-024-07627-2

Drug That Lowers Blood Lipids Shows Promise in Treating Common Liver Disease: Study

The University of Barcelona has led a study that suggested using the drug known as ‘Pemafibrate’ to treat liver disease associated with metabolic disorders, the most common liver pathology in the world, which affects one in four people. The drug has long been marketed for another use: improving blood lipid levels in patients with hyperlipidaemia, a common condition in diabetics.

Now, the study, carried out on laboratory animal models and published in the journal Biomedicine & Pharmacotherapy, could help address this serious liver disease, which still has no specific treatment.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, is a complex condition that can lead to severe liver issues like cirrhosis, liver cancer, or liver failure. This disease often shows no clear symptoms and can progress for many years unnoticed.

Currently, Pemafibrate is used to manage blood cholesterol and triglyceride levels, a condition known as dyslipidemia. According to a new study, Pemafibrate could also be repurposed to treat MASLD. This approach, known as drug repositioning, involves using existing and approved medications for new medical conditions. This strategy helps fully utilize the potential of drugs and reduces the time and cost needed to develop new treatments for diseases that currently lack effective therapies.

In the study, using female rats with liver disease, Pemafibrate was found to prevent the development of fatty liver, increase the breakdown of fatty acids, and improve cholesterol clearance in the liver.

This drug, which has a good safety profile, works by activating a receptor called PPAR-α, which boosts the liver's ability to oxidize fatty acids. This process is essential for breaking down triglycerides and cholesterol, which can build up in the liver and cause disease.

The findings also highlighted the importance of considering sex differences in chronic diseases, potentially reducing gender bias in research.

Overall, Pemafibrate shows promise as a new treatment for liver disease.

“To our knowledge, this drug has not been used in the context of pharmacological repositioning, apart from a few exploratory clinical studies on its effects in liver pathology. Now we want to study its efficacy and safety in experimental models of more advanced liver disease, with the presence of inflammation and fibrosis in metabolic associated steatohepatitis (MASH),” said Professor Juan Carlos Laguna, from the Department of Pharmacology, Toxicology and Therapeutic Chemistry.

Reference: Bentanachs, R., et al. (2024). Pemafibrate abrogates SLD in a rat experimental dietary model, inducing a shift in fecal bile acids and microbiota composition. Biomedicine & Pharmacotherapy. doi.org/10.1016/j.biopha.2024.117067.