مجله غدد درون ریز و متابولیسم ایران
سال بیست و چهارم شماره 4 (پیاپی 124، مهر و آبان 1401)

Precision medicine is a modern approach to medicine that employs the most effective strategies for preventing and treating each disease while considering individuals' diverse needs. This approach involves examining a person's ethnic background, lifestyle, genetic makeup, and metabolic profile to determine an appropriate diagnosis and treatment plan tailored to their specific circumstances and requirements. The necessary infrastructure for implementing this approach includes advances in tools and methods that identify individual molecular characteristics and enable the integration of large amounts of data. In addition to these technological advancements, physicians must possess the knowledge and skills to use these resources effectively to enhance their clinical practice. Therefore, the foundation for precision medicine lies in transforming medical education, which must focus on using massive genomic, metabolomic, epidemiological, clinical, and paraclinical data, utilizing computer technologies and artificial intelligence. The achievement of these goals can enable the adoption of tailored preventive, diagnostic, and therapeutic strategies for each patient group. This review article provides an introduction to precision medicine and its advancements in the field of endocrinology, with a focus on diabetes as one of the most prevalent endocrine diseases in contemporary societies. Additionally, we introduce the Tehran Cardiometabolic Genetic Study, which was conducted within the Tehran Lipid and Glucose Study framework and is a suitable candidate for implementing precision medicine approaches, given its 25-year follow-up and collection of genetic and clinical information from a population of fifteen thousand individuals.

 Bone metabolic disorders are complex abnormalities that result from multiple factors, including genetic and environmental factors such as nutrition and physical activity. This study aimed to investigate the effects of aerobic exercise and Dorema Aucheri (DA) extract on the expression of genes involved in bone tissue metabolism under hypothyroid conditions.

 Thirty female C57BL/6 mice, aged 6-7 weeks, were divided into five groups: 1. Hypothyroidism, 2. Hypothyroid with DA extract (0.4 mg/kg administered by gavage for eight weeks), 3. Hypothyroidism with aerobic exercise, 4. Hypothyroidism with DA extract and aerobic exercise, 5. Control. Hypothyroidism was induced by intraperitoneal injection of propylthiouracil (8 mg/kg) for one month. The genes involved in bone metabolic disorders affected by hypothyroidism were identified using bioinformatics databases and analysis. Aerobic exercise was performed at a moderate to high intensity (45 minutes, zero inclines, 25 meters per minute). Gene expression was assessed using the quantitative Real-Time PCR method.

 Based on the results of the bioinformatics analysis, the genes RUNX2, PGC1OSX, PPAR-γ, SIRT1, MAPK3, and OPG were identified and investigated. In the hypothyroidism group compared to the control group, the expression of OPG and RUNX2 increased, while the expression of OSX decreased. Also, the expression of PGC1α, SIRT1, MAPK3, and PPAR-γ decreased under hypothyroid conditions (p<0.001). Treatment with DA extract and aerobic exercise significantly increased the expression levels of SIRT1, MAPK3, PGC1α, and PPAR-γ (p<0.001).

 DA extract and aerobic exercise have the potential to modulate the genetic network of bone metabolism and exert a positive regulatory effect on it.

Previous research has demonstrated that chronic immobilization can induce oxidative stress and result in liver damage. Dried lemons (Citrus aurantifolia) possess antioxidant, anti-inflammatory, and anti-apoptotic properties, as well as neuroprotective and cardioprotective effects. The objective of the present study is to examine the impact of hydroethanolic extract from dried lemon peel on liver damage caused by chronic immobilization in male Wistar rats.

In this experimental study, 20 male Wistar rats were divided into four groups: control, dried lemon peel, chronic immobilization, and chronic immobilization-dried lemon peel. The chronic immobilization groups were subjected to restraint stress for 6 hours daily, continuously for 21 days. The dried lemon peel groups received a hydroethanolic extract of dried lemon peel (at a dose of 400 mg/kg body weight) by gavage. At the end of the study period, the levels of liver enzyme activity and liver malondialdehyde were measured.

The level of malondialdehyde in the liver of rats in the chronic immobilization group (0.532±0.045) was significantly higher compared to the control group (0.349±0.02). Moreover, the serum activity of alanine aminotransferase (51.61±4.58), aspartate aminotransferase (123.07±8.12), and alkaline phosphatase (310.62±13.96) enzymes in immobilized rats showed a significant increase compared to the control group (29.77±2.98, 73.10±7.03, and 209.53±7.00, respectively), indicating infiltration of inflammatory cells into the liver parenchyma. On the other hand, the chronic immobilization-dried lemon peel group exhibited a significant decrease in the level of malondialdehyde (0.407±0.004) and the activity of liver enzymes (alanine aminotransferase 35.73±2.29, aspartate aminotransferase 82.04±5.76, and alkaline phosphatase 231.0±15.91) compared to the chronic immobilization group.

It is concluded that dried lemon peel probably acts as a hepatoprotective agent by inhibiting oxidative stress and protecting the liver from damage caused by chronic immobilization.

 Periodontitis is a multi-factorial inflammatory disease that begins with the formation of microbial plaque, and its progression and severity are associated with conditions such as diabetes. Due to the relationship between tissue damage and changes in cytokine levels, this study aimed to evaluate the levels of Interleukin-17 (IL-17) in the saliva of patients with chronic periodontitis and type 2 diabetes.

 The study included 80 saliva samples from four groups, each consisting of 20 patients: individuals with periodontitis without diabetes, individuals with diabetes and periodontitis, individuals with diabetes without periodontitis, and a healthy control group without periodontitis. Participants were selected from the patients referred to the periodontology department of the Faculty of Dentistry and the Diabetes Center at Ahvaz University of Medical Sciences. The concentration of IL-17 was measured using the ELISA method. The data were analyzed using analysis of variance and Tukey's test. The correlation between clinical indicators, hemoglobin A1C (HbA1C) levels, and the concentration of Interleukin-17 was assessed using Spearman's correlation test.

 The lowest concentration of IL-17 was observed in healthy individuals without periodontal disease, while the highest concentration was found in diabetic patients with periodontitis (1.5±1.3 and 4.5±1.2 pg/ml, respectively). Salivary levels of interleukin in healthy individuals without diabetes showed a significant difference compared to the other groups. The comparison between the uncontrolled diabetic groups and the non-diabetic and controlled diabetic groups revealed a significant difference in IL-17 concentration (p<0.001 and p=0.001, respectively). There was a direct correlation between clinical parameters, HbA1C level, and IL-17 concentration.

 The association between periodontal disease and diabetes leads to an elevation in the concentration of interleukin-17, which can negatively impact the glycemic control of patients. Therefore, monitoring and treating periodontal disease, which has a chronic inflammatory nature, is recommended in patients with diabetes.

Evidence suggests a potential role of inflammation in increasing the risk of chronic diseases, including coronary artery disease (CAD) and atherosclerosis. This study aims to investigate the association between serum levels of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) and the risk of coronary artery involvement in individuals with CAD compared to the control group. 

 The study included 60 recently diagnosed CAD patients and 60 CAD-free individuals as the control group. Sociodemographic, clinical, and anthropometric data were collected, and serum samples were obtained to evaluate fasting serum glucose, lipid profile, and inflammatory markers. Logistic regression modeling was performed to estimate the effect of inflammatory markers on the likelihood of developing CAD, with adjustments for age, gender, and body mass index. The Pearson correlation coefficient was also used to assess the relationship between variables.

 The findings indicated a significant difference in the levels of TNF-α (P-value<0.001) and CRP (P-value=0.001) between the two groups. After adjusting for confounding variables and constructing a regression model, it was observed that with every 1 mg/dl increase in CRP level, the likelihood of developing CAD increased by 51% (P-value<0.008). Additionally, with every 1 pg/ml increase in TNF-α level, the risk of CAD increased by 45% (P-value<0.001).

 The obtained results indicate a correlation between inflammation and the pathogenesis of CAD, suggesting that these inflammatory markers may be used for predicting the occurrence and severity of CAD complications.

Polycystic Ovary Syndrome (PCOS) is linked to various cardiometabolic risk factors, including obesity, metabolic syndrome, hypertension, and low cardiorespiratory fitness. This study aimed to examine the impact of exercise training on serum lipid profile and blood pressure in women diagnosed with PCOS.

A systematic search was conducted in PubMed, Web of Science, SID, Magiran, and Google Scholar databases to extract English and Persian articles published until September 2022. Meta-analysis was performed to examine the effect of exercise training on serum triglyceride, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in women with PCOS. The standardized mean differences (SMD) or weighted mean differences (WMD) and 95% confidence interval (CI) were calculated using a random effects model. Heterogeneity was assessed using the I2 test, and publication bias was evaluated using a funnel plot and Egger's test.

The results of a meta-analysis comprising 20 studies involving 1242 patients with PCOS demonstrated that exercise training significantly reduced serum total cholesterol [SMD=-0.3, (CI: -0.47 to -0.12), p=0.001], serum LDL [SMD=-0.26, (CI: -0.44 to -0.09), p=0.003], and SBP [WMD=-3.12, (CI: -4.52 to -1.73), p=0.001] in women with PCOS compared to the control group. However, exercise training did not result in a significant decrease in serum triglycerides [SMD=-0.12, (CI: -0.31 to 0.06), p=0.2], serum HDL [SMD=0.06, (CI: -0.14 to 0.26), p=0.5], and DBP [WMD=-0.82, (CI: -2.04 to 0.39), p=0.1] in women with PCOS compared to the control group.

The findings of this study indicate that exercise training leads to a reduction in certain cardiometabolic risk factors, including total serum cholesterol, LDL, and systolic blood pressure (SBP) in women with PCOS. Therefore, exercise training is suggested as a non-pharmacological approach to mitigate the risk of cardiovascular complications for women with PCOS.