👤 Stergios A Polyzos

The development of novel sophisticated medications that induce weight loss has revolutionized the management of people living with obesity (PwO). However, when body weight is reduced, muscle and bone are lost along with fat. In the present review, we quote and discuss existing evidence on the effects of the major anti-obesity medications on bone metabolism. Glucagon-like peptide-1 receptor (GLP-1R) agonists have shown a positive impact in preclinical studies but a neutral or negative, albeit not clinically significant, effect on bone turnover markers and bone mineral density in clinical studies. Nevertheless, fracture risk does not seem to increase with GLP-1R agonists use, at least in clinically relevant doses. Limited, mostly preclinical, data suggest that other incretin analogues, including dual GLP-1R and glucose-dependent insulinotropic polypeptide (GIP) receptor (GIPR) agonists, dual GLP-1R and glucagon receptor (GCGR) agonists, and triple GLP-1R, GIPR and GCGR agonists, may have a positive effect on bone. Preclinical data with amylin analogues imply the same. Activin type II receptor (ActRII) antagonists may combine anti-obesity effects with simultaneous muscle and bone mass preservation and could be used either as monotherapy or in combination with incretin analogues. The bone effects of opioid receptor antagonists and setmelanotide are largely unknown, while the impact of the combination of phentermine with topiramate is assumed to be negative. Finally, very limited clinical evidence suggests that orlistat may have a neutral effect on bone metabolism. Show less

The evaluation of the effect of dulaglutide on glycated hemoglobin (HbA1c) and non-invasive indices of hepatic steatosis among different genotypes of the PNPLA3 I148M (rs738409) and CETP Taq1B (rs708272) polymorphisms in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Relevant data from patients with inadequately controlled T2DM, also displaying NAFLD, administered 1.5 mg dulaglutide weekly for 6 months were retrospectively retrieved. The non-invasive indices, fatty liver index (FLI) and hepatic steatosis index (HSI), were calculated. Genotyping for rs738409 and rs708272 were performed with polymerase chain reaction. Data from 80 patients (39 females), aged 64.4 ± 9.5 years and displaying a baseline BMI of 34.5 ± 5.8 kg/m rs738409, but not rs708272, was associated with the effect of dulaglutide on HbA1c, but not on presumed hepatic steatosis or other relevant parameters. Sex-specific effects were also noticed. Show less

This narrative review aims to critically summarize evidence on the potential contribution of cytokines, including members of the tumor necrosis factor (TNF) superfamily, interleukins (ILs), interferons (IFs), chemokines, lymphokines, and members of the transforming growth factor (TGF) superfamily to the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD). It also considers the translational relevance of cytokines, including their potential for non-invasive biomarkers or therapeutic targets of MASLD. MASLD and its inflammatory phenotype, metabolic dysfunction-associated steatohepatitis (MASH), are characterized by chronic, low-grade hepatic inflammation, primarily initiated by metabolic contributors and driven by various cytokines. Cytokines are major mediators of the transition from hepatic steatosis to MASH. Some of them seem to be predominantly protective (tumor necrosis factor weak inducer of apoptosis, IL-10, IL-22, IL-25, IL-27), others appear to exhibit a possibly dual-faceted effect, depending on the stage of MASLD (TNF-α, TNF-related apoptosis-inducing ligand, IL-2, IL-6, IL-18, IL-33, IFNs), whereas a third group of cytokines seems to be predominantly harmful, thus driving the progression of hepatic steatosis to MASH, fibrosis, cirrhosis, and possibly to hepatocellular carcinoma. In this regard, some cytokines may prove suitable non-invasive indices for distinguishing MASH or hepatic fibrosis from hepatic steatosis. Additionally, cytokine-based therapies, including anti-TNF-α agents (infliximab, adalimumab, etanercept), NLRP3 inhibitors, recombinant IL-1R antagonist (anakinra), selective C-C chemokine receptor type 2 inhibitors, anti-IL-17 (e.g., secukinumab and ixekizumab) or IL-17R (brodalumab) monoclonal antibodies, and recombinant IL-22, may prove promising pharmacological targets for the management of MASLD. Amounting evidence renders some cytokines key players in the pathophysiology of MASLD, which may possibly have diagnostic and therapeutic implications. Show less