Anand Vaidya, Gregory A Kline, Paolo Mulatero, Adina F Turcu, Tracy Ann Williams, Vin-Cent Wu, Jun Yang, Maria-Christina Zennaro, André Lacroix
{"title":"Primary aldosteronism.","authors":"Anand Vaidya, Gregory A Kline, Paolo Mulatero, Adina F Turcu, Tracy Ann Williams, Vin-Cent Wu, Jun Yang, Maria-Christina Zennaro, André Lacroix","doi":"10.1038/s41572-026-00714-w","DOIUrl":"10.1038/s41572-026-00714-w","url":null,"abstract":"<p><p>Primary aldosteronism (PA) results from excessive aldosterone production by one or both adrenal glands and is an important cause of hypertension, leading to increased cardiovascular and renal morbidities. PA is primarily caused by a spectrum of somatic or germline mutations in aldosterone-driver genes and superimposed aberrant adrenal expression of various G-protein-coupled receptors and their ligands, leading to dysregulated aldosterone production. PA remains underdiagnosed, and simplified testing by measuring renin and aldosterone is recommended in all people with hypertension to maximize the diagnosis of PA. Some individuals with PA may also have co-secretion of cortisol, which contributes to cardiometabolic morbidities. Adrenal vein sampling, emerging functional imaging and novel biomarkers can identify whether a unilateral source of PA can be treated with surgical adrenalectomy. However, the majority of patients with PA have bilateral disease, warranting medical therapy with dietary sodium restriction and mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors in the near future. Medical therapy objectives are to normalize blood pressure and serum potassium; a rise in renin can serve as a biomarker of adequate therapy and reduced risk for adverse cardio-renal outcomes. Patients with PA should be monitored longitudinally for disease progression or recurrence, to manage potential adverse effects of treatment, and to optimize therapy of cardiovascular and other co-morbidities.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148331448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Integrating sexual health into care for patients with cancer and chronic illness.","authors":"Jennifer B Reese, Sharon L Bober","doi":"10.1038/s41572-026-00712-y","DOIUrl":"https://doi.org/10.1038/s41572-026-00712-y","url":null,"abstract":"","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yishan Ye, Bipin Savani, Florent Malard, Annalisa Ruggeri, Imane Aboudale, Zinaida Peric, He Huang, Mohamad Mohty
{"title":"Chronic graft-versus-host disease.","authors":"Yishan Ye, Bipin Savani, Florent Malard, Annalisa Ruggeri, Imane Aboudale, Zinaida Peric, He Huang, Mohamad Mohty","doi":"10.1038/s41572-026-00711-z","DOIUrl":"10.1038/s41572-026-00711-z","url":null,"abstract":"<p><p>Chronic graft-versus-host disease (cGVHD) is a major complication of allogeneic haematopoietic cell transplantation. cGVHD has a heterogeneous biology and morbid manifestations, affecting 30-70% of recipients and substantially impairing quality of life and is the leading cause of non-relapse mortality in allo-HCT recipients. This immune-mediated condition arises from complex immune dysregulation involving B cell and T cell activation, regulatory T cell dysfunction, and fibrosis driven by macrophages and fibroblasts. Glucocorticoids remain the first-line treatment; however, ~50% of patients develop steroid-refractory or steroid-dependent cGVHD, necessitating prolonged immunosuppression causing considerable toxicity. Four second-line treatments have been approved by the FDA - ibrutinib, ruxolitinib, belumosudil and axatilimab - targeting B cell signalling, JAK-STAT, ROCK2 and CSF1R pathways, respectively, and emerging therapies such as rovadicitinib show promise. However, substantial challenges persist in cGVHD treatment, including the heterogeneous biology and morbid manifestations (that is, lung and skin sclerosis), drug resistance and suboptimal supportive care. Biomarkers for early diagnosis and personalized treatment remain under investigation. Multidisciplinary care, infection control and psychosocial support are critical to improving quality of life in patients with cGVHD. Future research should prioritize mechanistic insights, antifibrotic therapies and integrating organ-specific interventions to enhance outcomes in patients with cGVHD.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":76.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephan Weidinger, Valeria Aoki, Sandipan Dhar, Ncoza C Dlova, Kenji Kabashima, Lin Ma, Carsten Flohr, Alan D Irvine
{"title":"Atopic dermatitis.","authors":"Stephan Weidinger, Valeria Aoki, Sandipan Dhar, Ncoza C Dlova, Kenji Kabashima, Lin Ma, Carsten Flohr, Alan D Irvine","doi":"10.1038/s41572-026-00703-z","DOIUrl":"10.1038/s41572-026-00703-z","url":null,"abstract":"<p><p>Atopic dermatitis (AD) is the most common inflammatory skin disease and carries the highest disability-adjusted life-years burden, ranking 15th among all non-fatal diseases globally. It is characterized by intensely itchy skin and is associated with multiple comorbidities, such as food allergy, asthma, allergic rhinitis and eosinophilic oesophagitis, which are mainly driven by type 2 immune responses. Other comorbidities include mental health disorders, disordered bone health, and cutaneous and extracutaneous infections. AD is also associated with other immune-mediated inflammatory diseases, including alopecia areata, vitiligo and inflammatory bowel disease. AD most often starts in the first 2 years of life but can occur at any life stage and onset at >60 years of age is increasingly common. The twenty-first century has brought greater insights into disease pathology, with an understanding of the complex interplay between the skin barrier, cutaneous and systemic immune pathways, cutaneous microbiome and neural networks. This improved mechanistic understanding has enabled rational drug design and a shift from non-specific broad immunomodulation to targeted biologic therapies and small molecules for severe disease and from topical corticosteroids to next-generation therapies for mild and moderate disease. Yet, considerable global inequity remains in access to these novel therapeutics.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandra R Arnold, Vincenzo Giordano, William T Obremskey, Edward M Schwarz, Mark S Smeltzer, Deborah J Veis, James E Cassat
{"title":"Osteomyelitis.","authors":"Sandra R Arnold, Vincenzo Giordano, William T Obremskey, Edward M Schwarz, Mark S Smeltzer, Deborah J Veis, James E Cassat","doi":"10.1038/s41572-026-00707-9","DOIUrl":"10.1038/s41572-026-00707-9","url":null,"abstract":"<p><p>Osteomyelitis, defined as inflammation of bone, is a highly morbid disease that is most commonly caused by bacterial infection. Infectious osteomyelitis occurs across a spectrum of ages and affects previously healthy individuals as well as individuals with medical comorbidities. Establishment of osteomyelitis typically occurs following one of three general pathological mechanisms, including haematogenous seeding of healthy or injured bone, extension of a contiguous soft tissue infection, or direct inoculation of microorganisms into the bone following trauma. A wide spectrum of microbial pathogens can cause osteomyelitis in these settings. The most common aetiologies share common pathogenic traits such as the propensity to form biofilms, the elaboration of immunoevasive toxins and virulence factors, and the ability to adhere to and invade bone tissue. Challenges in diagnosing, prognosing and treating osteomyelitis remain owing to limitations of conventional cultures, absence of faithful biomarkers, inability to delineate acute versus chronic infection, and therapeutic recalcitrance. Despite prolonged antimicrobial therapy, many individuals with osteomyelitis fail treatment and go on to develop highly morbid complications. Improvements in the management of osteomyelitis will require an ongoing commitment to multidisciplinary clinical care, basic and translational research to uncover pathophysiological mechanisms of disease, and sustained investments in new approaches for the diagnosis, treatment and mitigation of complications.</p>","PeriodicalId":18910,"journal":{"name":"Nature Reviews Disease Primers","volume":"12 1","pages":""},"PeriodicalIF":79.8,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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