Atit Dharia, Abid Khan, Vikas S Sridhar, David Z I Cherney
{"title":"SGLT2 Inhibitors: The Sweet Success for Kidneys.","authors":"Atit Dharia, Abid Khan, Vikas S Sridhar, David Z I Cherney","doi":"10.1146/annurev-med-042921-102135","DOIUrl":"https://doi.org/10.1146/annurev-med-042921-102135","url":null,"abstract":"<p><p>Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) were originally developed as antidiabetic agents, with cardiovascular (CV) outcome trials demonstrating improved CV outcomes in patients with type 2 diabetes mellitus (T2D). Secondary analyses of CV outcome trials and later dedicated kidney outcome trials consistently reported improved kidney-related outcomes independent of T2D status and across a range of kidney function and albuminuria. Importantly, SGLT2 inhibitors are generally safe and well tolerated, with clinical trials and real-world analyses demonstrating a decrease in the risk of acute kidney injury. The kidney protective effects of SGLT2 inhibitors generally extend across different members of the class, possibly on the basis of hemodynamic, metabolic, anti-inflammatory, and antifibrotic mechanisms. In this review, we summarize the effects of SGLT2 inhibitors on kidney outcomes in diverse patient populations.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"369-384"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10732007","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":"Hepcidin and Iron in Health and Disease.","authors":"Elizabeta Nemeth, Tomas Ganz","doi":"10.1146/annurev-med-043021-032816","DOIUrl":"https://doi.org/10.1146/annurev-med-043021-032816","url":null,"abstract":"<p><p>Hepcidin, the iron-regulatory hormone, determines plasma iron concentrations and total body iron content. Hepcidin, secreted by hepatocytes, functions by controlling the activity of the cellular iron exporter ferroportin, which delivers iron to plasma from intestinal iron absorption and from iron stores. Hepcidin concentration in plasma is increased by iron loading and inflammation and is suppressed by erythropoietic stimulation and during pregnancy. Hepcidin deficiency causes iron overload in hemochromatosis and anemias with ineffective erythropoiesis. Hepcidin excess causes iron-restrictive anemias including anemia of inflammation. The development of hepcidin diagnostics and therapeutic agonists and antagonists should improve the treatment of iron disorders.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"261-277"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9943683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10748513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arndt Vogel, Oreste Segatto, Albrecht Stenzinger, Anna Saborowski
{"title":"FGFR2 Inhibition in Cholangiocarcinoma.","authors":"Arndt Vogel, Oreste Segatto, Albrecht Stenzinger, Anna Saborowski","doi":"10.1146/annurev-med-042921-024707","DOIUrl":"https://doi.org/10.1146/annurev-med-042921-024707","url":null,"abstract":"<p><p>Biliary tract cancer (BTC) is the second most common primary liver cancer after hepatocellular carcinoma and accounts for 2% of cancer-related deaths. BTCs are classified according to their anatomical origin into intrahepatic (iCCA), perihilar, or distal cholangiocarcinoma, as well as gall bladder carcinoma. While the mutational profiles in these anatomical BTC subtypes overlap to a large extent, iCCA is notable for the high frequency of IDH1/2 mutations (10-22%) and the nearly exclusive occurrence of FGFR2 fusions in 10-15% of patients. In recent years, FGFR2 fusions have become one of the most promising targets for precision oncology targeting BTC, with FGFR inhibitors already approved in Europe and the United States for patients with advanced, pretreated iCCA. While the therapeutic potential of nonfusion alterations is still under debate, it is expected that the field of FGFR2-directed therapies will be subject to rapid further evolution and optimization. The scope of this review is to provide an overview of oncogenic FGFR signaling in iCCA cells and highlight the pathophysiology, diagnostic testing strategies, and therapeutic promises and challenges associated with FGFR2-altered iCCA.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"293-306"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10671781","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}
Mackram F Eleid, Vuyisile T Nkomo, Sorin V Pislaru, Bernard J Gersh
{"title":"Valvular Heart Disease: New Concepts in Pathophysiology and Therapeutic Approaches.","authors":"Mackram F Eleid, Vuyisile T Nkomo, Sorin V Pislaru, Bernard J Gersh","doi":"10.1146/annurev-med-042921-122533","DOIUrl":"https://doi.org/10.1146/annurev-med-042921-122533","url":null,"abstract":"<p><p>This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"155-170"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10678930","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":"Origins of Racial and Ethnic Bias in Pulmonary Technologies.","authors":"Michael W Sjoding, Sardar Ansari, Thomas S Valley","doi":"10.1146/annurev-med-043021-024004","DOIUrl":"https://doi.org/10.1146/annurev-med-043021-024004","url":null,"abstract":"<p><p>Understanding how biases originate in medical technologies and developing safeguards to identify, mitigate, and remove their harms are essential to ensuring equal performance in all individuals. Drawing upon examples from pulmonary medicine, this article describes how bias can be introduced in the physical aspects of the technology design, via unrepresentative data, or by conflation of biological with social determinants of health. It then can be perpetuated by inadequate evaluation and regulatory standards. Research demonstrates that pulse oximeters perform differently depending on patient race and ethnicity. Pulmonary function testing and algorithms used to predict healthcare needs are two additional examples of medical technologies with racial and ethnic biases that may perpetuate health disparities.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"401-412"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883596/pdf/nihms-1827689.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9225575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"COVID-19 and Kidney Disease.","authors":"Maureen Brogan, Michael J Ross","doi":"10.1146/annurev-med-042420-104753","DOIUrl":"https://doi.org/10.1146/annurev-med-042420-104753","url":null,"abstract":"<p><p>COVID-19 can cause acute kidney injury and may cause or exacerbate chronic kidney diseases, including glomerular diseases. SARS-CoV-2 infection of kidney cells has been reported, but it remains unclear if viral infection of kidney cells causes disease. The most important causes of kidney injury in patients with COVID-19 include impaired renal perfusion and immune dysregulation. Chronic kidney disease, especially kidney failure with kidney replacement therapy and kidney transplant, is associated with markedly increased COVID-19 mortality. Persons with severe kidney disease have been excluded from most clinical trials of COVID-19 therapies, so therapeutic approaches must be extrapolated from studies of patients without kidney disease. Some medications used to treat COVID-19 should be avoided or used at reduced dosages in patients with severe kidney disease and in kidney transplant recipients. Additional research is needed to determine the optimal strategies to prevent and treat COVID-19 in patients with kidney disease.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"1-13"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9240737","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}
Jennifer A Sullivan, Kelly Schoch, Rebecca C Spillmann, Vandana Shashi
{"title":"Exome/Genome Sequencing in Undiagnosed Syndromes.","authors":"Jennifer A Sullivan, Kelly Schoch, Rebecca C Spillmann, Vandana Shashi","doi":"10.1146/annurev-med-042921-110721","DOIUrl":"10.1146/annurev-med-042921-110721","url":null,"abstract":"<p><p>Exome sequencing (ES) and genome sequencing (GS) have radically transformed the diagnostic approach to undiagnosed rare/ultrarare Mendelian diseases. Next-generation sequencing (NGS), the technology integral for ES, GS, and most large (100+) gene panels, has enabled previously unimaginable diagnoses, changes in medical management, new treatments, and accurate reproductive risk assessments for patients, as well as new disease gene discoveries. Yet, challenges remain, as most individuals remain undiagnosed with current NGS. Improved NGS technology has resulted in long-read sequencing, which may resolve diagnoses in some patients who do not obtain a diagnosis with current short-read ES and GS, but its effectiveness is unclear, and it is expensive. Other challenges that persist include the resolution of variants of uncertain significance, the urgent need for patients with ultrarare disorders to have access to therapeutics, the need for equity in patient access to NGS-based testing, and the study of ethical concerns. However, the outlook for undiagnosed disease resolution is bright, due to continual advancements in the field.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"489-502"},"PeriodicalIF":15.1,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10483513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10166378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annual review of medicinePub Date : 2023-01-27Epub Date: 2022-12-05DOI: 10.1146/annurev-med-043021-014005
Pratik Sinha, Nuala J Meyer, Carolyn S Calfee
{"title":"Biological Phenotyping in Sepsis and Acute Respiratory Distress Syndrome.","authors":"Pratik Sinha, Nuala J Meyer, Carolyn S Calfee","doi":"10.1146/annurev-med-043021-014005","DOIUrl":"10.1146/annurev-med-043021-014005","url":null,"abstract":"<p><p>Heterogeneity in sepsis and acute respiratory distress syndrome (ARDS) is increasingly being recognized as one of the principal barriers to finding efficacious targeted therapies. The advent of multiple high-throughput biological data (\"omics\"), coupled with the widespread access to increased computational power, has led to the emergence of phenotyping in critical care. Phenotyping aims to use a multitude of data to identify homogenous subgroups within an otherwise heterogenous population. Increasingly, phenotyping schemas are being applied to sepsis and ARDS to increase understanding of these clinical conditions and identify potential therapies. Here we present a selective review of the biological phenotyping schemas applied to sepsis and ARDS. Further, we outline some of the challenges involved in translating these conceptual findings to bedside clinical decision-making tools.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"457-471"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dinushika Mohottige, Opeyemi Olabisi, L Ebony Boulware
{"title":"Use of Race in Kidney Function Estimation: Lessons Learned and the Path Toward Health Justice.","authors":"Dinushika Mohottige, Opeyemi Olabisi, L Ebony Boulware","doi":"10.1146/annurev-med-042921-124419","DOIUrl":"10.1146/annurev-med-042921-124419","url":null,"abstract":"<p><p>In 2020, the nephrology community formally interrogated long-standing race-based clinical algorithms used in the field, including the kidney function estimation equations. A comprehensive understanding of the history of kidney function estimation and racial essentialism is necessary to understand underpinnings of the incorporation of a Black race coefficient into prior equations. We provide a review of this history, as well as the considerations used to develop race-free equations that are a guidepost for a more equity-oriented, scientifically rigorous future for kidney function estimation and other clinical algorithms and processes in which race may be embedded as a variable.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"385-400"},"PeriodicalIF":15.1,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9258106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clonal Hematopoiesis and Its Impact on Human Health.","authors":"Herra Ahmad, Nikolaus Jahn, Siddhartha Jaiswal","doi":"10.1146/annurev-med-042921-112347","DOIUrl":"https://doi.org/10.1146/annurev-med-042921-112347","url":null,"abstract":"<p><p>Aging is associated with increased mutational burden in every tissue studied. Occasionally, fitness-increasing mutations will arise, leading to stem cell clonal expansion. This process occurs in several tissues but has been best studied in blood. Clonal hematopoiesis is associated with an increased risk of blood cancers, such as acute myeloid leukemia, which result if additional cooperating mutations occur. Surprisingly, it is also associated with an increased risk of nonmalignant diseases, such as atherosclerotic cardiovascular disease. This may be due to enhanced inflammation in mutated innate immune cells, which could be targeted clinically with anti-inflammatory drugs. Recent studies have uncovered other factors that predict poor outcomes in patients with clonal hematopoiesis, such as size of the mutant clone, mutated driver genes, and epigenetic aging. Though clonality is inevitable and largely a function of time, recent work has shown that inherited genetic variation can also influence this process. Clonal hematopoiesis provides a paradigm for understanding how age-related changes in tissue stem cell composition and function influence human health.</p>","PeriodicalId":8056,"journal":{"name":"Annual review of medicine","volume":"74 ","pages":"249-260"},"PeriodicalIF":10.5,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125331","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}