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Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study

  • Li Chen , Ying Yi and Yun Zhu EMAIL logo
Published/Copyright: July 17, 2025
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Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Objective

This study aimed to investigate the potential causal relationship between immune cell and the risk of ulcerative colitis (UC), and to explore whether serum metabolites may mediate this association, thereby suggesting potential biomarkers or therapeutic targets.

Methods

We conducted a Mendelian randomization (MR) analysis using summary statistics from genome-wide association studies to evaluate both the direct effects and potential mediating roles of 731 immune cells and 1,400 serum metabolites in relation to UC. Instrumental variables were rigorously selected based on genome-wide significance and linkage disequilibrium thresholds. The primary analytical method was inverse variance weighted, supplemented by MR-Egger regression and weighted median methods to ensure robustness. Cochran’s Q test, MR-Egger intercept, and leave-one-out analysis were employed to evaluate heterogeneity and pleiotropy. Mediation MR analysis was conducted to examine potential metabolite-mediated pathways.

Results

We identified a statistically significant positive causal effect of CD39⁺ CD4⁺ T cell on UC risk (OR = 1.05, 95% CI = 1.03–1.08, beta_all = 0.05). Sensitivity analyses confirmed the robustness of this association, and reverse MR analysis indicated no causal effect of UC on CD39⁺ CD4⁺ T cell, suggesting a unidirectional relationship. Mediation analysis further revealed that succinyl carnitine (C4DC) partially mediated the effect of CD39⁺ CD4⁺ T cell on UC, with a mediation proportion of 3.3%.

Conclusion

Our findings suggest that CD39⁺ CD4⁺ T cell may increase the risk of UC, potentially by modulating the levels of succinyl carnitine (C4DC). These results indicate a potential immunometabolic pathway in UC pathogenesis and highlight CD39⁺ CD4⁺ T cell and C4DC as promising targets for further research. However, additional experimental validation is required to confirm these findings and assess their clinical relevance.

Keywords: T cells; succinyl carnitine; UC; Mendelian randomization; preventive treatment

1 Introduction

Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease characterized by continuous mucosal inflammation of the colon, it typically presents with symptoms such as diarrhea, abdominal pain, and rectal bleeding [1]. Although the precise etiology of UC remains unclear, increasing evidence suggests that its onset and progression result from a complex interplay among genetic susceptibility, environmental triggers, gut microbiota dysbiosis, and immune dysregulation [2]. Due to the absence of standardized and accurate early diagnostic criteria for UC [3], misdiagnosis remains common, which negatively affects patients’ quality of life and leads to substantial medical resource consumption. Identifying novel biomarkers may deepen our understanding of UC pathogenesis and help optimize diagnostic and therapeutic strategies [4].

A central pathological feature of UC is the disruption of intestinal immune homeostasis [5]. Under normal physiological conditions, the gut immune system maintains tolerance to self-antigens and commensal microbiota. In UC, this balance is disturbed, leading to excessive infiltration of immune cells – such as T lymphocytes, B cells, macrophages, and natural killer (NK) cells – into the colonic mucosa [6]. These immune cells secrete pro-inflammatory cytokines (e.g., TNF-α, IFN-γ, IL-17) and chemokines, which contribute to mucosal damage and chronic inflammation [7]. Studies have shown that the restoration of regulatory T cells (Tregs) may support clinical remission in UC patients [8]. For instance, CD4⁺ T cells can differentiate into pro-inflammatory Th1 and Th17 subsets in UC, promoting epithelial injury [9]. Additionally, increased activation of mucosal B cells [10] and macrophages [11] has been associated with disease severity and risk of relapse. Furthermore, genetic factors, including mutations in immune-related genes such as NOD2 and IL-23R, have also been linked to increased susceptibility to UC [12]. Thus, a more comprehensive understanding of immune regulatory mechanisms is essential for elucidating UC pathogenesis and developing novel treatment strategies.

Concurrently, serum metabolites have emerged as important contributors to UC pathogenesis, serving not only as potential biomarkers but also as mediators of disease processes [13,14]. Metabolic dysregulation – especially involving amino acid, lipid, and short-chain fatty acid (SCFA) metabolism – is commonly observed in UC patients [15]. However, observational studies have reported inconsistent findings regarding serum valine and tissue glutamate levels in UC compared to healthy controls [16,17]. Reduced levels of SCFAs are known to impair the integrity of the intestinal epithelial barrier, thereby increasing susceptibility to inflammation [18]. Moreover, certain lipid metabolites, such as lysophosphatidic acid, may exacerbate inflammation by promoting immune cell activation and migration [19]. Despite these findings, the mechanistic links between immune dysregulation and metabolic abnormalities in UC remain poorly understood. While prior studies have independently investigated immune cells and serum metabolites, few have systematically explored their interaction – particularly whether serum metabolites mediate the effect of immune cells on UC risk.

Mendelian randomization (MR), a genetic epidemiological approach, provides an effective tool for causal inference by using genetic variants as instrumental variables (IVs). It helps to minimize confounding and reverse causality that often limit traditional observational studies [20]. In this study, we employ a comprehensive two-sample MR framework to explore the causal relationships among immune cells, serum metabolites, and UC risk. Specifically, we aim to identify immune cells that contribute to UC pathogenesis through metabolite-mediated pathways. By elucidating these immunometabolic interactions, our findings may offer novel mechanistic insights and suggest potential targets for the prevention and treatment of UC.

2 Materials and methods

2.1 Study design

This study employed a two-sample MR design to investigate the causal relationship between 731 immune cells as exposure factors and UC as the outcome, as well as the potential mediating role of 1,400 serum metabolites. The specific analytical steps are summarized in Figure 1. (1) Analyze the unidirectional causal relationship between 731 immune cells as exposure factors and UC as the outcome variable, and identify the most robust immune cell associated with UC (CD39⁺ CD4⁺ %T cell. In this study, the trait “CD39⁺ CD4⁺ %T cell” refers to the proportion of CD4⁺ T cells that express CD39+, as defined in the original genome-wide association studies (GWAS) dataset. For clarity, we refer to this trait as “CD39⁺ CD4⁺ T cells” throughout the manuscript when discussing biological interpretation). (2) Conduct reverse MR analysis using UC as the exposure and the identified immune cell as the outcome to confirm the absence of reverse causality. (3) Analyze the causal relationship between the selected immune cells as exposure factors and 1,400 serum metabolites as outcome variables. (4) Analyze the causal relationship between 50 serum metabolites that have a causal relationship with the selected immune cells and UC as the outcome variable. Finally, calculate the total effect (beta_all) of the selected immune cells (CD39⁺ CD4⁺ T cell) on UC, the effect of the selected immune cells on the identified mediating serum metabolites (beta1), and the effect of the mediating serum metabolites on UC (beta2), in order to determine the mediating effect and mediation effect ratio of the serum metabolites in the influence of the selected immune cells on UC.

Figure 1 MR study design investigating the effects of 731 immune cells on UC mediated by 1,400 serum metabolites.
Figure 1

MR study design investigating the effects of 731 immune cells on UC mediated by 1,400 serum metabolites.

2.2 Data sources

2.2.1 Immune cell data

Summary statistics for 731 immune cells were obtained from the GWAS catalog (Registration Numbers GCST90001391–GCST90002121) [21]. The study data were derived from 3,757 European individuals, after adjusting for confounders such as age and sex, more than 22 million single nucleotide polymorphisms (SNPs) were genotyped using high-density arrays.

2.2.2 Serum metabolite data

A total of 1,400 serum metabolites were sourced from a Canadian aging longitudinal cohort study involving 8,299 participants [22], which included 1,091 metabolites and 309 metabolite ratios. These metabolites were categorized into eight major classes: amino acids, carbohydrates, cofactors and vitamins, energy metabolites, lipids, nucleotides, peptides, and xenobiotic metabolites. Detailed GWAS data are available through the GWAS Catalog (Registration Numbers: GCST90199621–GCST90204063).

2.2.3 UC data

UC summary statistics were obtained from the FinnGen project (R11 release), a nationwide public–private collaboration in Finland aimed at exploring the etiology of various diseases [23]. This dataset includes information from 6,435 UC patients and 446,419 control individuals. All data used in this study were derived from publicly available databases and did not involve direct patient contact or ethical approval.

2.3 Selection of IVs

SNPs were selected as IVs according to the three core assumptions of MR [24]: (1) SNPs significantly associated with the exposure factor are selected as IVs. (2) SNPs should be independent of known confounders, ensuring relative independence. (3) SNPs should influence the outcome variable solely through the exposure factor. Following previous similar studies [25–27], in order to ensure the integrity and accuracy of causal inference, this study applied a threshold of P < 1 × 10⁻⁵ when screening for SNPs associated with the 731 immune cells and 1,400 serum metabolites [28]. In order to remove SNPs in linkage disequilibrium and avoid statistical biases caused by genetic linkage, the study set parameters of R² = 0.001 and a 10,000 kb window [29]. Palindromic SNPs with intermediate allele frequencies were excluded to ensure strand alignment [30]. Finally, the strength of each instrument was evaluated using the F-statistic, with SNPs having F > 10 retained to minimize weak instrument bias [31].

2.4 Statistical methods

All statistical analyses were performed using R software (version 4.3.2), with the “Two-SampleMR” and “MR-PRESSO” packages. The inverse variance weighted (IVW) method was employed as the primary analytical approach, as it is widely accepted for causal effect estimation [32]. P < 0.05 was considered statistically significant [33], MR-Egger regression and the weighted median method were conducted as complementary analyses to assess robustness [34]. Heterogeneity was assessed using Cochran’s Q test under both the IVW and MR-Egger methods, with P > 0.05 indicating no significant heterogeneity. Horizontal pleiotropy was evaluated using the MR-PRESSO global test and the MR-Egger intercept test, where P > 0.05 was interpreted as absence of pleiotropy [35]. A leave-one-out sensitivity analysis was also performed to evaluate the influence of individual SNPs on the overall causal estimate. The effect relationships between exposures and outcomes were evaluated using odds ratios (OR) and their 95% confidence intervals (CI).

A two-step mediation MR analysis was conducted to estimate the total effect (beta_all) of selected immune cells on UC, the effect of immune cells on serum metabolites (beta1), and the effect of serum metabolites on UC (beta2). From these, the indirect mediation effect (beta12), direct effect (beta_dir), and mediation proportion (beta12_p) were calculated [36]. Specifically, the total effect represents the overall impact of selected immune cells on UC, which can be decomposed into the direct effect of selected immune cells on UC and the indirect effect mediated by the identified serum metabolites. The mediation effect (beta12 = beta1 × beta2) represents the indirect effect of selected immune cells on UC through the serum metabolites. The direct effect (beta_dir = beta_all − beta12) represents the direct impact of selected immune cells on UC. The mediation effect ratio (beta12_p = beta12/beta_all) reflects the proportion of the total effect that is mediated by the serum metabolites, providing insight into the percentage of UC risk influenced by selected immune cells through these metabolites. If the directionality of beta12 and beta_all is inconsistent (i.e., OR > 1 or < 1), the mediation proportion is not interpretable, and a one-sided test with a significance level of α = 0.05 was applied.

3 Results

3.1 Causal relationship between 731 immune cells and UC

After excluding immune cells with linkage disequilibrium and weak IVs, two-sample MR analysis was performed using immune cells as exposures and UC as the outcome. The IVW method identified 52 immune cells with P-values < 0.05. Further evaluation of heterogeneity and horizontal pleiotropy revealed that 27 of these immune cells exhibited significant heterogeneity (P < 0.05), including the following: myeloid DC %DC, DC AC, CD62L− DC %DC, CD86+ myeloid DC %DC, CD62L− myeloid DC AC, CD62L− myeloid DC %DC, CD62L− CD86+ myeloid DC %DC, CD33dim HLA DR+ CD11b+ AC, CD14+ CD16+ monocyte AC, T/B, NK %CD3− lymphocyte, HLA DR+ NK AC, HLA DR+ NK %NK, HLA DR+ NK %CD3− lymphocyte, CD127− CD8br %T cell, CD45RA− CD28− CD8br %T cell, CD19 on sw mem, CD28 on CD45RA−CD4 not Treg, CD86 on myeloid DC, CD16 on CD14− CD16+ monocyte, HLA DR on CD14− CD16+ monocyte, CX3CR1 on CD14+ CD16− monocyte, PDL-1 on monocyte, HLA DR on plasmacytoid DC, HLA DR on DC, and HLA DR on CD33dim HLA DR+ CD11b−, HLA DR on CD33− HLA DR+.

Additionally, two immune cells (IgD+ CD38− %B cell, EM CD8br %T cell) showed evidence of horizontal pleiotropy (P < 0.05). Another immune cell (CD45RA− CD28− CD8br AC) had an OR close to 1 and was thus excluded. After excluding these 30 immune cells mentioned above, a forest plot of the remaining 22 immune cells was generated using three MR methods (Figure 2).

Figure 2 Forest plot of MR analysis between immune cells and UC. The black line represents the 95% CI of the effect size; the red, green, and blue dots represent effect estimates obtained from different MR methods; exposure: immune cell phenotypes; nsnp: number of SNPs; method: analytical method used; P val: P-value.
Figure 2

Forest plot of MR analysis between immune cells and UC. The black line represents the 95% CI of the effect size; the red, green, and blue dots represent effect estimates obtained from different MR methods; exposure: immune cell phenotypes; nsnp: number of SNPs; method: analytical method used; P val: P-value.

To further assess the reliability of the results, this study combined MR-Egger and weighted median analyses. It was found that two immune cells exhibited a more reliable causal relationship with UC. Specifically, immune cells (CD39+ CD4+ %T cell, SSC-A on HLA DR+ T cell) demonstrated P IVW < 0.05, with both MR-Egger and weighted median methods showing P < 0.05. After comparing the P IVW values, the study ultimately selected the immune cell with the most stable causal relationship (CD39+ CD4+ %T cell, P < 0.001) for subsequent analysis.

3.2 Reverse MR

To meet the requirements for the mediation MR study, this research conducted a reverse MR analysis with UC as the exposure and immune cells (CD39+ CD4+ %T cell) as the outcome. The results showed that all five analytical methods had P ＞0.05, indicating no statistical significance. This suggests that, in the context of reverse causality, there is no causal relationship between UC and CD39+ CD4+ %T cell (Table 1).

Table 1

Reverse MR analysis of UC and CD39+ CD4+ %T cell

Method nsnp β se P val or or_lci95 or_uci95
MR Egger 40 0.05 0.10 0.60 1.05 0.87 1.28
Weighted median 40 0.05 0.04 0.37 1.04 0.95 1.14
IVW 40 0.03 0.03 0.37 1.03 0.97 1.10
Simple mode 40 0.08 0.08 0.44 1.06 0.91 1.24
Weighted mode 40 0.05 0.07 0.42 1.06 0.93 1.21

β = beta, se = standard error.

3.3 Causal relationship between CD39+ CD4+ %T cell and 1,400 serum metabolites

To investigate the causal relationship between the most stable immune cell (CD39+ CD4+ %T cell) and serum metabolites in UC, the study conducted 1,400 two-sample MR analyses after removing linkage disequilibrium and weak IVs. In the analysis, CD39+ CD4+ %T cell was used as the exposure and 1,400 serum metabolites as the outcomes.

The results revealed that 51 serum metabolites had P IVW < 0.05, indicating a significant causal relationship. To further validate the reliability of the results, heterogeneity and horizontal pleiotropy tests were performed. The analysis found that the serum metabolite (13−HODE + 9−HODE) displayed heterogeneity (P < 0.05). After excluding this serum metabolite, a forest plot of 50 serum metabolites from the IVW analysis method was generated (Figure 3).

Figure 3 Forest plot of MR analysis between CD39+ CD4+ %T cell and serum metabolites. The black line represents the 95% CI of the effect size; the red dot represents the effect size; exposure: immune cell phenotypes; nsnp: number of SNPs; method: analytical method used; P val: P-value.
Figure 3

Forest plot of MR analysis between CD39+ CD4+ %T cell and serum metabolites. The black line represents the 95% CI of the effect size; the red dot represents the effect size; exposure: immune cell phenotypes; nsnp: number of SNPs; method: analytical method used; P val: P-value.

3.4 Causal relationship between 50 serum metabolites associated with CD39+ CD4+ %T cell and UC

After removing serum metabolite linkage disequilibrium and weak IVs, this study conducted 50 two-sample MR analyses with 50 serum metabolites as the exposures and UC as the outcome. The results revealed that three serum metabolites had P IVW < 0.05, suggesting a causal relationship with UC. Sensitivity analysis further confirmed the reliability of the results, and no evidence of heterogeneity or horizontal pleiotropy was observed. Specifically: 1-oleoylglycerol (18:1) showed a negative correlation with UC (OR = 0.92, 95% CI = 0.85–1.00). Succinyl carnitine (C4DC) showed a positive correlation with UC (OR = 1.08, 95% CI = 1.01–1.15). 1,2-Dilinoleoyl-GPC (18:2/18:2) showed a positive correlation with UC (OR = 1.25, 95% CI = 1.12–1.38). The remaining 47 serum metabolites showed no significant association with UC (P IVW > 0.05).

3.5 Mediation of the effect of immune cells on UC by serum metabolites

A two-step mediation MR analysis was conducted to explore whether serum metabolites mediated the effect of CD39⁺ CD4⁺ T cell on UC: (1) The analysis confirmed a positive correlation between CD39+ CD4+ %T cell and UC (OR = 1.05, 95% CI = 1.03–1.08, β_all = 0.05). Additionally, CD39+ CD4+ %T cell were positively correlated with 1-oleoylglycerol (18:1) (OR = 1.03, 95% CI = 1.00–1.05, β1 = 0.03). However, 1-oleoylglycerol (18:1) was negatively correlated with UC (OR = 0.92, 95% CI = 0.85–1.00, β2 = −0.08). The total effect of exposure on the outcome (β_all = 0.05) and the mediation effect (β12 = −0.002) were inconsistent in direction, suggesting that exposure might not influence the outcome through this mediator. (2) The analysis found a positive correlation between CD39+ CD4+ %T cell and UC (OR = 1.05, 95% CI = 1.03–1.08, β_all = 0.05). CD39+ CD4+ %T cell were positively correlated with succinyl carnitine (C4DC) (OR = 1.02, 95% CI = 1.00–1.05, β1 = 0.02). Succinyl carnitine (C4DC) was also positively correlated with UC (OR = 1.08, 95% CI = 1.01–1.15, β2 = 0.08). The total effect of exposure on the outcome (β_all = 0.05) and the mediation effect (β12 = 0.002) were consistent in direction, with the mediation effect ratio (β12_p) being 3.3%. This suggests that succinyl carnitine (C4DC) mediates the relationship between CD39+ CD4+ %T cell and UC, contributing to the increased risk of UC. (3) CD39+ CD4+ %T cell were positively correlated with UC (OR = 1.05, 95% CI = 1.03–1.08, β_all = 0.05). 1,2-Dilinoleoyl-GPC (18:2/18:2) was negatively correlated with CD39+ CD4+ %T cells (OR = 0.98, 95% CI = 0.95–1.00, β1 = −0.02). However, 1,2-dilinoleoyl-GPC (18:2/18:2) was positively correlated with UC (OR = 1.25, 95% CI = 1.12–1.38). The total effect of exposure on the outcome (β_all = 0.05) and the mediation effect (β12 = −0.005) were inconsistent in direction, indicating that exposure might not influence UC through this mediator.

4 Discussion

CD39 (ectonucleoside triphosphate diphosphohydrolase1, ENTPD1) is widely expressed on T cells, regulatory T cells (Tregs), and certain innate immune cells [37]. Its primary function is to hydrolyze adenosine triphosphate and adenosine diphosphate into adenosine monophosphate, which is subsequently converted into immunosuppressive adenosine by CD73. Adenosine, in turn, binds to adenosine receptors – such as the A2A receptor – thereby inhibiting immune cell activation and reducing the release of pro-inflammatory cytokines, including IL-1β and TNF-α. This mechanism plays an important role in modulating inflammatory responses. Studies [38] have shown that CD39 expression is upregulated in certain inflammatory diseases, and dysregulation of its immunosuppressive function may contribute to aberrant immune responses and the persistence of chronic inflammation.

CD4+ T cells [39], as helper T (Th) cells, play a pivotal role in adaptive immune responses by secreting cytokines and activating other immune cells. Previous studies have demonstrated that activated memory CD4⁺ T cells and follicular helper T cells are particularly involved in promoting immune activation and inflammation in UC [40]. In UC patients, CD39⁺ CD4⁺ T cell may disrupt intestinal immune homeostasis by altering the balance between Tregs and effector T cells. This imbalance can result in excessive immunosuppression, impaired immune surveillance of gut microbiota, and exacerbated intestinal inflammation. Moreover, these cells may aggravate disease progression by releasing pro-inflammatory cytokines or through direct interaction with the intestinal microenvironment [41].

Our mediation MR analysis further suggests that CD39⁺ CD4⁺ T cell may influence UC risk by regulating the level of succinyl carnitine (C4DC). Succinyl carnitine [42] is a carnitine ester formed through conjugation with succinyl-CoA, a key intermediate in the tricarboxylic acid (TCA) cycle. Carnitine derivatives [43], including C4DC, facilitate the mitochondrial transport of fatty acids and their intermediates, bridging β-oxidation and the TCA cycle. C4DC levels are closely linked to T-cell metabolic adaptation, energy metabolism, oxidative stress, and immune regulation. CD39⁺ CD4⁺ T cell may affect mitochondrial metabolism by influencing the conversion of succinyl-CoA into C4DC. Accumulation of C4DC may contribute to UC-associated inflammation through the following mechanisms: (1) overactivation of effector T cells, (2) increased release of pro-inflammatory cytokines (e.g., IL-17, IFN-γ), and (3) enhanced oxidative stress leading to disruption of the intestinal epithelial barrier [44]. Moreover, altered C4DC levels may modulate immune signaling pathways, affecting T-cell functionality and the stability of the intestinal microenvironment. In particular, CD39⁺ CD4⁺ T cell – which represent a subpopulation of CD4⁺ T cell expressing the immunosuppressive ectoenzyme CD39 – may exacerbate immune dysregulation and chronic inflammation in the gut, thereby promoting UC pathogenesis and progression.

Despite providing novel insights into the immunometabolic mechanisms of UC, this study has several limitations. (1) Although the MR approach effectively reduces confounding and reverse causation, the validity of its conclusions relies on the strength and assumptions of the IVs. (2) The prevalence and clinical features of UC vary significantly across ethnic groups [45]. For example, UC is more prevalent in Western than in Asian populations, and within Western cohorts, it is more common among Caucasians than Black individuals. These differences suggest that the generalizability of our findings may be limited, and replication in diverse populations is warranted. (3) While C4DC was identified as a key metabolite-linking metabolism and immune function, its specific biological mechanisms remain incompletely understood. Most existing studies focus on indirect associations; further experimental validation is needed to clarify its direct role. (4) The mediation effect ratio observed in this study was only 3.3%, indicating that C4DC may be just one of multiple intermediates involved. Other potential mediators and pathways should be explored in future research. (5) The immune cell data used in this study were derived from peripheral blood. However, immune cell phenotypes and functions in the gastrointestinal tract may differ. Thus, peripheral measurements may not fully reflect gut-specific immune responses. Future studies should consider directly analyzing mucosal immune cells for more tissue-relevant insights.

To build upon these findings, future research should integrate clinical and experimental approaches to investigate the biological mechanisms through which CD39⁺ CD4⁺ T cell regulate UC via C4DC. Large-scale cohort studies and multi-center collaborations will be essential for validating our results and assessing their clinical relevance. This study provides a theoretical foundation for understanding the immune-metabolic network in UC and may offer novel targets and strategies for disease prevention and therapeutic intervention.

5 Conclusion

This study is the first to apply a mediation MR approach to investigate the causal relationships among immune cells, serum metabolites, and UC. Our findings reveal a positive causal association between CD39⁺ CD4⁺ T cell and UC, which was supported by multiple sensitivity analyses. Reverse MR analysis did not identify a causal effect of UC on CD39⁺ CD4⁺ T cell, suggesting a unidirectional influence of these cells on disease risk. Moreover, the mediation MR analysis indicated that CD39⁺ CD4⁺ T cell may contribute to UC pathogenesis by modulating the levels of succinyl carnitine (C4DC), with a mediation effect proportion of 3.3%.

These findings provide novel insights into the immunometabolic mechanisms underlying UC and offer a new perspective for future mechanistic studies and therapeutic target exploration in this field.

Abbreviations

CI

confidence intervals

GWAS

genome-wide association studies

IVs

instrumental variables

IVW

inverse variance weighted

MR

Mendelian randomization

NK

natural killer

OR

odds ratios

SCFA

short-chain fatty acid

SNPs

single nucleotide polymorphisms

UC

ulcerative colitis

Acknowledgments

The authors gratefully acknowledge the investigators and participants of the genome-wide association studies whose publicly available summary statistics were used in this study.

  1. Funding information: Open Fund of Hubei Provincial Clinical Medical Research Center for Precision Prevention and Treatment of Gastrointestinal Cancer in the Elderly (2024EGC-02).

  2. Author contributions: Li Chen wrote the main manuscript, Ying Yi designed the study, and Yun Zhu reviewed and edited the manuscript.

  3. Conflict of interest: The authors state no conflict of interest.

  4. Data availability statement: The datasets were derived from publicly available sources: immune cell (https://www.ebi.ac.uk/gwas/), serum Metabolite (https://www.ebi.ac.uk/gwas/publications/36635386), ulcerative colitis (https://www.finngen.fi/en/access_results). The result data underlying this article will be shared on reasonable request to the corresponding author.

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Received: 2025-02-25
Revised: 2025-06-04
Accepted: 2025-06-16
Published Online: 2025-07-17

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/med-2025-1240
Keywords for this article
T cells; succinyl carnitine; UC; Mendelian randomization; preventive treatment
Creative Commons
BY 4.0

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  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. FAHD1 prevents neuronal ferroptosis by modulating R-loop and the cGAS–STING pathway
  126. Association of placenta weight and morphology with term low birth weight: A case–control study
  127. Investigation of the pathogenic variants induced Sjogren’s syndrome in Turkish population
  128. Nucleotide metabolic abnormalities in post-COVID-19 condition and type 2 diabetes mellitus patients and their association with endocrine dysfunction
  129. TGF-β–Smad2/3 signaling in high-altitude pulmonary hypertension in rats: Role and mechanisms via macrophage M2 polarization
  130. Ultrasound-guided unilateral versus bilateral erector spinae plane block for postoperative analgesia of patients undergoing laparoscopic cholecystectomy
  131. Profiling gut microbiome dynamics in subacute thyroiditis: Implications for pathogenesis, diagnosis, and treatment
  132. Delta neutrophil index, CRP/albumin ratio, procalcitonin, immature granulocytes, and HALP score in acute appendicitis: Best performing biomarker?
  133. Anticancer activity mechanism of novelly synthesized and characterized benzofuran ring-linked 3-nitrophenyl chalcone derivative on colon cancer cells
  134. H2valdien3 arrests the cell cycle and induces apoptosis of gastric cancer
  135. Prognostic relevance of PRSS2 and its immune correlates in papillary thyroid carcinoma
  136. Association of SGLT2 inhibition with psychiatric disorders: A Mendelian randomization study
  137. Motivational interviewing for alcohol use reduction in Thai patients
  138. Luteolin alleviates oxygen-glucose deprivation/reoxygenation-induced neuron injury by regulating NLRP3/IL-1β signaling
  139. Polyphyllin II inhibits thyroid cancer cell growth by simultaneously inhibiting glycolysis and oxidative phosphorylation
  140. Relationship between the expression of copper death promoting factor SLC31A1 in papillary thyroid carcinoma and clinicopathological indicators and prognosis
  141. CSF2 polarized neutrophils and invaded renal cancer cells in vitro influence
  142. Proton pump inhibitors-induced thrombocytopenia: A systematic literature analysis of case reports
  143. The current status and influence factors of research ability among community nurses: A sequential qualitative–quantitative study
  144. OKAIN: A comprehensive oncology knowledge base for the interpretation of clinically actionable alterations
  145. The relationship between serum CA50, CA242, and SAA levels and clinical pathological characteristics and prognosis in patients with pancreatic cancer
  146. Identification and external validation of a prognostic signature based on hypoxia–glycolysis-related genes for kidney renal clear cell carcinoma
  147. Engineered RBC-derived nanovesicles functionalized with tumor-targeting ligands: A comparative study on breast cancer targeting efficiency and biocompatibility
  148. Relationship of resting echocardiography combined with serum micronutrients to the severity of low-gradient severe aortic stenosis
  149. Effect of vibration on pain during subcutaneous heparin injection: A randomized, single-blind, placebo-controlled trial
  150. The diagnostic performance of machine learning-based FFRCT for coronary artery disease: A meta-analysis
  151. Comparing biofeedback device vs diaphragmatic breathing for bloating relief: A randomized controlled trial
  152. Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality
  153. Multiple organ scoring systems for predicting in-hospital mortality of sepsis patients in the intensive care unit
  154. Single-cell RNA sequencing data analysis of the inner ear in gentamicin-treated mice via intraperitoneal injection
  155. Review Articles
  156. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  157. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  158. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  159. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  160. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  161. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  162. The application of augmented reality in robotic general surgery: A mini-review
  163. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  164. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  165. Plant polyphenols, terpenes, and terpenoids in oral health
  166. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  167. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  168. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  169. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  170. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  171. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  172. Giant borderline ovarian tumours – review of the literature
  173. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  174. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  175. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  176. Supplement strategies for infertility in overweight women: Evidence and legal insights
  177. Scurvy, a not obsolete disorder: Clinical report in eight young children and literature review
  178. A meta-analysis of the effects of DBS on cognitive function in patients with advanced PD
  179. Protective role of selenium in sepsis: Mechanisms and potential therapeutic strategies
  180. Strategies for hyperkalemia management in dialysis patients: A systematic review
  181. C-reactive protein-to-albumin ratio in peripheral artery disease
  182. Case Reports
  183. Delayed graft function after renal transplantation
  184. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  185. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  186. Giant right atrial hemangioma presenting with ascites: A case report
  187. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  188. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  189. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  190. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  191. Rapid Communication
  192. Biological properties of valve materials using RGD and EC
  193. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  194. Letter to the Editor
  195. Role of enhanced external counterpulsation in long COVID
  196. Expression of Concern
  197. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  198. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  199. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  200. Corrigendum
  201. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  202. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  203. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  204. Retraction
  205. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  206. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  207. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  208. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  209. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  210. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  211. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  212. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  213. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  214. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  215. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  216. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  217. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  218. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  219. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  220. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  221. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  222. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  223. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  224. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  225. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  226. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  227. A review of brain research on T2DM-related cognitive dysfunction
  228. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  229. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  230. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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