GENERAL MEDICAL NEWS
The staff of The Reproductive Times here offers brief referenced notes on interesting general medical and scientific news with broad relevance to reproductive medicine and biology. Some of these news items may become subjects of more detailed reporting in The Reproductive Times on later occasions. The purpose of these short notifications is to give readers the opportunity to get immediately more detailed information by looking up the reference of the note.
Are we fooling ourselves with time-restricted eating?
After several studies suggested that time-restricted eating is successful in achieving weight loss, a U.S. study in the Annals of Internal Medicine now suggests that we all may have fallen victim to poor study design and mass hysteria.1 In a prospectively randomized study of relatively small size (41 participants, with mean age of 59 years with mean BMI of 36kg/m2, 93% women and of Black race) neither did time-restricted eating reduce weight nor did it significantly affect glucose hemostasis if the study was controlled for caloric intake. In other words, time-restricted eating may apparently reduce caloric intake – thereby leading to weight loss and effects on glucose hemostasis. But an equal decline in consumed calories at any time of the day would achieve the same goals.
Reference
1. Maruthur et al., Ann Int Med 2024;177(5):549-5
GLP-1 receptor agonists continue to surprise.
It seems like hardly a day passes without a new report pointing out additional previously unknown medical benefits from GLP-1s. The latest report comes from data of a study recently presented at the American Diabetes Association conference (the SURMOUNT-OSA study1) in Orlando, FL, in June. The study investigated obese individuals with obstructive sleep apnea, where in a controlled prospective trial patients either got tirzepatide (Mounjaro®) or a placebo. Mounjaro at the end of the study reduced their so-called apnea-hypopnea index by over 60%,2 a quite remarkable result.
And then–even harder to believe–a recent heart study of 17,604 patients led to the discovery that semaglutide (Wegovy®) appears to significant degrees to prevent death from COVID.3 Compared to placebo even a very low dosage of semaglutide of 2.4mg lowered all causes of death in obese cardiac patients, driven similarly by cardio-vascular and non-cardio-vascular deaths. Fewer non-cardiovascular deaths were mostly due to fewer infectious deaths, including, but not limited to, COVID. The treatment did not reduce the incidence of COVID, but reduced its severity and, therefore, serious complications and deaths.
References
1. Malhotra et al., Contemp Clin Trials 2024;141:107516.
2. Jain, AB, Kim JW. Medscape Diabetes & Endocrinology. September 3, 2024. https://www.medscape.com/viewarticle/sumount-osa-result impre...ci_tech_240904_etid6801994&uac= 223637CN&impID=6801994
3. Scirica et al., J Am Coll Cardiol 2024;S)735-1097(24):08156-7
And misrepresentations in Reproductive Immunology continue
One reason why reproductive immunology to this day has little credibility in the fertility field, is especially in the 1980s and early 1990s a history of false claims and poor-quality studies which the field of reproductive endocrinology (RE) initially believed. After substantial shortcomings and exaggerations in reported studies became apparent, this was considered good reason to almost completely exclude reproductive immunology from the RE field. As a consequence, clinicians and serious researchers really never got together to determine (considering the enormous progress immunology research in general has been making) the big questions they could try to tackle together. Consequently, reproductive immunology, which really should be an integral part of reproductive endocrinology and infertility (REI), has remained an at best only peripheral entity within REI. That it fully deserves this standing is from time to time reemphasized by the kind of paper recently published in Early Human Development 1, generally considered a better journal than its impact factor would suggest.
Here three authors claim as fact that human pregnancies established with “unrelated” embryos (i.e., egg donation and use of gestational carriers) are “riskier” than normal semi-allogeneic pregnancies. Where they see the evidence for such a claim is unclear from their paper. But that does not prevent them from building a complete biological hypothesis around this alleged increased risk a 100% allogeneic pregnancy brings with it in comparison to natural 50% allogeneic pregnancies.
It is exactly this kind of unsupported grandioseness in pronunciations that led reproductive immunology into medical exile. This article is here, therefore, presented because it is such a good example for things that should not be done. This is to be further discussed in more detail in The Reproductive Times soon.
Reference
1. McCoy et al., Early Hum Development 2024;196:106072
Is our immune system changing?
And while we are talking about our immune system, here is a (perhaps somewhat surprising) question: Are we witnessing some kind of systemic changes in our immune systems? You, furthermore, may ask why we are asking this question now: First, it seems like we are worldwide in the midst of many more large-scale infectious events than in the past and that–if confirmed–can only have two causes: infectious agents have become more aggressive or our immune systems have weakened. And then, The Wall Street Journal just reported on September 3, 2024 (and in print in a frontpage article on September 5, 2024) that the prevalence of preeclampsia in pregnancy (including the postpartum period) has more than doubled between 2007 and 2019.1 And that brings us back to our immune system.
This doubling in prevalence represents rather astonishing news but the surprise is further enhanced by the fact that the medical literature has not reported this fact, or at least not prominently enough to be noticed. The article also points out how little research about preeclampsia is being conducted (not the least because of above-noted ignorance about the importance of the immune system for reproductive success).
What causes preeclampsia is still only poorly understood. It is increasingly accepted that the condition involves the maternal immune system and is associated with inflammation; but why then such an enormous increase in prevalence and especially in the postpartum period, as the article also pointed out? Some investigators consider preeclampsia to reflect an abnormal ending of immunologic tolerance of the fetal-placental semi-allograft (or in cases of egg donation a full allograft) by the maternal immune system.2
On a sidenote, not only are the etiology and pathophysiology of preeclampsia not well understood; the same also applies to the initiation of labor, whether at term or prematurely. Here, too, the immune system appears involved, and some researchers have described the onset of labor as an inflammatory process.3 As the Wall Street Journal article suggests, there is much work left to be done when it comes to preeclampsia and more than a doubling of preeclampsia incidence in 12 years raises serious new questions.
References
1. McKay B. The Wall Street Journal, September 3, 2024, https://www.wsj.com/health/preeclampsia-rise-united-states-pregnancy-20115589
2. Gleicher et al., J Assist Reprod Genet 2017;34(4):425-430
3. Kyathanahalli et al., Biol Reprod 2023;108(1):23-40
The never-ending scandals in medical publishing.
As if there haven’t already been enough scandals in medical publishing in recent times, the latest involves not only a very prominent microbiologist pursuing cutting-edge cancer research, but a highly prestigious research institution and what likely is the most prestigious scientific journal in the world. Moreover, the study has been cited in other papers more than 600 times. And this paper was retracted in June. The senior author was a professor at the University of California, San Diego, widely regarded a pioneer in big-data microbial analyses, now widely performed in practically all medical specialties after the importance of the gut microbiome was discovered. The journal that retracted the study in June was Nature magazine, and the principal claim made by the paper–now retracted–was that microbiomes of cancers might allow for peripheral blood diagnosis.
As The Wall Street Journal reported on August 30, 2024, research groups that built their own studies on the results of this paper are dealing with the fallout of this scandal. Eight since published studies that relied on this paper are now, themselves, under review at varying journals. Corresponding authors of these studies did not respond to requests for comments. A start-up linked to the project shut down.
Reference
1. Subbaraman N. The Wall Street Journal. August 30, 2024. https://www.wsj.com/health/healthcare/cancer-study-retracted-research-fallout-9573f842