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BackgroundHyperglycemia is recognized as a common adverse event for patients receiving alpelisib but has been little studied outside of clinical trials. We report the frequency of alpelisib-associated hyperglycemia in a real-world setting and evaluate proposed risk factors.Patients and methodsWe retrospectively identified patients with PIK3CA-mutated, hormone receptor-positive, metastatic breast cancer who initiated treatment with alpelisib plus fulvestrant between August 2019 and December 2021. Ordinal logistic regression evaluated 5 characteristics (diabetes, prediabetes, body mass index [BMI], age, and Asian ancestry) as independent risk factors for ALP-associated hyperglycemia grades 2-4. Risk of error from multiple hypothesis testing was controlled using the false discovery rate method.ResultsThe study included n = 92 subjects, all but 1 female, mean age 59.9 (+11.9) years with 50% non-Hispanic White, 15% Hispanic/Latino, 13% Asian, 9% African/Black, and 13% other/unknown. In total 34% of patients had diabetes, 10% had pre-diabetes, and 56% had normoglycemia. Thirty-six percent were obese, 32% were overweight, 25% were normal weight, and 7% were lean. Frequency of grades 1-4 hyperglycemia in current subjects (64.1%) was similar to hyperglycemia reported in the SOLAR-1 trial (63.7%). Our subjects' risk of grades 2-4 hyperglycemia was independently increased by pre-existing diabetes (Odds ratio 3.75, 95% CI, 1.40-10.01), pre-diabetes (6.22, 1.12-34.47), Asian ancestry (7.10, 1.75-28.84), and each unit of BMI above 20 (1.17, 1.07-1.28).ConclusionWhile receiving alpelisib, patients of Asian ancestry, as well as patients with pre-existing hyperglycemia and/or BMI above 20, should be closely monitored for hyperglycemia. The mechanism underlying the current association of alpelisib-associated hyperglycemia with Asian ancestry is independent of BMI and merits further study. The high incidence of hyperglycemia resulted in a change in practice to include consultation with a diabetes nurse educator or endocrinologist at the start of alpelisib.

This paper utilizes the digital economy, regional spatial distribution digital mining technology, establishes the indicator system, assigns values to the indicators, and applies the indicator system to evaluate the development of industrial structure upgrading and transformation of the regional economy. According to the research results of the basic structure and algorithm of the self-organized neural network model, combined with the classification layer smoothing algorithm, the regional spatial clustering model is constructed. Using the constructed model, the regional economic spatial dynamic data is mined, and the path of industrial transformation and upgrading in the regional spatial area is dynamically studied. Furthermore, using the CA algorithm, the evolution law of land use structure in the region is predicted, and the development of the regional economy is inferred. At the same time, through the spatial autocorrelation regional prediction model, the relevant regional spatial expansion prediction method is proposed, the three research hypotheses of this paper are made, and the constructed model is utilized to innovate the exploration of industrial transformation and upgrading paths from the spatial dimension. Using empirical research methods, descriptive statistics, and mediating effect heterogeneity analysis are carried out to analyze the factors that influence regional economic variables in place A. The empirical analysis shows that the fluctuation range interval of industrial structure is between [0.811,10.2805], which brings a large positive impact on the regional economy.2017 national digital economic growth rate changed from -0.17446 to 0.17143 to realize a positive growth rate, and at the same time, there is a heterogeneity in the development of the east-west and central regions of A. The hypotheses presented in this paper are all valid.

Cancer: vitamin A derivative prevents salivary gland tumors spreading Treatment of salivary gland tumors with a metabolite of vitamin A could help prevent rare cancer from spreading to the lungs. A team led by Xiao-hong Chen and Lu Kong from Capital Medical University in Beijing, China, performed extensive molecular profiling on primary and metastatic tumor cells taken from two patients with advanced salivary gland cancer. Even though these patients’ cancers did not harbor either of two common mutations that are hallmarks of the disease, both of which drive tumor proliferation and spread, the cells did show signs of altered gene expression and faulty molecular signaling consistent with these same mutational profiles. The abnormal signaling could be overcome by treatment with retinoic acid, a derivative of vitamin A that, when given to mouse models of cancer, reduced the development of lung metastases.

Abstract Salivary adenoid cystic carcinoma (SACC) with a unique MYB‐NFIB fusion has been considered an “immune‐cold” tumor, but the mechanisms behind this remain unclear. In this study, we analyzed the immune status of 29 SACC patients and found that most lung metastases exhibited an immunoinflammatory state, in contrast to the primary SACC tissues. Single‐cell sequencing data showed that anergic T‐cell types were low in primary inflammatory tissues, while inflammatory metastatic lung tissues had elevated levels of anergic CD8+ natural killer T (NKT)‐like cells and low levels of memory T cells. Primary exclusive tissues had high levels of myeloid‐derived suppressor cells (MDSCs) and low levels of activated CD8+ NKT‐like cells. These data support the fact that metastatic SACC cells might induce a stronger immune response in the lung. Additionally, an in vivo experiment showed that a minimally invasive SACC cell line with higher expression of human leukocyte antigens ‐B and ‐C induced NKT cell activation in mice and effectively attenuated the incidence of lung metastases caused by a highly invasive SACC cell line. This suggests that NKT therapy may be active in treating SACC lung metastasis. Conclusively, this study sheds light on the immune microenvironment of SACC and highlights the potential of NKT‐based therapy.

Simple Summary: Despite major advances in treating non-small-cell lung cancer (NSCLC), the five-year survival rates for patients without specific genetic mutations remain low. This study aims to find better ways to treat these patients. We focused on a protein called Aurora kinase A (AURKA), which our prior study suggested may play a role in modulating resistance to the common cancer drug cisplatin. We looked at how AURKA affects the sensitivity of NSCLC cells to platinum-based chemotherapy and radiation. In lab tests, AURKA levels increased after cisplatin treatment. Blocking AURKA with a drug called alisertib or using a genetic method made cisplatin and radiation more effective, causing tumors to shrink in mouse models. The treated cancer cells showed more DNA damage and underwent cell death. Blocking AURKA also increased markers that help the immune system recognize cancer. Our study suggests that combining AURKA inhibitors with other treatments could improve outcomes for NSCLC patients. Despite major advances in non-small-cell lung cancer (NSCLC) treatment, the five-year survival rates for patients with non-oncogene-driven tumors remain low, necessitating combinatory approaches to improve outcomes. Our prior high-throughput RNAi screening identified Aurora kinase A (AURKA) as a potential key player in cisplatin resistance. In this study, we investigated AURKA's role in platinum and radiation sensitivity in multiple NSCLC cell lines and xenograft mouse models, as well as its effect on immune checkpoints, including PD-L1, B7x, B7-H3, and HHLA2. Of 94 NSCLC patient tumor specimens, 91.5% tested positive for AURKA expression, with 34% showing moderate-to-high levels. AURKA expression was upregulated following cisplatin treatment in NSCLC cell lines PC9 and A549. Both AURKA inhibition by alisertib and inducible AURKA knockdown potentiated the cytotoxic effects of cisplatin and radiation, leading to tumor regression in doxycycline-inducible xenograft mice. Co-treated cells exhibited increased DNA double-strand breaks, apoptosis, and senescence. Additionally, AURKA inhibition alone by alisertib increased PD-L1 and B7-H3 expression. In conclusion, our study demonstrates that AURKA inhibition enhances the efficacy of platinum-based chemotherapy in NSCLC cells and modulates the expression of multiple immune checkpoints. Therefore, combinatory regimens with AURKA inhibitors should be strategically designed and further studied within the evolving landscape of chemo-immunotherapy. [ABSTRACT FROM AUTHOR]

Testing drugs for anti-aging effects has historically been conducted in mouse life-span studies, but are costly and time consuming, and more importantly, difficult to recapitulate in humans. In addition, life-span studies in mice are not well suited to testing drug combinations that target multiple factors involved in aging. Additional paradigms for testing therapeutics aimed at slowing aging are needed. A new paradigm, designated as the Geropathology Grading Platform (GGP), is based on a standardized set of guidelines developed to detect the presence or absence of low-impact histopathological lesions and to determine the level of severity of high-impact lesions in organs from aged mice. The GGP generates a numerical score for each age-related lesion in an organ, summed for total lesions, and averaged over multiple mice to obtain a composite lesion score (CLS). Preliminary studies show that the platform generates CLSs that increase with the age of mice in an organ-dependent manner. The CLSs are sensitive enough to detect changes elicited by interventions that extend mouse life span, and thus help validate the GGP as a novel tool to measure biological aging. While currently optimized for mice, the GGP could be adapted to any preclinical animal model.

In order to assess the characteristics of polybrominated diphenyl ether (PBDEs) in the atmosphere of urban Jinan, eastern China, gas phase and PM2.5 were hereby sampled in July 2020. The concentration and composition characteristics of 11 PBDEs were obtained. The Human exposure was evaluated by the daily exposure calculation method. During the observation period, the average concentration of ∑11PBDEs in PM2.5 and gas phase was 214.8±31.3 pg/m3, that of low-PBDEs was 119.1±2.1 pg/m3, and that of BDE209 was 95.8±15.4 pg/m3. Among the 10 low-PBDEs, the highest single content was BDE99, followed by BDE47, accounting for 43%. PCA showed the main sources of PBDEs in the atmosphere of urban Jinan were Penta-BDEs and Deca-BDEs. The daily respiratory exposure of children were higher than that of adults, and the potential risk should be taken seriously.

The roles of lamin A/C in adipocyte differentiation and skeletal muscle lipid metabolism are associated with familial partial lipodystrophy of Dunnigan (FPLD). We confirmed that LMNA knockdown (KD) in mouse adipose-derived mesenchymal stem cells (AD-MSCs) prevented adipocyte maturation. Importantly, in in vitro experiments, we discovered a significant increase in phosphorylated lamin A/C levels at serine 22 or 392 sites (pLamin A/C-S22/392) accompanying increased lipid synthesis in a liver cell line (7701 cells) and two hepatocellular carcinoma (HCC) cell lines (HepG2 and MHCC97-H cells). Moreover, HCC cells did not survive after LMNA knockout (KO) or even KD. Evidently, the functions of lamin A/C differ between the liver and adipose tissue. To date, the mechanism of hepatocyte lipid metabolism mediated by nuclear lamin A/C remains unclear. Our in-depth study aimed to identify the molecular connection between lamin A/C and pLamin A/C, hepatic lipid metabolism and liver cancer. Gain- and loss-of-function experiments were performed to investigate functional changes and the related molecular pathways in 7701 cells. Adenosine 5’ monophosphate-activated protein kinase α (AMPKα) was activated when abnormalities in functional lamin A/C were observed following lamin A/C depletion or farnesyltransferase inhibitor (FTI) treatment. Active AMPKα directly phosphorylated acetyl-CoA-carboxylase 1 (ACC1) and subsequently inhibited lipid synthesis but induced glycolysis in both HCC cells and normal cells. According to the mass spectrometry analysis, lamin A/C potentially regulated AMPKα activation through its chaperone proteins, ATPase or ADP/ATP transporter 2. Lonafarnib (an FTI) combined with low-glucose conditions significantly decreased the proliferation of the two HCC cell lines more efficiently than lonafarnib alone by inhibiting glycolysis or the maturation of prelamin A.

Inflammation of adipose tissue induces metabolic derangements associated with obesity. Thus, determining ways to control or inhibit inflammation in adipose tissue is of clinical interest. The present study tested the hypothesis that in mouse adipose tissue, endogenous prostaglandin E2 (PGE2) negatively regulates inflammation via activation of prostaglandin E receptor 4 (EP4). PGE2 (5–500nM) attenuated lipopolysaccharide-induced mRNA and protein expression of chemokines, including interferon-γ-inducible protein 10 and macrophage-inflammatory protein-1α in mouse adipose tissue. A selective EP4 antagonist (L161,982) reversed, and two structurally different selective EP4 agonists [CAY10580 and CAY10598] mimicked these actions of PGE2. Adipose tissue derived from EP4-deficient mice did not display this response. These findings establish the involvement of EP4 receptors in this anti-inflammatory response. Experiments performed on adipose tissue from high-fat-fed mice demonstrated EP4-dependent attenuation of chemokine production during diet-induced obesity. The anti-inflammatory actions of EP4 became more important on a high-fat diet, in that EP4 activation suppressed a greater variety of chemokines. Furthermore, adipose tissue and systemic inflammation was enhanced in high-fat-fed EP4-deficient mice compared with wild-type littermates, and in high-fat-fed untreated C57BL/6 mice compared with mice treated with EP4 agonist. These findings provide in vivo evidence that PGE2-EP4 signaling limits inflammation. In conclusion, PGE2, via activation of EP4 receptors, functions as an endogenous anti-inflammatory mediator in mouse adipose tissue, and targeting EP4 may mitigate adipose tissue inflammation.

It is difficult to accurately measure the air exchange rate (AER) in residential and office buildings during occupation via on-site field measurement. The tracer gas method was widely applied to estimate the AER in these buildings, and human metabolic carbon dioxide (CO2) was often used as a tracer gas in different models. This study introduced three models (the ASHRAE model, the ASHRAE China-specific modified model, and the BMR model), which were proposed to estimate the AER based on exhaled CO2. We verified these models by comparing the exhaled CO2-based AER with AER from field measurements using sulfur hexafluoride (SF6) as a tracer gas. We also analyzed the potential factors that could affect the uniformity of the indoor tracer gas distribution. Our results indicate that the ASHRAE China-specific modified model has the best performance with an average deviation of −6.67% and a maximum deviation of −14.6% with multiple measurement points, a stable personnel activity, and proper Parameter settings in a single room in China. [ABSTRACT FROM AUTHOR]

The roles of lamin A/C in adipocyte differentiation and skeletal muscle lipid metabolism are associated with familial partial lipodystrophy of Dunnigan (FPLD). We confirmed that LMNA knockdown (KD) in mouse adipose-derived mesenchymal stem cells (AD-MSCs) prevented adipocyte maturation. Importantly, in in vitro experiments, we discovered a significant increase in phosphorylated lamin A/C levels at serine 22 or 392 sites (pLamin A/C-S22/392) accompanying increased lipid synthesis in a liver cell line (7701 cells) and two hepatocellular carcinoma (HCC) cell lines (HepG2 and MHCC97-H cells). Moreover, HCC cells did not survive after LMNA knockout (KO) or even KD. Evidently, the functions of lamin A/C differ between the liver and adipose tissue. To date, the mechanism of hepatocyte lipid metabolism mediated by nuclear lamin A/C remains unclear. Our in-depth study aimed to identify the molecular connection between lamin A/C and pLamin A/C, hepatic lipid metabolism and liver cancer. Gain- and loss-of-function experiments were performed to investigate functional changes and the related molecular pathways in 7701 cells. Adenosine 5' monophosphate-activated protein kinase α (AMPKα) was activated when abnormalities in functional lamin A/C were observed following lamin A/C depletion or farnesyltransferase inhibitor (FTI) treatment. Active AMPKα directly phosphorylated acetyl-CoA-carboxylase 1 (ACC1) and subsequently inhibited lipid synthesis but induced glycolysis in both HCC cells and normal cells. According to the mass spectrometry analysis, lamin A/C potentially regulated AMPKα activation through its chaperone proteins, ATPase or ADP/ATP transporter 2. Lonafarnib (an FTI) combined with low-glucose conditions significantly decreased the proliferation of the two HCC cell lines more efficiently than lonafarnib alone by inhibiting glycolysis or the maturation of prelamin A. [ABSTRACT FROM AUTHOR]

Simple Summary: Aromatase inhibitors (AIs) remain key elements of endocrine therapy for patients with hormone receptor positive HER2 negative metastatic breast cancer (HR+ HER2− MBC). Recent advances include the use of CDK 4/6 inhibitors or PIK3CA inhibitor in the clinic; however, few immunotherapy trials have been conducted in HR+ HER2− metastatic disease. The current phase II trial was designed to test the safety and efficacy of AIs in combination with immune checkpoint inhibitor pembrolizumab in patients with HR+ HER2− MBC (NCT 02648477). This combination was well tolerated, but minimal clinical activity was observed likely due to lack of PD-L1 pre-selection and heavily pretreated patient population. This study investigated the safety and antitumor activity of aromatase inhibitors (AI) with immune checkpoint inhibitor (ICI) pembrolizumab in patients with hormone receptor positive (HR+) human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (MBC) in a phase II study with a safety lead-in (NCT 02648477). Patients received pembrolizumab plus AI up to 2 years or until confirmed progression or unacceptable toxicity. Key eligibility criteria were HR+ HER2− MBC; RECIST v1.1 measurable disease; adequate organ function; and ECOG 0-1. Primary endpoints were safety and overall response rate. A 3-at-risk design was used for the safety lead-in with a targeted accrual of 20 patients. Grade 2 adverse events (AEs) included 35% fatigue, 20% rash, and 10% hot flashes. Grade 3 immune-related AEs (irAEs) related to pembrolizumab included 5% elevated AST/ALT, 5% rash, and 5% lymphopenia. Two (10%) patients had partial responses, three (15%) had stable disease, and 15 (75%) had progression of disease. Median progression-free survival was 1.8 months (95% CI 1.6, 2.6), median overall survival was 17.2 months (95% CI 9.4, NA), and median follow-up time was 40.1 months (range 31.3–46.8 months). The combination was well tolerated, but clinical activity was comparable to AI alone. [ABSTRACT FROM AUTHOR]

Introduction: Adherence to warfarin is associated with improved outcome in patients with atrial fibrillation (AF), but the adherence status of patients in rural areas of China is not known. Methods: A questionnaire-based study evaluating warfarin adherence of rural residents with AF was carried out in Dongyang, China. Potentially eligible patients were screened and contacted by telephone, and their demographic characteristics were collected. Illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ), and warfarin adherence was assessed using a Chinese-version adherence scale. Univariate and multivariate analyses were conducted to identify factors associated with unsatisfactory adherence. Results: A total of 201 patients (male, n=99; mean age, 70.3± 8.12 years) were included, among whom 95 (47.3%) patients showed good adherence and 63 (31.3%) poor adherence. Number of co-dispensed drugs (multivariate analysis: odds ratio [OR]=3.64, 95% confidence interval [CI] 1.35– 9.81, p=0.011) and BIPQ score (OR=1.25, 95% CI 1.17– 1.33, p< 0.001) were identified as factors associated with good adherence. Conclusion: Medical adherence to warfarin needs to improve in rural patients with AF. Efforts that can reduce the number of co-dispensed drugs and increase illness perception may improve warfarin adherence. This study may benefit future management of warfarin administration to rural patients with AF. [ABSTRACT FROM AUTHOR]

Although remarkable development of titanate‐based glasses has been achieved, challenge remains to elucidate the correlation between structure and glass‐forming properties in these systems due to their complex structure that is inconsistent with the classic Zachariasen's model. In this work, we aim to correlate the structural evolution of titanate melts to their glass‐forming ability (GFA). The prototypical material barium dititanate (BaTi2O5, BT2) melts with different GFA were rendered by controlled melting atmospheres, and the corresponding structural changes were determined using in situ high‐energy synchrotron X‐ray diffraction combined with empirical potential structure refinement and ab initio molecular dynamics. The results show that BT2 melt in reducing atmosphere shows poor GFA but that in oxidizing atmosphere presents good GFA. Structural analysis demonstrates the mean coordination number of [TiOm] polyhedra is analogous in the melt under two different atmospheres but an enhanced heterogeneous cations aggregation takes place in the melt under reducing atmosphere, which is closely related to oxygen‐deficiencies. Furthermore, we reveal that the enhanced heterogeneous cations aggregation promotes crystallization (and therefore hinders glass formation) through disordering the distribution of [TiOm] and [BaOn] polyhedra, changing the connectivity between these polyhedra, creating more crystal‐like Ti‐Ti clusters, and decreasing topological disorder of BT2 melt. Our work provides a new viewpoint to understand the GFA of titanates melt from structural heterogeneity beyond the previous perspectives that only focus on [TiOm] polyhedra. [ABSTRACT FROM AUTHOR]

New strategies for highly selective and sensitive detection of highly toxic environmental pollutants are still a pressing need. Here, through Cu2+ metalated porous nanoscale covalent organic framework (NCOF), a novel heterogeneous NCOF fluorescence probe has been synthesized for sensitive and selectivity detection of hydrogen sulfide (H2S). Upon H2S addition, the Cu2+ released from the CuCOF, accompanied by the fluorescence recovered of COF. As far as we know, NCOF has not been reported as fluorescence probe for H2S detection. The as‐prepared nano CuCOF displays an excellent sensitive response to H2S with a detection limit of 10 nM. In addition, such heterogeneous fluorescence probe exhibited high selectivity towards to H2S relative to other thiols and anionic species. Moreover, the detection of H2S was achieved successfully in different actual water samples. [ABSTRACT FROM AUTHOR]

The morphological transition and growth mechanism of Al3Ni phase during solidification at the liquid Al/solid Ni interface was investigated through synchrotron radiography. The remelted peritectic Al3Ni is dominated by coalescence of adjacent grains and precipitation with the morphology changing from columnar, irregular, scallop type to faceted shape. The hollow proeutectic Al3Ni is formed on a solid base. The increased r/R ratio and steep variation lead to the change from regular to irregular hollowness with asymmetrical shape. [ABSTRACT FROM AUTHOR]

Annealed titanate glasses are important candidate materials for high-performance electronic components, but their structural response to temperature-induced properties upon thermal annealing remains elusive. Here, using high-energy synchrotron X-ray scattering, high-temperature Raman spectroscopy, and empirical potential structure refinement simulation, we track the structural evolution in situ of a barium dititanate (BaTi 2 O 5) glass upon annealing around and below the glass transition temperature. We find that the network structure is intrinsically floppy, as the network units ([TiO m ] polyhedra) themselves and their topological packing can be easily modulated by annealing temperature. The floppy nature of the glassy titanate network challenges the currently well-cognized Rigid-Unit Mode model explaining temperature-driven structural reorganization of prototypical network glasses (e.g., silicate/borate glasses). As temperature increases, the floppy network of BaTi 2 O 5 glass undergoes a non-monotonic, two-stage network rearrangement. After cooling back to room temperature, the distortion of network units is found recoverable whereas the change of network connectivity in the intermedium-range order is irreversible. Simulation ensembles further show the irreversible connectivity change can be ascribed to the local development of crystal-like cationic motifs, which in turn induce excess enthalpy relaxation. Our findings provide an atomic-scale perspective on temperature-dependent structural and enthalpy relaxation of a model titanate glass upon annealing, which are crucial for understanding thermal-related changes in the properties of titanate glasses. [Display omitted] [ABSTRACT FROM AUTHOR]

Chronic health conditions of the elderly lead to limitations in physical activity with disability, anxiety, and increased need for medical care and assisted living conditions. Physical performance tests are used to screen for pending loss of mobility and can serve as endpoints to monitor the effectiveness of intervention measures. Since limited mobility is associated with the physical and mental health of a person, evaluation of this in preclinical aging studies in mice will provide a translational approach for testing new intervention strategies. We assessed physiological parameters in 4, 12, 20 and 28 month old C57BL/6 and CB6F1 male mice using a rotating rod, a free running wheel, and a photo beam activity field, designed to determine changes in coordinated walking ability, self-motivated running distance, and anxiety response to a novel environment, respectively. Older mice showed decreased coordinated walking times and decreased running distances, predictive of physical performance ability and motivation in the elderly. Changes in both lateral and vertical movements were observed in a novel cage environment suggesting different levels of anxiety. Because the genetic background of the two mouse strains influenced test results in an age-dependent manner, it is imperative to recognize that diverse genetic backgrounds in mice may yield different data in preclinical studies and would need to be interpreted individually for translational applications. [ABSTRACT FROM AUTHOR]

Aims. To measure plasma levels of superoxide dismutases 1, 2, and 3 (SOD1, 2, 3) and determine whether SODs can function as biomarkers for coronary artery disease (CAD). Patients & Methods. Patient groups were as follows: patients with stable angina pectoris (SAP, n=33), patients with acute coronary syndrome (ACS, n=49), and controls (n=42). Protein quantification was done using ELISA. Results. The concentrations of plasma SOD1 and SOD2 were higher in CAD than in healthy controls. No difference in SOD3 levels between CAD and control groups was found. Limited correlations were found between SODs and gender, age, and severity of coronary artery stenosis. Conclusions. Plasma levels of SOD1 and SOD2 were elevated in patients with CAD and might serve as surrogate biomarkers for CAD. [ABSTRACT FROM AUTHOR]

Abstract: Fibroblast growth factor 21 (FGF21) is an atypical member of the FGF family that functions as an endocrine factor. In obese animals, elevation of plasma FGF21 levels by either pharmacological or genetic approaches reduces body weight, decreases hyperglycemia and hyperlipidemia, alleviates fatty liver and increases insulin sensitivity. FGF21 exerts its pleiotropic metabolic effects through its actions on multiple targets, including adipose tissue, liver, brain and pancreas. The expression of FGF21 is under the control of both peroxisome proliferator-activated receptor gamma (PPARγ) and peroxisome proliferator-activated receptor alpha (PPARα). A growing body of evidence suggests that the metabolic benefits of these two nuclear receptors are mediated in part by induction of FGF21. In humans, plasma levels of FGF21 are elevated in obese subjects and patients with type 2 diabetes, but are reduced in patients with autoimmune diabetes. This review summarizes recent advances in understanding the physiological roles of FGF21 and the molecular pathways underlying its actions, and also discusses the future prospective of developing FGF21 or its agonists as therapeutic agents for obesity-related medical complications. [Copyright &y& Elsevier]