Volume 10 Issue 4, April 2014

Research published in Cell has shed light on the reorganization of circadian rhythm by nutrients. Mice fed a high-fat diet displayed extensive reprogramming of the hepatic clock with profound effects on key metabolic pathways. These changes involved repression of the Clock–Bmal1 network and PPARγ-regulated induction of a novel gene set.

Increased infiltration of adipose tissue macrophages (ATMs) and their subsequent inflammatory effects are implicated in the development of insulin resistance among individuals with obesity. Interestingly, new data published in Cell Metabolism suggest that ATMs might also have important noninflammatory roles in lipid trafficking and its metabolic consequences.

Prediction of fracture risk is increasingly used to guide clinical use of antiosteoporosis drugs. Data from a large primary care prospective study in 10 countries has now been used to generate an empirical composite 5-year fracture risk model based on clinical data (excluding BMD). This model performed better than current widely used models.

A new trial has shown that targeting a blood glucose level of 4.0–7.0 mmol/l in critically ill children has some benefits, including a reduced incidence of kidney failure, shortened duration of hospital stay and lowered health-care costs. However, the chosen short-term primary end point was unaffected, which limits the applicability of the findings.

Advances in the field of genetics have enabled the discovery of numerous loci associated with type 2 diabetes mellitus (T2DM). This Review examines current knowledge about T2DM genetic risk prediction, the effect of lifestyle intervention according to genetic risk and the role of genetic counselling to support behavioural modification.

The authors review the roles of T₃ in skeletal muscle development, homeostasis and pathology, with a focus on the emerging local deiodinase-mediated control of T₃signalling. Moreover, this Review addresses how manipulation of deiodinase activity in skeletal muscle might be therapeutically harnessed to improve satellite-cell-mediated muscle repair in patients with skeletal muscle disorders, muscle atrophy or injury.

This Review describes the progress that has been made towards classification of adrenocortical tumours to date based on key genomic approaches. In addition, the potential for the development and use of various molecular tools to personalize the management of patients with adrenocortical tumours is discussed.

The newly appreciated heterogeneity in type 1 diabetes mellitus implies that a personalized approach could be used to treat this disease; treatments that modify the immune system might be ideally suited to this purpose. This Review discusses the current knowledge on immune regulation and dysfunction in humans that could be used to develop new therapies.

Acromegaly usually occurs owing to a growth-hormone-secreting adenoma in the pituitary gland, which leads to metabolic and anatomical changes in the patient. This Expert Consensus Document outlines the current recommendations for the treatment of acromegaly as determined by the Acromegaly Consensus Group in March 2013.