Apostolos Evangelopoulos

Background: Statins are established therapies for reducing cardiovascular and cerebrovascular risk. Beyond their lipid-lowering effects, they exert pleiotropic actions, including anti-inflammatory, immunomodulatory, antioxidant, anti-apoptotic, and vascular effects. Methods: This narrative review explores the effects of statins in a range of characteristic neurological disorders beyond stroke prevention, encompassing migraine, neurodegenerative and neuroinflammatory diseases, myasthenia gravis (MG), traumatic brain injury (TBI), brain tumors, epilepsy, and peripheral neuropathy (PN). A literature search was conducted in PubMed, Embase, and Scopus, focusing on proposed mechanisms of action, clinical outcomes, and potential neurological adverse effects. Results: Research suggests potential benefits of statins in migraine, TBI and its complications, brain tumors, and epilepsy. Favorable findings have also been reported in neurodegenerative and neuroinflammatory conditions, including Parkinson’s disease, Huntington’s disease, and multiple sclerosis. Despite earlier concerns regarding a possible association between statin use and an increased risk of dementia, subsequent studies have challenged this association, with some suggesting even a protective effect. Potential neurological adverse effects also warrant attention, particularly the reported association between statin exposure and new-onset or worsening MG. In contrast, data linking statin use to amyotrophic lateral sclerosis and PN are controversial and do not support causality. Interpretation of the available findings is complicated by heterogeneity in statin type and lipophilicity, dosage, treatment duration, disease stage, and study design. Clinical evidence is derived predominantly from observational studies, which are susceptible to confounding and other methodological limitations. Randomized controlled trials remain relatively few, with some further limited by small sample sizes. Conclusions: The pleiotropic properties of statins provide a rationale for investigating their potential therapeutic role across a broad spectrum of neurological disorders. Nevertheless, the available evidence remains heterogeneous and, in several conditions, conflicting. Further adequately powered randomized controlled trials are needed to establish whether statins translate their proposed pleiotropic effects into clinically meaningful benefits in specific neurological disorders and to better characterize their potential neurological risks.

Chronic kidney disease (CKD) is a progressive, irreversible condition that imposes a substantial burden of morbidity and mortality. While inadequate glycemic and blood pressure control remain its central drivers, dietary patterns are increasingly recognized as modifiable determinants of disease trajectory. Ultra-processed foods (UPFs), now pervasive in contemporary diets, have attracted particular attention due to their distinct physicochemical properties and biological effects. These products are industrial formulations that undergo multiple processing steps and are typically characterized by low nutritional quality, high energy density, and extensive use of additives. Epidemiological data suggest an association between higher UPF intake and adverse renal outcomes, yet the underlying mechanisms remain insufficiently defined. We posit inflammaging, a chronic, low-grade inflammatory state linked to biological aging, as a conceptual framework through which UPF-related renal injury may be interpreted. Within this context, gut dysbiosis and excess dietary phosphate emerge as potential mediators. Although no causal relationship has been established until now, there is mounting evidence interconnecting UPF’s consumption, hidden dietary phosphorus, chronic low-grade inflammation, accelerated aging and gut dysbiosis with CKD progression. We highlight critical research gaps and emphasize the need for policy and population-level strategies to reduce UPF consumption and slow CKD progression.

Porto-sinusoidal vascular disorder (PSVD) is an umbrella term proposed by the Vascular Liver Disease Interest Group (VALDIG) in 2019. It refers to a group of non-cirrhotic vascular liver diseases that cause portal hypertension. These were previously described as idiopathic non-cirrhotic portal hypertension, hepatoportal sclerosis, nodular regenerative hyperplasia, and incomplete septal fibrosis. PSVD is characterized by injury and remodeling of portal venules and sinusoids. Immune dysregulation, prothrombotic states, infections, medications (e.g., oxaliplatin, thiopurines), toxins (e.g., arsenic), and genetic susceptibility often drive this process. Clinically, PSVD ranges from asymptomatic patients with only abnormal liver tests to severe complications of portal hypertension, such as variceal bleeding, ascites, and portal vein thrombosis. Patients typically have preserved liver synthetic function, helping distinguish PSVD from cirrhosis. Diagnosis is based on VALDIG criteria and requires an adequate liver biopsy that shows no cirrhosis. It also requires specific combinations of clinical signs of portal hypertension and characteristic histological lesions, such as obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal fibrosis. Non-invasive tools, including imaging and liver stiffness measurement, are supportive. They often show discordance between marked portal hypertension and low liver stiffness, suggesting a non-cirrhotic cause. Management follows cirrhosis-based portal hypertension guidelines. This includes non-selective beta-blockers, endoscopic variceal ligation, TIPS, anticoagulation in selected patients, and liver transplantation for refractory or end-stage disease. Prognosis is generally better than in cirrhosis, with a 5-year transplant-free survival rate of approximately 85% compared to 60% in matched cirrhotics. However, major gaps remain in the true epidemiology, the natural history of early or subclinical PSVD, validated non-invasive biomarkers, and disease-modifying therapies.

Chronic kidney disease (CKD) is on the rise, with sarcopenia accompanying CKD in an estimated 25% of patients, featuring as a potentially debilitating issue that should not be overlooked. Sarcopenia, characterized by a loss of skeletal muscle mass and strength, is multifactorial. The aging process, uremic toxins, systemic inflammation, oxidative stress, gut dysbiosis, hormonal dysregulation, dietary deficits, and even air pollution are among the major parameters being implicated in sarcopenia among patients with CKD. Additionally, the existence of various comorbidities, such as type 2 diabetes mellitus (T2DM), depression, and cardiovascular diseases (CVD), also contribute to the chronic low-grade inflammation associated with skeletal muscle inflammation and atrophy. The purpose of this review is to delve into the complex interplay of multiple factors being involved in the pathogenesis of sarcopenia in patients with CKD. Moreover, we aim to shed light upon nutritional aspects that could delay the development and progression of sarcopenia among patients with CKD. To address vitamin D deficiency, micronutrients and macronutrients together with physical activity remain the cornerstone of delaying the progression of sarcopenia in this sub-population. Additionally, experimental drugs exhibiting therapeutic potential are also being discussed. As sarcopenia and quality of life are interconnected, the timely recognition of sarcopenia, together with nutritional and therapeutic interventions, is of the utmost importance in our crusade for a better quality of life (QoL) in patients with CKD.

Celiac disease (CeD) is a chronic, immune-mediated enteropathy triggered by dietary gluten in genetically susceptible individuals, with environmental and epigenetic factors also contributing to its pathogenesis. Once considered a rare pediatric malabsorptive disorder, CeD is now recognized as a systemic condition that can manifest with both gastrointestinal and extraintestinal symptoms across the lifespan. Although strict adherence to a gluten-free diet (GFD) remains the cornerstone of treatment, up to 30–40% of patients experience persistent symptoms and/or ongoing mucosal injury despite reported compliance. This therapeutic gap, combined with advances in molecular understanding of disease mechanisms, has driven the development of novel strategies targeting key pathogenic pathways. Intraluminal interventions include gluten-degrading enzymes and gluten-sequestering agents, while other approaches target tissue transglutaminase 2, induce antigen-specific immune tolerance, or modulate cytokine-driven inflammation, with particular emphasis on interleukin-15 (IL-15) signaling. Additional strategies aim to inhibit lymphocyte trafficking to the intestinal mucosa and enhance intestinal barrier function through zonulin modulation. Adjunctive therapies under investigation include nutraceuticals, microbiota-targeted interventions, and vaccine-based approaches. More recently, advanced experimental and computational platforms, such as human intestinal organoids, organ-on-chip systems, and machine learning–driven analytics, are being leveraged in efforts to accelerate translational research and support the rational design of precision medicine approaches. This narrative review synthesizes current evidence for therapies beyond the GFD, examines challenges in clinical implementation, and discusses how technological innovations may reshape the future therapeutic landscape of CeD.

Background/Objectives: Sepsis-associated liver injury (SALI) is a critical and often early complication of sepsis, defined by distinct hyper-inflammatory and immunosuppressive phases that shape patient phenotypes. Methods: Characterizing these phases establishes a foundation for immunomodulation strategies tailored to individual immune responses, as discussed subsequently. Results: The initial inflammatory response activates pathways such as NF-κB and the NLRP3 inflammasome, leading to a cytokine storm that damages hepatocytes and is frequently associated with higher SOFA scores and a higher risk of 28-day mortality. Kupffer cells and infiltrating neutrophils exacerbate hepatic injury by releasing proinflammatory cytokines and reactive oxygen species, thereby causing cellular damage and prolonging ICU stays. During the subsequent immunosuppressive phase, impaired infection control and tissue repair can result in recurrent hospital-acquired infections and a poorer prognosis. Concurrently, hepatocytes undergo significant metabolic disturbances, notably impaired fatty acid oxidation due to downregulation of transcription factors such as PPARα and HNF4α. This metabolic alteration corresponds with worsening liver function tests, which may reflect the severity of liver failure in clinical practice. Mitochondrial dysfunction, driven by oxidative stress and defective autophagic quality control, impairs cellular energy production and induces hepatocyte death, which is closely linked to declining liver function and increased mortality. The gut-liver axis plays a central role in SALI pathogenesis, as sepsis-induced gut dysbiosis and increased intestinal permeability allow bacterial products, including lipopolysaccharides, to enter the portal circulation and further inflame the liver. This process is associated with sepsis-related liver failure and greater reliance on vasopressor support. Protective microbial metabolites, such as indole-3-propionic acid (IPA), decrease significantly during sepsis, removing key anti-inflammatory signals and potentially prolonging recovery. Clinically, SALI most commonly presents as septic cholestasis with elevated bilirubin and mild transaminase changes, although conventional liver function tests are insufficiently sensitive for early detection. Novel biomarkers, including protein panels and non-coding RNAs, as well as dynamic liver function tests such as LiMAx (currently in phase II diagnostics) and ICG-PDR, offer promise for improved diagnosis and prognostication. Specifying the developmental stage of these biomarkers, such as identifying LiMAx as phase II, informs investment priorities and translational readiness. Current management is primarily supportive, emphasizing infection control and organ support. Investigational therapies include immunomodulation tailored to immune phenotypes, metabolic and mitochondrial-targeted agents such as pemafibrate and dichloroacetate, and interventions to restore gut microbiota balance, including probiotics and fecal microbiota transplantation. However, translational challenges remain due to limitations of animal models and patient heterogeneity. Conclusion: Future research should focus on developing representative models, validating biomarkers, and conducting clinical trials to enable personalized therapies that modulate inflammation, restore metabolism, and repair the gut-liver axis, with the goal of improving outcomes in SALI.

Campylobacter spp. remain among the most common pathogens causing acute diarrhea worldwide. Campylobacter jejuni and Campylobacter coli are the main species that cause gastroenteritis. Campylobacteriosis is a food-borne disease, although this Gram-negative bacterium may be transmitted via water-borne outbreaks as well as direct contact with animals, emphasizing its zoonotic potential. Campylobacterisosis does not usually require hospitalization. Antimicrobials are warranted only for patients with severe disease, as well as patients who are at risk for severe disease, such as the elderly, pregnant women or immunocompromised patients. Nonetheless, the irrational use of antibiotics in human and veterinary medicine enhances antimicrobial resistance (AMR). Resistance of Campylobacter spp. to fluoroquinolones, macrolides and tetracyclines is a significant concern to the scientific community. Point mutations, horizontal gene transfer and efflux pumps are the main mechanisms for the development and transmission of AMR in Campylobacter spp. Emerging evidence suggests that climate change may indirectly contribute to the spread of AMR in Campylobacter, particularly through its influence on bacterial ecology, transmission pathways and antibiotic use patterns. Higher temperatures and extreme weather events accelerate bacterial growth, amplify the transfer of AMR genes and magnify disease transmission, including drug-resistant infections. Horizontal gene transfer, especially in the context of biofilm formation, may further perplex the situation. Excessive farming and overuse of antibiotics as growth promoters in animals may also contribute to increased AMR rates. Climate change and AMR are interconnected and pose a significant threat to global public health. Multidisciplinary strategies mitigating both phenomena are crucial in order to contain the spread of Campylobacter-related AMR. The aim of this review is to describe the molecular mechanisms that result in AMR of Campylobacter spp. and underscore the association between climate change and Campylobacteriosis. Novel methods to mitigate Campylobacter-related AMR will also be discussed.

Antimicrobial resistance (AMR), recognized as one of the top ten global public health threats, is projected to cause around 10 million deaths annually by 2050. This trajectory can be averted by adopting the One Health Approach, which acknowledges the interconnection between human, animal, and environmental health. In this narrative review, we explore the multifactorial drivers of AMR, with particular emphasis on its relationship to climate change, examining the link between extreme weather events and the emergence of resistance. Furthermore, we highlight measures essential for mitigating both climate change and AMR. We provide a detailed account of the steps clinicians should implement in daily practice and underscore the importance of collaboration among individuals, healthcare professionals, livestock farmers, and agricultural workers to reduce AMR rates. Finally, we emphasize that interdisciplinary teams, organizations, and governments must work collectively within the concept of the One Health Approach to combat AMR.