Systematic review and meta-analysis for the 2024 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis.

OBJECTIVES: To update evidence on the efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) and provide information to the taskforce for the 2024 update of the Japan College of Rheumatology (JCR) clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA). METHODS: We searched various databases for randomised controlled trials on RA published until June 2022, with no language restriction. For each of the 15 clinical questions, 2 independent reviewers screened the articles, evaluated the core outcomes, and performed meta-analyses. RESULTS: Subcutaneous injection of methotrexate (MTX) showed similar efficacy to oral MTX in MTX-naïve RA patients. Ozoralizumab combined with MTX improved drug efficacy compared to the placebo in RA patients with inadequate response (IR) to csDMARD. Rituximab with and without concomitant csDMARDs showed similar efficacy to other bDMARDs in bDMARD-IR RA patients. Combined Janus kinase inhibitors and MTX achieved similar clinical responses and equal safety during a 4-year period compared to tumour necrosis factor inhibitors in MTX-IR RA patients. Biosimilars showed efficacy equivalent to that of the original bDMARDs in csDMARD-IR and bDMARD-IR RA patients. CONCLUSION: This systematic review provides latest evidence for the 2024 update of the JCR CPG for RA management.

Effects of oxidized low-density lipoprotein on differentiation of mouse neural progenitor cells into neural cells.

In Alzheimer's disease (AD), a decline in function of neural progenitor cells (NPCs) results in a reduced capacity for neural regeneration. It has been shown that plasma oxidized low-density lipoprotein (ox-LDL) levels are positively correlated with severity in patients with AD. However, the direct effects of ox-LDL on NPCs are unknown. Thus, we examined the effects of ox-LDL on the proliferation and differentiation of mouse NPCs into neural cells. Mouse induced pluripotent stem (iPS) cell-derived embryoid bodies were stimulated with Noggin and SB431542 for 4 days. Mouse NPCs were then collected using anti-polysialic acid-neural cell adhesion molecule antibodies in a magnetic separator. The proliferation of mouse NPCs was examined using the MTT assay. The differentiation of mouse NPCs into neural cells was examined by the expression of NeuN (a neuronal-specific nuclear protein) using immunofluorescence staining and Western blot analysis. Treatment with ox-LDL did not affect the proliferation of mouse NPCs. While treatment with all-trans retinoic acid (ATRA), epidermal growth factor (EGF), and basic fibroblast growth factor (FGF) significantly induced NeuN expression in the differentiated NPCs (P < 0.01), the addition of ox-LDL significantly inhibited the NeuN expression (P < 0.05). Pretreatment with SC-79 (an Akt activator) significantly reversed the inhibitory effect of ox-LDL on NeuN expression (P < 0.05). Treatment with ox-LDL significantly inhibited Akt phosphorylation (P < 0.05) and CREB phosphorylation induced by ATRA, EGF, and basic FGF (P < 0.05). The present study indicates that treatment with ox-LDL inhibits the differentiation of mouse NPCs into neural cells by inhibiting Akt and CREB activation.