Autoimmune liver diseases (AILDs) include autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis. The etiologies of AILD are not well understood but appear to involve a combination of genetic and environmental factors. AILDs commonly affect young individuals and are characterized by a highly variable clinical course. These diseases significantly influence quality of life and can progress toward liver decompensation or the onset of hepatocellular or cholangiocarcinoma; a significant number of patients eventually progress to end-stage liver disease, requiring liver transplantation. In this review, we focus on the sex characteristics and peculiarities of AILD patients and highlight the relevance of a sex-specific analysis in future studies. Understanding the sex differences underlying AILD immune dysregulation may be critical for developing more effective treatments.

Parkinson’s disease (PD) is a neurodegenerative disorder primarily characterized by the loss of dopaminergic neurons in the substantia nigra. While most cases are sporadic, there is growing evidence of a link between PD and metabolic dysfunctions such as type 2 diabetes mellitus, obesity, and metabolic syndrome. Proposed pathogenic mechanisms underlying this overlap include insulin resistance and chronic inflammation. Similar patterns of cellular damage are observed in both metabolic disorders and PD, including mitochondrial dysfunction, impaired autophagy, oxidative stress, endoplasmic reticulum stress, and gut microbiota alterations. Given the current lack of disease-modifying therapies for PD, there is increasing interest in interventions traditionally used to treat metabolic conditions, such as lifestyle and dietary modifications. Notably, antidiabetic drugs like metformin and incretin mimetics have shown beneficial effects in PD due to their neuroprotective and anti-inflammatory properties, their ability to restore insulin sensitivity, and their role in reducing neuronal susceptibility to toxic insults, as demonstrated in both preclinical and clinical studies. Conversely, traditionally antiparkinsonian drugs such as bromocriptine have long been approved for improving glycemic control in diabetes. This cross-efficacy between drugs used for the two conditions may indirectly support the hypothesis of a shared pathogenesis. A deeper understanding of the connections between metabolic disorders and PD could pave the way for novel preventive and therapeutic strategies.

Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for patients with limited-stage muscle-invasive bladder cancer. RC is associated with a complication rate of approximately 50–88%. Immunonutrition (IMN) refers to the administration of substrates, such as omega-3 fatty acids, arginine, glutamine, and nucleotides, that modulate the immune response. IMN has been associated with improved outcomes following surgery for esophagogastric, colorectal and pancreatic cancer. In this paper, we describe a study protocol for a multicentre, randomised, open-label clinical trial to evaluate the effect of IMN in patients undergoing RC for bladder cancer. A 7-day preoperative course of IMN is compared with a standard high-calorie high-protein oral nutritional supplement. The primary outcome of this study is the rate of complications (infectious, wound-related, gastrointestinal, and urinary complications) in the first 30 days after RC. Secondary outcomes include time to recovery of bowel function and postoperative mobilisation, changes in muscle strength and body weight, biochemical modifications, need for blood transfusion, length of stay, readmission rate, and mortality. The results of this study may provide new insights into the impact of IMN on postoperative outcomes after RC and may help improve IMN prescribing based on patient nutritional status parameters.

Background: Parkinson’s disease (PD) is increasingly recognized as a multisystem disorder in which metabolic dysfunction may contribute to disease susceptibility and progression. Peripheral insulin resistance (IR) has been implicated in PD, but data in levodopa-naïve patients are currently limited. Objective: To investigate the prevalence of IR and metabolic dysfunction in early-stage, levodopa-naïve PD patients and their association with clinical features. Methods: We conducted an exploratory case–control study including 20 levodopa-naïve PD patients and 40 age-, sex-, and BMI-matched healthy controls. Participants underwent comprehensive clinical and metabolic assessments, including fasting glucose, insulin, lipid profiles, and HOMA-IR calculation. Peripheral IR was defined using HOMA-IR cut-offs of ≥2.0 (primary analysis) and ≥2.5 (sensitivity analysis). ANCOVA adjusted for age, sex, and BMI was used for between-group comparisons. Results: PD patients exhibited higher fasting insulin (10.7 ± 5.2 vs. 8.0 ± 4.4 µIU/mL; p = 0.020) and HOMA-IR (2.63 ± 1.40 vs. 1.89 ± 1.21; p = 0.014) compared to controls. Using a HOMA-IR ≥ 2.0, IR prevalence was 70% in PD vs. 32.5% in controls (OR = 4.85, 95% CI 1.52–15.50, p = 0.012). ANCOVA analysis confirmed group differences after adjusting for covariates (respectively, p = 0.032 for insulin and p = 0.023 for HOMA-IR). A sensitivity analysis excluding six patients receiving dopaminergic therapy further supported the robustness of the results. No significant correlations were observed between IR and disease severity scores. Conclusions: Early-stage, levodopa-naïve PD patients exhibit a higher prevalence of peripheral insulin resistance compared with matched controls. These findings support the hypothesis that metabolic dysfunction is an intrinsic component of PD pathophysiology and may represent a target for early intervention.

Background/Objectives: Twins discordant for Parkinson’s disease (PD) share genetic background and early-life exposures, offering a model for non-genetic determinants of disease. We aimed to evaluate longitudinally the mortality, clinical and lifestyle features, nutritional status and dietary habits of a cohort of PD-discordant twins, with specific attention to the monozygotic (MZ) subgroup. Methods: One hundred and eight subjects from 54 PD-discordant twin pairs (26 MZ, 28 dizygotic [DZ]), with genetically confirmed zygosity, were assessed at baseline (T0) and after 10 years by telephone interview (T1; 33 pairs), using Kaplan–Meier/Cox survival analyses, a clinical and lifestyle history questionnaire, body mass index (BMI), and a food frequency questionnaire (FFQ). Results: Ten-year mortality was markedly higher in PD (31.5% vs. 5.6%; HR 6.83), with all MZ deaths occurring in the affected twin. Constipation was more frequent in PD at both time points (T0 p = 0.004; T1 p = 0.011). Comorbidities, smoking, weight and BMI did not differ within pairs. Preserved-fish intake was stably lower in PD (T0 p = 0.021; T1 p = 0.004); fruit intake was lower in PD at baseline (MZ, p = 0.001) but higher at follow-up (p = 0.029). Conclusions: The mortality difference persisted despite no detected within-pair differences in BMI and comorbidities, consistent with a major contribution of PD itself. Preserved-fish intake remained stably lower in affected twins, whereas increased fruit intake at follow-up may reflect adaptation to constipation; these exploratory dietary findings warrant confirmation.