Urea at post-dialysis levels induces increased ROS in a number of cell types. The aim of this study was to determine whether urea-induced production of ROS remains elevated after urea is no longer present, and, if it does, to characterize its origin and effects. Human arterial endothelial cells were incubated with 20 mM urea for two days, and then cells were incubated for an additional two days in medium alone. Maximal ROS levels induced by initial urea continued at the same level despite urea being absent. These effects were prevented by either MnSOD expression or by Nox1/4 inhibition with GKT13781. Sustained urea-induced ROS caused a persistent reduction in mtDNA copy number and electron transport chain transcripts, a reduction in transcription of mitochondrial fusion proteins, an increase in mitochondrial fission proteins, and persistent expression of endothelial inflammatory markers. The SOD-catalase mimetic MnTBAP reversed each of these. These results suggest that persistent increases in ROS after cells are no long exposed to urea may play a major role in continued kidney damage and functional decline despite reduction of urea levels after dialysis.

Alternative proteins denote non-traditional, high-protein foods. These innovative sources aim to compete with conventional animal products by providing protein-rich, sustainable, nutritious, and flavorful options. Currently, five main categories of alternative proteins are being developed: plant-based proteins, cultured meat, single-cell proteins, edible insects, and seaweed. Nonetheless, several chemical and microbiological food safety hazards are associated with these alternatives Incorporating novel protein sources into food products may heighten the prevalence of existing food allergies. This could arise from extracting proteins from their natural matrices and utilizing them at significantly higher concentrations. Additionally, the introduction of new proteins may lead to the development of novel food allergies. Proteins that are currently seldom or never consumed may cause primary sensitisation or trigger cross-reactivity with known allergens. To date, alternative proteins have not been thoroughly studied for their allergenic potential, and there is no standardised method for assessing this risk. This review aims to explore non-traditional protein sources, discussing their nutritional and functional properties, as well as their potential allergenicity based on available research. We conducted a literature search in PubMed and Embase databases. We used specific keywords and MESH terms. A total of 157 studies were included in the review. The studies reviewed in our analysis reveal significant limitations, such as inconsistent methodologies, limited participant numbers, and a lack of long-term data, which hinder the ability to make clear conclusions regarding the safety of these new proteins for individuals with allergies. To address current challenge, future research should integrate food science, regulatory perspectives and advanced technologies.

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication, which develops within 3–6 weeks after SARS-CoV2 infection. The coronavirus disease 2019 (COVID-19) vaccine was firstly introduced in adults and adolescents and later in patients aged 5–11 years old. Although a reduced incidence of MIS-C and with less severe symptoms has been reported in vaccinated adolescents, there is little knowledge in children younger than 12 years of age. In addition, it is not understood whether MIS-C in vaccinated patients can be triggered by Covid19 vaccination or be secondary to a recent asymptomatic Sars-Cov2 infection. Case presentation: We describe the case of a Caucasian 6-year-old girl, one month after double COVID-19 vaccination, who presented fever, acute abdominal pain, rash, pharyngotonsillitis, cheilitis, cervical lymphadenopathy without a prior detected Sars-Cov2 infection. She also had lymphopenia, increase in inflammatory markers, cardiac and pulmonary involvement. Therefore, we dosed both anti Sars-Cov2 Spike and Nucleocapsid antibodies, which were positive and allowed us to confirm the diagnosis of MIS-C. We promptly administered intravenous immunoglobulins and methylprednisone, resulting in the initial regression of fever. During the hospitalization, the child also developed pancreatitis and severe neurological involvement, including irritability, drowsiness, distal tremor, dyskinesia and buccal asymmetry with complete resolution after 2 months. After 3 months from the onset of the symptoms, she reported a transient loss of hair compatible with telogen effluvium. After 12 months of follow-up, she did not show any symptomatic sequelae. Conclusions: This case raises the question of whether COVID-19 vaccination may be involved in the pathogenesis of MIS-C in children between the ages of 5 and 11 years old.

Background: Milk ladder (ML) is considered a potential therapeutic option for managing cow’s milk allergy (CMA). Although the ML was initially developed to reintroduce cow's milk into the diet for individuals with non‐IgE mediated CMA, it has also recently been used in IgE‐mediated CMA. Objective: To perform a systematic review and meta‐analysis of the safety and efficacy of ML in children with IgE‐mediated milk allergy. Methods: We conducted a systematic literature review and meta‐analysis of controlled studies in accordance with PRISMA guidelines. ML safety and ML efficacy compared to a strict avoidance diet and oral immunotherapy in children with IgE mediated CMA was evaluated. Meta‐analysis was performed where ≥ 3 studies reported data. Methodological quality and risk of bias were systematically assessed. Results: Six controlled studies (two randomized controlled trials and four observational controlled studies) met the inclusion criteria. ML resulted in the development of tolerance in 69% of participants (OR = 4.48; 95% CI = 2.51–8.00), with a significant improvement compared to the elimination diet. The meta‐analysis of four studies showed that ML was 4.5 times more effective than a strict avoidance diet in inducing partial or total tolerance in ITT analysis and 8.4 times in PP analysis. Certainty of evidence was moderate, with low heterogeneity among studies. No significant difference in adverse events, severe systemic allergic reactions, and adrenaline use between the ML and avoidance diet groups were found. Only one study reported comparable efficacy between ML and oral immunotherapy with raw milk (OIT). No difference was found in the total number of mild to moderate adverse reactions between the groups (68.2% and 77.8, respectively; p = 0.44). The rates of epinephrine use at home were 14.3% and 11.8%, respectively, without significant difference between ML and OIT groups ( p = 1). Conclusions: ML represents a promising therapeutic approach for accelerating tolerance in children with IgE‐mediated CMPA. Further research is needed to clarify milk ladder safety, as well as to identify predictive biomarkers for patient selection.

Meat, fish, and dairy products have long served as the primary sources of protein in our diets. However, contemporary food production heavily relies on intensive farming and fishing practices, which present significant environmental threats. With the global popu-lation growing rapidly, food systems must identify sustainable alternatives to meet the increasing demand for protein. Alternative proteins denote non-traditional, high-protein foods. These innovative sources aim to compete with conventional animal products by providing protein-rich, sustainable, nutritious, and flavourful options. Currently, five main categories of alternative proteins are being developed: plant-based proteins, cultured meat, single-cell proteins, edible insects, and seaweed. Nonetheless, several chemical and microbiological food safety hazards are associated with these alternatives. Incorporating novel protein sources into food products may heighten the prevalence of existing food al-lergies. This could arise from extracting proteins from their natural matrices and utilising them at significantly higher concentrations. Additionally, the introduction of new proteins may lead to the development of novel food allergies. Proteins that are currently seldom or never consumed may cause primary sensitisation or trigger cross-reactivity with known allergens. To date, alternative proteins have not been thoroughly studied for their aller-genic potential, and there is no standardised method for assessing this risk. This narrative review aims to explore non-traditional protein sources, discussing their nutritional and functional properties, as well as their potential allergenicity based on available research.