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Aging Cell

Wiley

Preprints posted in the last 7 days, ranked by how well they match Aging Cell's content profile, based on 165 papers previously published here. The average preprint has a 0.15% match score for this journal, so anything above that is already an above-average fit.

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A Scalable Biological Clock for Metabolic Disease Prediction from the Phenome India Cohort

Tiwari, P.; Garg, M.; Pattanayak, S.; Sarkar, I.; Roy, R.; Bhatraju, N.; Verma, A.; K, S. R.; Prakash, S.; Kumar, V. S.; Uddin, M. A.; Rawat, N.; Sahu, A.; Kumar, Y.; Leuva, P. H.; Mridha, A.; Yenamandra, V.; Singh, A. P.; Mishra, A.; Raychaudhuri, S.; Tallapaka, K. B.; Chandak, G. R.; Kulkarni, M. J.; Dharne, M.; Wahengbam, R.; Kalita, J.; Manna, P.; Subudhi, U.; Majumder, S.; Chakraborty, P.; Chaudhary, K.; Sengupta, S.; Phenome India Consortium, ; Sardana, V.; Chatterjee, S.; Ganguly, D.

2026-09-03 endocrinology 10.64898/2026.08.29.26361656 medRxiv
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Background: India has a rising incidence of chronic non-communicable diseases, making it a major healthcare burden today. Growing evidence suggests that chronic low-grade inflammation links ageing with cardiometabolic disorders, captured by the emerging concept of inflammaging. However, most evidence on biological ageing comes from Western populations, with no similar models developed for the Indian population. Given the country's distinctive genetic makeup, unique exposome, and heterogeneous NCD presentation, Western models may not capture inflammaging and its effects in the Indian population. Methods: We analysed baseline data from 4,240 adults in the Phenome India CSIR Health Cohort Knowledgebase (PI CheCK), a nationwide multi-centre cohort. Participants were stratified into eight cardiometabolic phenotype groups by BMI (Asian cut off), blood pressure and HbA1c status. We trained a Super Learner ensemble to predict chronological age in the lean normotensive-normoglycaemic reference group (n=615) using 44 plasma cytokines, sex, haemoglobin, and bioimpedance-derived visceral fat area, per cent body fat, and total body water. Performance was assessed by repeated five-fold cross-validation and in a held-out healthy test set. Calibrated biological age acceleration was then estimated in the remaining 3,625 participants. Results: Median age was 51.0 years (IQR 41.0 to 62.0) and 49.4% were female. The Super Learner outperformed elastic net and XGBoost comparators. Permutation importance identified visceral fat area, per cent body fat, CTACK, SDF1a, haemoglobin and sex as leading contributors, with body composition measures accounting for the largest share, indicating an immune-metabolic rather than cytokine-only signal. Biological age acceleration was concentrated in overweight/obese phenotypes. Lean phenotypes showed acceleration close to the reference (0.32 0.50 years). Conclusions: Cytokine and body composition measures capture a quantifiable immunometabolic ageing signal in a South Asian cohort, with acceleration driven predominantly by adiposity. External validation and longitudinal follow up are required.

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Age-related clonal hematopoiesis and mosaic sex chromosome loss define distinct systemic proteomic programs and disease vulnerabilities

Weyrich, M.; Ware, A.; Steixner-Kumar, A.; Windschmitt, J.; Sarakpi, T.; Abplanalp, W.; Dimmeler, S.; Speer, T.; Zeiher, A. M.

2026-08-31 genetic and genomic medicine 10.64898/2026.08.29.26361722 medRxiv
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Clonal hematopoiesis (CH) increases with age, but whether different somatic clones represent an ageing phenotype or exert distinct systemic effects is unclear. In 450,587 UK Biobank participants, including 46,324 with plasma proteomics, we compared clonal hematopoiesis of indeterminate potential (CHIP) and mosaic loss of chromosome Y (mLOY) or X (mLOX) across biological ageing, incident disease, and circulating proteins. Despite shared age dependence, these alterations showed distinct disease spectra: non-DNMT3A CHIP was associated with broad multisystem disease burden, mLOY with a more focused respiratory, musculoskeletal and cardiovascular profile, whereas mLOX lacked broad age-related disease associations. Clone burden mapped to distinct proteomic programs: mLOY to neutrophil degranulation and extracellular-matrix remodeling, non-DNMT3A CHIP to myeloid immune regulation, and mLOX unexpectedly to cytotoxic lymphocyte/NK-cell responses. Mendelian randomization supported selected protein-disease relationships. Thus, age-related hematopoietic clones are not interchangeable markers of ageing but define alteration-specific systemic programs associated with distinct disease vulnerabilities.

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Both ageing and frailty status impact vaccine-induced transcriptomic profiles and subsequent humoral immunity: results from the VITAL cohort

Joshi, M.; Carre, C.; Cevirgel, A.; Bijvank, E.; Chabaud-Riou, M.; Courtois, V.; Chautard, E.; Larocque, D.; Burny, W.; Beckers, L.; Buisman, A.-M.; Rots, N.; van der Heiden, M.; van Beek, J.; van Sleen, Y.; van Baarle, D.

2026-08-31 allergy and immunology 10.64898/2026.08.26.26361408 medRxiv
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Vaccine responses vary across individuals due to differences in ageing and health status. Using transcriptomic profiling, we analyzed early gene expression profiles after influenza (QIV) followed by pneumococcal (PCV13) vaccination in 148 participants spanning young, middle-aged, and older adults. The two vaccines induced distinct immune signatures: QIV elicited innate and interferon immune activation, while PCV13 triggered inflammation-based responses. Older adults showed weaker but similar transcriptomic profiles compared to young adults. Among older adults, frailty, in addition to age, was strongly associated with reduced innate responses. In addition, we identified associations between early-stage transcriptomic profiles and later-stage antibody responses for QIV; however, no such associations were observed for PCV13. Importantly, observed group differences arose not from altered immune modules but from differences in the magnitude of gene expression, paving the way for immune-boosting interventions to enhance early gene expression in at-risk populations.

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Causal roles of phenotypic age and metabolic health on dementia: a Mendelian randomisation and structure learning study

Baousi, A.; Dobinda, K.; Zhu, J.; Yu, X.; Muir, K.; Lophatananon, A.; McMillan, B.; Clarkson, P.; Tang, E. Y. H.; Guo, H.

2026-09-03 genetic and genomic medicine 10.64898/2026.09.01.26360731 medRxiv
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Background Phenotypic age acceleration (PhenoAgeAccel), derived from PhenoAge, and MetaboHealth are composite exposures of biological ageing and metabolic health associated with dementia-related outcomes. Whether these associations are causal and reflect the exposures, constituent biomarkers, or both remains unclear. Methods This study included UK Biobank participants of White British genetic ancestry. MetaboHealth was derived from nuclear magnetic resonance (NMR) metabolomics and PhenoAgeAccel from clinical biomarkers and chronological age. Genome-wide association studies (GWAS) were conducted for MetaboHealth (n=272,568) and PhenoAgeAccel (n=274,077). Independent genome-wide significant variants were used as genetic instruments in two-sample Mendelian randomisation (MR) with FinnGen all-cause dementia summary statistics. Inverse-variance weighting was the primary MR method. Causal network analysis estimated relationships among constituent biomarkers and dementia. Findings GWAS identified 126 and 141 independent genome-wide significant variants for MetaboHealth and PhenoAgeAccel, of which 109 and 141 were retained as genetic instruments. MR found no evidence of a causal effect of genetically predicted MetaboHealth (per unit: OR 0.83, 95% CI 0.49-1.42; p=0.51) or PhenoAgeAccel (per year: OR 0.99, 95% CI 0.95-1.02; p=0.44) on all-cause dementia, with consistent findings across sensitivity analyses and robust MR methods. Lower lymphocyte percentage and higher NMR-derived glucose had direct relationships with dementia in the joint constituent-biomarker network. Interpretation MR provided no evidence that either composite exposure causally influenced dementia. The network prioritised lymphocyte percentage and NMR-derived glucose, supporting examination of composite exposures alongside their constituent biomarkers. Funding NIHR, UKRI, MRC, UK Dementia Research Institute, Innovate UK, and European Union. Full funding details are provided in the acknowledgements.

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Multi-organ aging quantified from routine chest CT predicts chronic disease risk and mortality

Sato, J.; Salehjahromi, M.; Zafar, A.; Muneer, A.; Xu, X.; Zhu, E.; Vokes, N. I.; Cascone, T.; Le, X.; Altan, M.; Gardner, E. E.; Sheshadri, A.; Ostrin, E. J.; Salahudeen, A. A.; Li, T.; Merad, M.; Chaudhuri, A. A.; Gerber, D. E.; Kay, F. U.; Godoy, M. C. B.; Carter, B. W.; Shroff, G. S.; Byers, L. A.; Chung, C.; Jaffray, D.; Rice, D.; Liao, Z.; Chang, J. Y.; Vaporciyan, A. A.; Gibbons, D. L.; Wu, C. C.; Heymach, J. V.; Zhang, J.; Wu, J.

2026-08-31 radiology and imaging 10.64898/2026.08.26.26361434 medRxiv
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Biological aging occurs heterogeneously across individuals and organs. However, current measures of biological age incompletely capture organ-specific differences in health and disease risk. Because chest CT visualizes multiple thoracic organs, it offers an opportunity to quantify structural aging across organ systems. Here, we developed MOSAIC-Age, a framework characterizing eight organ-specific aging clocks on chest CT. The clocks were developed and validated using 9,971 CT scans from CT-RATE and MIDRC, and subsequently locked and applied to two independent prospective cohorts with 35,293 participants from the National Lung Screening Trial and Genetic Epidemiology of COPD study. CT-derived biological age gaps (BAGs) were examined in relation to lifestyle and socioeconomic factors, prevalent comorbidities, incident chronic diseases, and all-cause and cause-specific mortality. Higher BAGs, indicating organs that appeared older on CT than expected for their chronological age, were broadly associated with adverse health characteristics, chronic disease burden, and increased mortality risk. Multiple disease outcomes were associated with aging across several organs, whereas in multivariable analyses including all eight organ-specific BAGs, the remaining associations were more organ specific. A greater number of markedly older-appearing organs and a faster pace of aging were each associated with higher mortality. Together, these findings demonstrate that routine chest CT captures both shared and organ-specific patterns of biological aging and establish CT-derived organ aging as a quantitative imaging biomarker for assessing multi-organ health and long-term disease risk.

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Loss of RUBCN causes autophagy overdrive in a neurodevelopmental disorder with age-dependent neurodegeneration

Efthymiou, S.; Tabata, K.; Dafsari, H. S.; Schober, E.; Latza, C.; Isaoglu, M.; Abuelrub, A.; Rad, A.; Firoozfar, Z.; Turchetti, V.; Lin, R. Q.; Maroofian, R.; Wiethoff, S.; Afzal, E.; Zafar, F.; Rana, N.; McRae, A. M.; Kaiyrzhanov, R.; Guliyeva, U.; Gulieva, S.; Melikishvili, G.; Lespinasse, J.; Vitobello, A.; Denomme-Pichon, A.-S.; Wentzensen, I. M.; Mefford, H. C.; Briere, L. C.; A Walker, M.; A High, F.; Sweetser, D. A.; Kendall, M.; Franchi, M.; Brown, M.; Latner, D.; Joset, P.; Ivanovski, I.; Alfadhel, M.; Alluhaydan, I.; Frederiksen, A. S.; Arriens, V.; Hanker, B.; Mankad, K.; Guerin, J

2026-09-01 genetic and genomic medicine 10.64898/2026.08.27.26360298 medRxiv
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Pathogenic variants in RUBCN, encoding the Run domain Beclin-1 interacting and cysteine-rich domain-containing protein (Rubicon) have been implicated in autosomal recessive spinocerebellar ataxia 15 (SCAR15). However, the molecular mechanisms underlying disease pathogenesis remain poorly understood. Here, we report 18 individuals from 15 unrelated families harbouring biallelic RUBCN variants, who present with an aggressive neurodevelopmental disorder variably characterized by seizures, developmental delay, intellectual disability and movement abnormalities that cause regression, progressive brain atrophy and neurodegenerative features. Through functional characterization, we demonstrate that a subset of disease-associated putative truncating variants disrupt autophagy regulation. In Caenorhabditis elegans models, loss-of-function RUBCN variants result in an increased autophagic flux and impaired neuronal function, recapitulating key features in humans. Correspondingly, cellular assays reveal that nonsense and frameshift RUBCN variants lead to defective autophagy inhibition, underscoring a crucial role for RUBCN as a key negative autophagy regulator. Molecular dynamics simulations rank the eleven missense variants by structural effect, with p.Arg813Trp alone altering the target protein at both the local and the regional level and lying within the RAB7A-binding module that the truncating alleles remove altogether. Our findings establish and expand the RUBCN-related disorders as a clinically and molecularly distinct subset of autophagy-related diseases. By delineating both the genetic landscape and cellular consequences of Rubicon dysfunction, this study enhances our understanding of autophagy-related neurodevelopmental disorders and provides a foundation for future therapeutic investigations.

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MOSurvivor-Guided Joint CpG Selection and XGBoost Hyperparameter Optimization for Compact Epigenetic Age Prediction

Yelgi, A.; Tavangari, S.; Shakarami, Z.; Janfaza, S.

2026-08-29 genomics 10.64898/2026.08.26.747213 medRxiv
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Accurate epigenetic age prediction from DNA methylation profiles is intrinsically high-dimensional, creating a need for parsimonious models that preserve predictive performance while reducing the number of assayed cytosine-phosphate-guanine (CpG) loci. This study introduces MOSurvivor, a population-based multi-objective search framework that jointly optimizes a weight-threshold CpG selector and eight XGBoost hyperparameters. Experiments used the GSE40279 whole-blood cohort (656 individuals profiled on the Illumina HumanMethylation450 platform). After retaining 1,000 age-correlated CpGs, five strategies were evaluated on the same 30 seeded 80:20 train/test splits: fixed-parameter XGBoost using all 1,000 CpGs, random search, a genetic algorithm, particle swarm optimization, and MOSurvivor. Internal fitness was estimated using three-fold cross-validation on each training set. Across the 30 held-out test sets, MOSurvivor achieved a mean absolute error (MAE) of 4.149 {+/-} 0.300 years, root mean squared error of 5.545 {+/-} 0.392 years, and R2 of 0.855{+/-} 0.027 while retaining 211.6 {+/-} 54.8 CpGs. Relative to full-feature XGBoost (MAE 4.095 {+/-} 0.285 years), MOSurvivor reduced the feature set by 78.8% at an MAE increase of only 0.054 years (1.3%). Paired Wilcoxon tests found no significant accuracy difference between MOSurvivor and any comparator (all unadjusted p > 0.05; all Holm-adjusted p [≥] 0.476). The most recurrent locus, cg16867657, appeared in 29 runs, whereas mean pairwise Jaccard similarity was 0.124, indicating a small stable core embedded in multiple near-equivalent feature subsets. MOSurvivor thus offers a competitive accuracy-parsimony trade-off rather than superior absolute accuracy. External validation and leakage-free nested feature preselection remain necessary before biological or clinical translation. Keywords: epigenetic clock, DNA methylation, feature selection, multi-objective optimization, XGBoost, metaheuristics, biological aging.

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Senotherapeutic role of pemafibrate through autophagy/mitophagy regulation in chronic obstructive pulmonary disease

Matsubayashi, S.; Ito, S.; Hosaka, Y.; Yoshida, M.; Kadota, T.; Hashimoto, M.; Hatano, S.; Maruyama, T.; Fujimoto, S.; Nishioka, S.; Inukai, S.; Fujita, Y.; Minagawa, S.; Hara, H.; Nakada, T.; Nakayama, K.; Ohtuska, T.; Kuwano, K.; Araya, J.

2026-09-02 respiratory medicine 10.64898/2026.08.31.26361865 medRxiv
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Inadequate autophagy promotes smoking-induced cellular senescence involved in chronic obstructive pulmonary disease (COPD) pathogenesis. Transcription factor EB (TFEB) is a master regulator of the autophagy-lysosome axis. For the first time, we investigated the therapeutic potential of pemafibrate, a putative TFEB inducer. COPD lung epithelial cells showed reduced TFEB expression. Pemafibrate enhanced autophagy/mitophagy flux and restored lysosomal acidification observed during cigarette smoke (CS) extract exposure in human bronchial epithelial cells, resulting in reduced cellular senescence. TFEB knockdown demonstrated involvement of pemafibrate-induced TFEB in these effects. Pemafibrate induced TFEB expression, mitigated alveolar enlargement and airflow obstruction, and attenuated the CS-induced increase in static lung compliance in a long-term CS-exposed mouse model. It reduced the CS exposure-induced cellular senescence, possibly through autophagy/mitophagy, as suggested by bulk RNA sequencing of mouse lungs. A retrospective cohort study showed that patients given pemafibrate displayed attenuated FEV1.0 decline compared with those given bezafibrate or fenofibrate. In conclusion, pemafibrate is a promising therapeutic agent for COPD, potentially exerting its effects through the regulation of the TFEB-autophagy/mitophagy-lysosome axis.

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BCG vaccination recalibrates innate immunity in ART-treated people with HIV

Dolle, C.; Tutumlu, T. K.; Bartl, L.; Depouilly, B.; Russenberger, D.; Zeeb, M.; Kusejko, K.; West, E.; Braun, D. L.; Schwarzmüller, M.; Elie, B.; Trkola, A.; Günthard, H. F.; Nemeth, J.

2026-09-02 hiv aids 10.64898/2026.08.28.26361620 medRxiv
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Despite suppressive antiretroviral therapy, many people with HIV (PWH) retain chronic interferon-associated immune dysregulation. Observational data from the Swiss HIV Cohort Study linked asymptomatic mycobacterial exposure to lower viral set points, reduced interferon-associated activity, and attenuated HIV-specific antibody responses, a pattern sharing features with HIV elite controllers and natural hosts of primate lentiviruses. We therefore examined whether Bacillus Calmette-Guerin (BCG) vaccination could induce a related immune configuration in ART-treated PWH. Using longitudinal systems-level profiling within the BELIEVE trial, we found that BCG reduced constitutive NK cell IFN-{gamma} production and PBMC-mediated direct cytotoxicity without impairing inducible cytokine responses or antibody-dependent cellular cytotoxicity. Multiomic and proteomic analyses showed reduced interferon- and activation-associated programs, while adaptive immune parameters remained largely stable and follow-up revealed no obvious adverse clinical pattern. This configuration, reduced baseline interferon activity coexisting with preserved Fc-dependent effector function, shares selected features with immune states described in natural lentiviral control and provides a rationale for testing BCG in combination with antibody-based HIV interventions.

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External Validation of a Mathematical Model of Brain Health

Sadia, H.; Doyon, N.; Duchesne, S.

2026-09-03 neurology 10.64898/2026.09.01.26361929 medRxiv
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Background Understanding the mechanisms underlying brain aging and age-related pathological changes is essential for advancing brain health research. Our group previously developed a mechanistic mathematical model of healthy brain, Chamberland et al. (2024) that integrates key biological processes involved in normal aging, from which Alzheimer's disease (AD) related changes may emerge naturally. Objectives To characterize and validate this brain model by evaluating its sensitivity, calibrating its parameters, and assessing generalizability in independent populations. Methods The model represents the evolution of key biological processes associated with brain aging, including amyloid beta (A{beta}), tau pathologies, neuroinflammation, and neuronal death. After identifying the 30 most influential parameters, we calibrated the model using cognitively normal (CN) participants from the AD Neuroimaging Initiative (ADNI) database (n = 211) by minimizing a loss function composed of three outcomes (AB) plaques, tau tangles, and neuronal density). The calibrated model was then applied to the UK Biobank cohort (n = 35,899) of normal controls (aged 44-82 years). The effects of sex and APOE were evaluated using stratified simulations. Results Parameter calibration significantly reduced the prediction errors for A{beta} and tau. Neuronal density predictions showed strong agreement in the UK Biobank cohort. The variance decomposition identified APOE status as a major contributor to variability in A{beta}. Conclusion Our validated brain health model links mechanistic pathways with population data and reproduces neuronal density patterns in an independent cohort. These findings support its use as a framework for studying brain aging and investigating how Alzheimer's disease related pathological changes may emerge with aging.

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Proteoform-resolved neoGFAP as a diagnostic and prognostic biomarker across the TBI--MCI--AD continuum in Veterans

Haskins, W. E.; Wang, K. K.; Cai, G.; Boukholda, K.; Elbayoumi, E.; Bajpai, R.; Jackson, D.; Tehas, K.; Radeker, K.; DeLizza, A.; Popper, C.; Kiendl, M.; Badrnya, S.; Miholits, M.; Jellbauer, S.; Kilbaugh, T.; Okumu, F.; Puccio, A.; Gardner, R. C.; Manley, G.; Williamson, J. B.; Waters, A. B.; Li, G. G.; Peskind, E. R.

2026-09-03 neurology 10.64898/2026.09.01.26361845 medRxiv
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Service members with traumatic brain injury are at approximately two- to four-fold higher risk of Alzheimer's disease or related dementias than those without such an injury, with risk increasing with injury severity. The amyloid/tau/neurodegeneration biomarker framework treats amyloid, tau, and neurodegeneration as independent axes but omits astroglial injury, despite evidence that reactive astrogliosis (indexed by glial fibrillary acidic protein, GFAP) must be elevated for cognitive decline to occur in amyloid-positive individuals. Total GFAP immunoassays aggregate intact protein with multiple calpain- and caspase-cleaved proteoforms, blurring the biological signal. We compared a calpain-cleaved GFAP neoepitope, the glial fibrillary acidic protein neoepitope (neoGFAP), against total GFAP across the full traumatic brain injury--mild cognitive impairment--Alzheimer's disease continuum in Veterans using a two-stage plasma-to-cerebrospinal-fluid biomarker approach. A plasma triage gate combining phosphorylated tau 217 and amyloid beta 42 was applied to 367 unique subjects; a cerebrospinal-fluid benchmarking cohort of 57 subjects (controls, chronic blast traumatic brain injury, mild cognitive impairment, and Alzheimer's disease) received head-to-head neoGFAP and total GFAP measurement. In the whole benchmarking cohort, neoGFAP discriminated mild cognitive impairment plus Alzheimer's disease from non-Alzheimer subjects with an area under the receiver-operating-characteristic curve of 0.81 versus 0.73 for total GFAP, a trend-level advantage that did not reach nominal significance. Within the gate-positive, amyloid-committed subset of 23 subjects, neoGFAP dominance became significant by McNemar's exact test (six discordant subjects favored neoGFAP, none the reverse). Across diagnostic contrasts, neoGFAP outperformed total GFAP for Alzheimer's disease versus control and, importantly for Veterans, for mild cognitive impairment versus chronic blast-exposed Veterans without cognitive impairment. In chronic blast injury, neoGFAP was paradoxically depleted relative to controls, consistent with tissue sequestration of aggregated proteoform fragments. Unbiased proteomic profiling confirmed coordinated elevation across astrocytic, neuronal, mitochondrial, and microglial compartments. An exploratory subject-level reclassification improved accuracy from 71.1 percent using plasma alone to 79.5 percent with added cerebrospinal-fluid markers and age. In a same-cohort ProQuantum replication (n=57), CSF neoGFAP preserved its discrimination advantage over total GFAP for MCI+AD versus non-AD (AUROC 0.76 vs 0.72; cross-platform Spearman {rho}=0.84), while plasma neoGFAP achieved AUROC 0.90, comparable to pTau217 (0.92) and exceeding A{beta}42/40 (0.84). In this small sample, neoGFAP is a superior proteoform-resolved diagnostic and prognostic biomarker across the continuum and supports adding an astroglial-proteoform axis to amyloid/tau/neurodegeneration biomarker frameworks in high-risk populations.

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RGC-specific reversal of lipid peroxidation drives neuroprotection and vision restoration in optic nerve ischemia by targeting GPX4

Yang, M.; Pan, J.; Modgil, S.; Pujari, R.; Pan, C.; Alkhabaz, A.; Ren, X.; Liu, L.; Shariati, M. A.; Ahmed, T.; Wu, H.; Dalal, R.; Liao, Y. J.

2026-08-29 neuroscience 10.64898/2026.08.25.747113 medRxiv
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Nonarteritic anterior ischemic optic neuropathy (NAION) is the leading cause of acute optic nerve related vision loss in older adults, yet no disease modifying therapy exists. Although ischemia is a defining feature of NAION, prior therapeutic efforts targeting vascular insufficiency or nonspecific oxidative stress have failed to prevent irreversible retinal ganglion cell (RGC) degeneration, underscoring an unresolved mechanistic gap between ischemic insult and permanent axonal failure. In this endeavour, we identify lipid peroxidation as an important driver of neurodegeneration in NAION. Analyses of human NAION retina, together with a rigorously validated mouse model, demonstrated a remarkable activation of phospholipid peroxidation within the retina following ischemic injury. RGC-specific overexpression of glutathione peroxidase 4 (GPX4), the only known enzyme capable of directly detoxifying phospholipid hydroperoxides within biological membranes, confers striking protection of RGC survival, axonal integrity, and visual function. We further demonstrate that mitochondrial-targeted GPX4 provides superior protection, suggesting mitochondria as a critical locus of lipid peroxidation-driven vulnerability in NAION. Leveraging real-time multiparametric in vivo imaging to directly interrogate axonal metabolism and function, we demonstrate that RGC-specific GPX4 overexpression robustly restores axonal and retinal mitochondrial abundance, improves ATP bioenergetics, and suppresses superoxide stress following optic nerve ischemia. Mitochondria-targeted GPX4 expression further restores axonal transport and retinofugal projections to central visual targets, thereby stabilizing visual pathway connectivity. Notably, these neuroprotective effects are recapitulated by Ebselen, a clinically tested GPX mimetic, identifying lipid peroxide detoxification as a translatable and imaging-validated therapeutic strategy. Collectively, this work establishes ischemia-induced lipid peroxidation as an essential driver of neurodegeneration in NAION and identifies GPX4 as a key molecular determinant of retinal ganglion cell resilience.

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Early-Life Wildfire Smoke Exposure Is Associated with Long-Term Systemic Immune Remodeling and Epigenetic Reprogramming

Layman, C. E.; Morrow, D.; Wheeler, K.; Caron, T. J.; Davis, B. A.; Bergstrom, P.; Vigh-Conrad, K.; Anderson, T. J.; McElfresh, G. W.; Sterner, K. N.; Sadoughi, B.; Snyder-Mackler, N.; Hansen, S. G.; Bimber, B. N.; Lancioni, C.; Carbone, L.; Okhovat, M.

2026-08-29 immunology 10.64898/2026.08.27.742220 medRxiv
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Wildfire smoke is an escalating global public health threat exposing millions of people, including children, to hazardous air pollution each year. Although wildfire smoke toxicants have been linked to a range of adverse health outcomes, including immune dysregulation, the long-term consequences of real-world pediatric wildfire smoke exposure on health and development remain largely unknown. To investigate the persistent effects of early-life exposure on immune health, here we leveraged a cohort of rhesus macaques that experienced nine consecutive days of hazardous wildfire smoke exposure in infancy during the 2020 Oregon Labor Day wildfires. By integrating ex vivo immune stimulations, multiplex cytokine profiling, single-cell transcriptomics, and genome-wide DNA methylation profiling, we identified persistent immunological consequences across molecular and functional levels. We found that a single severe postnatal exposure, in the first three months of life, was associated with persistent change in the innate immune response, including reduced pro-inflammatory cytokine response to a bacterial endotoxin, with subtle but consistent transcriptional changes in myeloid cells, particularly among males. Wildfire smoke exposure was also associated with changes in proportion of B and T/NK cells, and within the T/NK cell compartment, exposed animals exhibited an expansion of cytotoxic cells. Consistent with this, CD8+ T cells displayed extensive transcriptional remodeling and shifted toward more differentiated effector states, with the greatest differentiation observed in animals exposed at the youngest ages. Genome-wide DNA methylation profiling identified smoke-associated methylation changes consistent with acceleration of epigenetic aging, as well as persistent epigenetic alterations impacting genes involved in oxidative stress responses, innate immunity, T cell differentiation, and hematopoiesis. These findings demonstrate that a single severe wildfire smoke exposure during a critical developmental window is associated with extensive immune and epigenetic remodeling that persist years after exposure, providing new insight into the long-term biological consequences of early-life wildfire smoke exposure.

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Mitochondrial DNA copy number in neurodegenerative diseases: a global meta-analysis of 156 comparisons across 76 studies

Mathews, R.; Bouyadjera, S. B.; Donegan, J. J.; Havird, J. C.

2026-08-29 neuroscience 10.64898/2026.08.25.747144 medRxiv
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Mitochondria are central hubs for cellular metabolism and mitochondrial dysfunction is a hallmark of many chronic diseases. Consequently, changes in mitochondrial DNA copy number (mtDNA-CN), the number of mtDNA genomes per cell or tissue sample, are associated with diseases ranging from cancer and obesity to psoriasis and all-cause mortality. MtDNA-CN especially holds promise as a biomarker for neurodegenerative diseases, but whether and how mtDNA-CN changes with neurodegeneration is controversial. Here, we performed a systematic review and meta-analysis of 76 studies including 156 comparisons of mtDNA-CN in populations with or without a neurodegenerative disease to identify overall trends and potential moderators that explain variation among studies. Overall, mtDNA-CN was not statistically different with neurodegeneration, but heterogeneity among studies was extreme (I2 = 99.5%). The diagnosed disease explained the most variation. For example, Alzheimer's patients showed a 21% decrease in mtDNA-CN, but there was no change in mtDNA-CN with Parkinson's disease. Decreases in mtDNA-CN during neurodegeneration were also more extreme at older ages. Surprisingly, the tissue sampled for mtDNA-CN was not particularly influential, except for certain diseases. Studies published in earlier years also showed more extreme decreases in mtDNA-CN with neurodegeneration. Excessive heterogeneity persisted even after accounting for all moderators and their interactions (I2 = 85.7%). We conclude that the general perception of decreased mtDNA-CN with neurodegeneration is a vast oversimplification that may stem from legacy effects of early studies. However, mtDNA levels offer great promise as biomarkers for neurodegeneration, other diseases, and general health metrics, assuming appropriate complications can be considered.

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Integrating mouthguard kinematics, finite element brain strain, and plasma biomarkers to explore brain injury thresholds in collision sport

Hickey, J. W.; Chan, E. Y. K.; Evans, L. J.; O'Brien, W. T.; Xie, B.; Roberts, S. S. H.; Butler, S. E.; Ernst, J.; Zhou, W. J. Q.; Zimmerman, K. A.; Spitz, G.; Parker, T. D.; O'Brien, T. J.; Shultz, S. R.; Sharp, D. J.; Ghajari, M.; McDonald, S. J.

2026-08-31 sports medicine 10.64898/2026.08.26.26360869 medRxiv
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Purpose: Identifying head impacts linked to brain injury in sport remains challenging. Instrumented mouthguards quantify head-impact kinematics, and finite element (FE) modelling can transform these data into brain strain estimates, which may better reflect injury risk than kinematics alone. Here, we examined associations between mouthguard-measured kinematics, FE-derived strain, and plasma brain injury biomarker GFAP following head impacts. Methods: We analysed 41 video-verified impacts from male Australian football players, including 22 assessed for concussion (17 diagnosed) and 19 unassessed. Instrumented mouthguards recorded peak linear acceleration (PLA), peak rotational acceleration, and peak rotational velocity (PRV). Brain strain was estimated using the Imperial College FE brain model, and plasma GFAP was quantified using Simoa. Biomechanical-GFAP associations were examined using Spearman correlations and segmented regression. Results: For impacts overall, plasma GFAP was moderately correlated with PLA ({rho}=0.46, 95% CI: 0.20-0.66), PRV ({rho}=0.53, 95% CI: 0.20-0.78), and strain ({rho}=0.60, 95% CI: 0.32-0.80). Associations were stronger within concussion cases for strain ({rho}=0.86, 95% CI: 0.58-0.97) and PRV ({rho}=0.64, 95% CI: 0.15-0.93). Piecewise regression identified strain levels above which strain-GFAP relationships steepened across the whole-brain and brainstem. In concussion cases, supra-threshold brainstem strain was associated with greater symptoms. Conclusion: Finite element brain strain may better predict brain injury risk following a sport-related head impact than peak acceleration metrics. Stronger associations with plasma GFAP, particularly among concussion cases, and evidence of a biomechanical threshold, support the use of biomarker-informed strain measures in future risk modelling and the development of brain injury screening thresholds.

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Long-Term Impact of Cumulative Hyperglycaemia on DNA Methylation and its Role in Diabetic Kidney Disease

Luo, X.; Syreeni, A.; Hill, C.; Smyth, L. J.; Dahlstrom, E. H.; Mutter, S.; Chen, Z.; Natarajan, R.; Pan, S.; Parton, A.; Jackson, H.; McKay, G.; Susztak, K.; Hirschhorn, J. N.; Florez, J. C.; Maxwell, A. P.; Groop, P.-H.; McKnight, A. J.; Sandholm, N.

2026-09-03 genetic and genomic medicine 10.64898/2026.08.31.26361614 medRxiv
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Hyperglycaemia is a hallmark of diabetes and a major risk factor for diabetic kidney disease (DKD). However, the molecular consequences of long-term cumulative hyperglycaemia (CH) remain unclear. As a stable epigenetic modification, DNA methylation may capture past glycaemic exposure. Here, we assessed CH-associated DNA methylation in 1,245 participants with type 1 diabetes (T1D) from Finland and the United Kingdom-Republic of Ireland cohorts. We identified 17 CH-associated CpGs, with the strongest association at cg19693031 (TXNIP). Longitudinal analyses demonstrate that these CH-associated DNA methylation levels remain stable despite short-term glycaemic fluctuations, suggesting lasting epigenetic imprints of earlier metabolic control. Integrative analyses combining genomic, epigenetic, and proteomic data characterized these CpGs and potential target proteins. Mendelian randomization suggested a causal association between cg20853880 (KLF11) and DKD, supported by chromatin accessibility and kidney KLF11 expression. Our findings suggest that epigenetic changes contribute to metabolic memory and may mediate the effects of hyperglycaemia on DKD.

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A germline KDM3C polymorphism impairs DNA repair and sensitizes to chemoradiotherapy

Hasan, A.; Demidova, E. V.; Priyadarshini, P.; Czyzewicz, P.; Gathuka, L.; Murayama, T.; Zhou, Y.; Kiss, Z. A.; Shastry, R. K.; Andrake, M.; Hearne, G.; Devarajan, K.; Wu, C.; Shah, A.; Schultz, B. M.; Connolly, D. C.; Rosen, G. L.; Canadas, I.; Liu, J. C.; Burtness, B. A.; Smith, J. J.; Dunbrack, R. L.; Golemis, E. A.; Whetstine, J. R.; Meyer, J. E.; Arora, S.

2026-08-31 genetic and genomic medicine 10.64898/2026.08.26.26360896 medRxiv
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Chemoradiotherapy (CRT) is the standard-of-care therapy for many solid malignancies, yet predictive biomarkers of treatment response remain limited. We identified a germline single nucleotide polymorphism (SNP) in an intrinsically disordered region of the lysine demethylase KDM3C/JMJD1C (p.S464T) that is associated with CRT outcomes in locally advanced rectal cancers (LARC) and head and neck squamous cell carcinoma (LA-HNSCC). In silico modeling with AlphaFold predicted S464T substitution influenced interaction between phosphorylated KDM3C and RNF8 FHA domain. In cellular models, conversion of S464 to T464 increased sensitivity to DNA-damaging agents. S464T substitution impaired damage-induced MDC1-RAP80 signaling and downstream RAP80-BRCA1 colocalization. SNP carrying cells impaired DNA repair causing genotoxic stress that is associated with increased cGAS-cGAMP innate immune signaling and increased apoptosis. Population analyses with the SNP highlighted an increase incidence of UV-induced skin and other cancers, linking inherited variation in the chromatin regulatory gene KDM3C to genome instability, cancer risk, and therapeutic vulnerability.

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Developing the Longitudinal Study of Aging in Guatemala (ELEGUA): Rationale and pilot protocol

Corzantes, K.; Choy, K.; Adar, S.; Castellanos, L. F.; Gross, A. L.; Langa, K. M.; Rohloff, P.; Weerman, B.; Briceno, E.; Ramirez-Zea, M.; Behrman, J.; Flood, D.

2026-08-31 epidemiology 10.64898/2026.08.26.26361136 medRxiv
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Introduction Guatemala is the most populous country in Central America and a setting with unique opportunities for aging research. Approximately 40% of Guatemala's population is Indigenous Maya, who together speak 22 Mayan languages. Currently, there is no population-based aging study in Guatemala and few aging studies in Latin America among Indigenous populations. The Longitudinal Study of Aging in Guatemala (ELEGUA) aims to address these gaps by developing a nationally representative, population-based, longitudinal aging study modeled on the Health and Retirement Study and the Harmonized Cognitive Assessment Protocol, adapted to the cultural and linguistic context of Guatemala. The objective of this protocol is to describe the rationale and design of the ELEGUA pilot survey. Methods and analysis The ELEGUA pilot was a cross-sectional household survey of adults aged 40 years or older in Tecpan, Guatemala. Tecpan was chosen because its diverse population facilitated testing of study procedures in both Spanish and Kaqchikel, a common Mayan language. The survey included up to 600 households sampled using a multistage stratified cluster design. Within each household, one individual aged 40 years or older was selected, with oversampling of adults aged 55 years or older. This respondent completed a comprehensive questionnaire, including detailed cognitive tests, and provided physical measurements and a venous blood sample. Household respondents provided information on household economics and family structure, and an informant reported on the individual respondent's cognitive function. Data were collected using a computer-assisted personal interviewing system. Planned analyses include survey-weighted descriptive statistics and psychometric evaluation of the cognitive assessments. Ethics and dissemination Ethics approval was obtained from the ethics committees of the Institute of Nutrition of Central America and Panama, Maya Health Alliance, and the University of Michigan. Results will be disseminated through publications in peer-reviewed journals and presentations to local, national, and international audiences.

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Convergent Innate Immune and Metabolic Signatures in Parkinson's Disease and Viral Infection

Belyea, M. M.; Shafiq, M.; Lass, J.; Much, C.; Liu, Z.; Kruse, N.; Haendler, K.; Sreenivasan, V.; Gelpi, E.; Siebels, B.; Ondruschka, B.; Spielmann, M.; Klein, C.; Trinh, J.; Glatzel, M.

2026-09-01 pathology 10.64898/2026.08.28.26361092 medRxiv
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Viral infections have long been proposed as environmental contributors to neurodegenerative diseases, including Parkinson's disease (PD), yet the molecular mechanisms linking infection and neurodegeneration are not well defined. Neuroinflammation and disruption of central nervous system (CNS) homeostasis have emerged as potential mediators. In this study, we used severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, as a model pathogen to investigate convergent molecular pathways between viral infection and PD. Single-nucleus RNA sequencing (snRNA-seq) was performed on post-mortem striatal tissue from 14 individuals stratified into four groups: COVID-19 only (COVID-19), PD only (PD), comorbid PD with COVID-19 (PD/COVID-19), and controls (Control). The PD/COVID-19 group exhibited an expanded astrocytic population and a pronounced interferon-associated molecular signature characterized by increased expression of canonical interferon-stimulated genes, including IFI44L (average log2FC= 3.9; adjusted p=2.3 x 10-373), IFI44 (average log2FC=2.9; adjusted p=8.0 x 10-266), ISG15 (average log2FC=3.1; adjusted p=1.2 x 10-197), and RSAD2 (average log2FC= 3.5; adjusted p=8.6 x 10-111). Pathway analyses demonstrated activation of innate immune and antiviral signaling pathways, particularly within microglia and astrocytes, including interferon signaling, pattern-recognition receptor pathways, and complement-associated responses. In parallel, genes involved in lipid metabolism, cholesterol homeostasis, synaptic maintenance, and neuronal signaling were reduced across disease groups. Proteomic analyses independently confirmed enrichment of antiviral and interferon-associated pathways and identified convergent suppression of sterol, cholesterol, and lipid metabolic processes. Our findings identify a convergent molecular signature linking PD and COVID-19, pronounced in comorbid individuals and characterized by interferon-driven innate immune activation, glial inflammatory responses, and dysregulation of lipid metabolic homeostasis. Collectively, the data support a model in which severe viral infection amplifies biological pathways already implicated in PD pathogenesis.

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Deep phenotyping and multi-omics analyses reveal systems-wide metabolic dysregulation in a refined trisomy mouse model of Down syndrome

Saqib, M.; Chen, F.; Mistri, D. K.; Tan, L.; Wright, N.; Sarver, D. C.; Anders, R.; Aja, S.; Wong, G. W.

2026-08-29 physiology 10.64898/2026.08.26.747201 medRxiv
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Trisomy 21 or Down syndrome (DS) affects multi-organ systems across the lifespan. The presence of an extra chromosome, along with genome dosage imbalance due to triplicated genes, contributes to the DS phenotypes. Of the DS mouse models, few are aneuploid with a freely segregating extra chromosome. We previously showed that the aneuploid Ts65Dn mice exhibit metabolic deficits consistent with the metabolic profile of DS. However, the genotype-phenotype relationships in Ts65Dn mice are complicated by the presence of triplicated genes unrelated to human chromosome 21 (Hsa21). To address this issue, we leveraged a refined model, Ts66Yah, where the extra triplicated genes in Ts65Dn have been removed. Deep phenotyping and multi-omics analyses showed that Ts66Yah mice develop pronounced and widespread metabolic disturbances. Despite sexual dimorphism in weight gain, body temperature, lipid and lipoprotein profiles, hepatic injury and adipose fibrosis, both male and female Ts66Yah mice share a common phenotype of pronounced glucose intolerance and insulin resistance, reduced mitochondrial respiratory capacity in visceral fat, altered serum inflammatory cytokine profile, and dysregulated serum and liver metabolomes. Pan-tissue transcriptomes also reveal signatures of immune activation, disrupted metabolic processes and cellular respiration, altered cytokine signaling, enhanced oxidative stress, and extracellular matrix remodeling. These combined changes across tissues disrupt metabolic homeostasis more severely in Ts66Yah than in Ts65Dn mice. Several phenotypes, including glucose intolerance, insulin resistance, tissue fibrosis, and oxidative stress were further exacerbated by an obesogenic diet. This foundational data establishes Ts66Yah as a valuable reference model for the mechanistic and comparative study of metabolic dysfunction in DS.