Biology of Sex Differences

Autism spectrum disorder (ASD) exhibits a profound male biased sex ratio. While numerous genes have been implicated in ASD, the functional basis of this sex difference is unclear. One enticing hypothesis is genome-wide transcriptional regulation through estrogens and androgens. While hormone-mediated transcription is well-studied in reproductive tissues, its role in cortical development is poorly defined. Thus, we profiled androgen (AR) and estrogen (ESR1/ESR2) receptor expression in mid-gestation human fetal (GW16-24) cortex and complementary cortical organoid models, by single-cell RNA-seq. AR was primarily expressed in radial glia and intermediate progenitors while ESR1/ESR2 was more broadly distributed across multiple cell types of the developing cortex, although with the highest expression in radial glia. To study their genetic effects, we exposed iNeurons and cortical organoids to physiological levels of dihydro-testosterone (DHT) and estradiol (E2). DHT consistently up-regulated oxidative metabolism programs enriched in progenitor cells and down-regulated neuronal maturation pathways, while E2 exhibited a much more attenuated effect. The presence of DHT reduced NTRK2 (TrkB) expression, correlating with expression in fetal cortex where NTRK2 had significantly higher expression in progenitor cells of the female cortex, which is also reflected in the increased expression of AR in radial glia. Together, these data indicate that in developing human cortical lineages, sex hormones act as selective, cell-state-dependent modulators that tune metabolic and maturation programs rather than broadly reprogramming the genome. Thus, the effects of variation in transcriptional regulation through estrogens and androgens are likely to be minor, but not absent, in ASD.

The hippocampus undergoes extensive cellular remodelling throughout life. Aging affects hippocampal structure, contributing to cognitive decline and neurodegenerative disease risk. Parity, as the experience of pregnancy and motherhood, triggers profound hormonal and metabolic changes which modulate brain plasticity in the short and long term. Signatures of past parity are seen in the hippocampus in humans and rodents, but how parity shapes cellular composition in the short and long-term after pregnancy have not been systematically examined using quantitative, cell-type-specific approaches. We performed cell type deconvolution on bulk RNA-sequencing data from female rat hippocampus, comparing nulliparous and parous females across ages (7 or 13 months; parous animals studied 30 days or 7 months after parturition). We harmonized 349 cell type annotations from three single-cell reference datasets into 27 biologically coherent categories using female-only data. Three-way ANOVA identified independent and interactive effects, while complementary analyses (random forest, PCA, DESeq2) identified parity-associated transcriptional signatures. Cell-specific functional enrichment employed weighted gene set meta-analysis across multiple pathway databases. Age emerged as the dominant factor, significantly altering six cell types, particularly somatostatin and parvalbumin/Vip interneurons. Regional effects (dorsal and ventral hippocampus) affected nine cell types, while agexregion interactions identified two cell types. Parity independently affected three populations: dorsal CA3 pyramidal neurons, SST interneurons, and astrocytes. Cell-type-specific pathway analysis revealed distinct mechanisms including protein degradation in CA3 neurons, stress-response regulation in astrocytes, and disrupted GPCR/signalling-receptor programs in SST interneurons. Our study shows that parity selectively remodels hippocampal cellular architecture through distinct, cell-type-specific molecular programs operating independently of age and region, establishing parity as a critical biological variable in neuroscience and aging research.

Polycystic Ovarian Syndrome (PCOS) is a complex endocrine disorder characterised by hyperandrogenism, oligo- or anovulation, and polycystic ovaries. Endocrine dysfunction in PCOS disrupts both hormonal and neurotransmitter balance, contributing to the psychological distress frequently reported by affected individuals. Although hormonal imbalances have been associated with memory impairments, their specific contribution to cognitive dysfunction in PCOS remains incompletely understood. In this study, we investigated the impact of PCOS on the hippocampus, a brain region critical for memory formation and highly sensitive to sex steroid modulation. A dehydroepiandrosterone (DHEA)-induced PCOS mouse model was employed to assess anxiety-like behaviour, locomotion, and memory. In the open field test (OFT), DHEA-treated mice spent significantly less time in the central zones and travelled a shorter total distance compared with controls, indicating increased anxiety-like behaviour. DHEA treatment also resulted in significantly impaired performance in both the object location test (OLT) and novel object recognition test (NORT), as reflected by a reduced discrimination index. Analysis of hippocampal immediate early gene expression using qRT-PCR revealed altered transcription of memory-related markers, including downregulation of Npas4 and Grin2a, and upregulation of Grin1, Arc, Egr1, and Egr2. Collectively, these findings suggest that elevated androgen levels induce anxiety- and depression-like behaviours and impair cognitive function, including spatial, recognition, and motor learning abilities, in PCOS. Our results further indicate that disrupted cortex-hippocampus communication may underlie these cognitive deficits, underscoring the importance of evaluating memory and cognitive health in women with PCOS to support brain health and overall well-being.

Breeding female mice represent an essential but often overlooked workforce sustaining biomedical research. Despite their central role, the physiological and behavioral consequences of repeated reproductive cycles have been poorly characterized, in part because breeding animals fall outside the primary focus of laboratory animal welfare efforts, and in part because meaningful welfare readouts for laboratory rodents remain an active area of research. Here we report findings from an exploratory phenotypic study designed to capture a composite picture of maternal health in female mice of two commonly used inbred strains, BALB/cByJ and C57BL/6J, exposed to one, two, or four consecutive cycles of pregnancy and lactation, with age-matched virgin females as controls. Assessments were conducted during the final lactation period and in the five weeks following weaning, spanning behavioral, metabolic, and physiological readouts selected for their known sensitivity to reproductive or environmental challenge. Repeated reproduction altered maternal physiology, most clearly in bone microstructure, which showed progressive and dose-dependent changes across parity levels, and more subtly in body mass, energy balance, and glucose homeostasis. Behavioral readouts of maternal motivation, by contrast, remained largely stable across reproductive load. Strain differences were pervasive, underscoring that reproductive adaptation is not uniform across standard laboratory models and cautioning against generalizing from a single strain. Together, the data suggest that mouse dams demonstrate considerable resilience under intensive breeding conditions, while also highlighting that breeding shapes the maternal body in ways that accumulate across reproductive cycles and deserve greater scientific attention.

Psychosocial stressors are key contributors to ovarian functional decline. Chronic unpredictable mild stress (CUMS) is widely used to model stress-induced premature ovarian insufficiency (POI) in mice; however, current animal models do not adequately reflect middle-aged women, who represent a key population exposed to chronic psychosocial stress, nor do they capture the dynamic progression toward POI. Here, female C57BL/6 mice aged 2 or 6 months were subjected to CUMS for 8 or 12 weeks. Estrous cyclicity, endocrine profiles, ovarian histology, and transcriptomic changes in HPO axis-related tissues were systematically analyzed. After 8 weeks of exposure, 2-month-old mice exhibited impaired pituitary responsiveness to estradiol negative feedback, as evidenced by dysregulated FSH secretion, indicating reduced stress tolerance compared with 6-month-old mice. Following 12 weeks of CUMS exposure, both age groups showed significant reductions in ovarian size and follicle numbers across all developmental stages. These findings demonstrate that CUMS induces an age-dependent progression toward POI, with short-term exposure eliciting compensatory phases preceding overt ovarian insufficiency, accompanied by distinct endocrine and reproductive alterations and differential responsiveness of the HPO axis. Transcriptomic analyses revealed age-dependent stress responses: ovaries of 2-month-old mice displayed marked activation of inflammatory and immune-related pathways, whereas 6-month-old mice showed sustained upregulation of protein kinase-related signaling networks. Notably, the 6-month-old CUMS model more closely recapitulates stress-associated reproductive aging in adult women. In briefCUMS has been widely used to establish mouse models of psychosocial stress-induced POI. However, current animal models do not adequately reflect middle-aged women, who represent a key population exposed to chronic psychosocial stress, nor do they capture the dynamic progression toward premature ovarian insufficiency (POI). In this study, we demonstrate that different durations of CUMS exposure induce distinct stages of ovarian dysfunction in both young and middle-aged mice, with short-term exposure driving age-dependent compensatory phases and prolonged exposure leading to overt POI, both accompanied by divergent endocrine and reproductive alterations, alongside age-dependent changes in HPO axis responsiveness to CUMS. Notably, the 6-month-old CUMS model shows greater clinical relevance in recapitulating chronic psychosocial stress and stress-related reproductive aging in adult women.

BackgroundPrenatal cannabis use is becoming increasingly more commonplace. However, cannabis exposure is linked to adverse pregnancy outcomes, including gestational hypertension, preeclampsia, and preterm birth. The aim of this study was to determine the morphological and molecular effects of prenatal cannabinoid exposure on the placenta. MethodsPregnant Sprague-Dawley rats were exposed daily to vaporized THC (100 mg/mL) starting at gestational day (GD)5 until GD19 when dams were sacrificed and fetuses and placentas collected. Fetuses were genotyped for genetic sex and transcriptomic analysis was performed on male and female THC-exposed and control placentas. ResultsOn GD19, both the fetuses and placentas from the THC group were significantly larger than the control. When separated by sex, both male and female THC fetuses were significantly larger; however, only male THC placentas were significantly larger than male control placentas with no significant difference in placental weight between female control and THC placentas. RNA-sequencing revealed enriched biological processes related to nutrient transport and lipid catabolism, protein-lipid complex formation, and lipoprotein particle remodeling and organization. Further transcriptomic analysis determined that the differentially expressed genes and enriched biological processes related to lipid metabolism were preferentially enriched in the female THC placentas compared to the male, suggesting a sex-specific effect. DiscussionCollectively, these data present sex-specific effects of prenatal cannabinoid exposure on placental growth and global gene expression. These data also suggest that sex influences gene expression of genes related to lipid metabolism in the THC-exposed placentas.

Sex is a critical biological variable that impacts disease risk, progression, and treatment response across virtually every organ system. However, decades of biomedical research have relied primarily on male study subjects, leaving large gaps in our understanding of female-specific disease biology. Quantifying the extent of this imbalance across thousands of disease areas and millions of publicly available biological samples has remained computationally intractable. Here, we present a multimodal computational framework that infers the biological sex of [~]230,000 publicly available human transcriptome samples and links inferred sex labels to disease terms extracted from [~]9,000 associated study records and [~]5,000 publication abstracts to quantify sex imbalance at scale. Applying this approach revealed that the majority of disease terms with the largest research-derived sex imbalance are skewed toward male representation, including areas with no known biological justification for that imbalance. After adjusting for global sex-specific disease prevalence to isolate biologically unjustified imbalance, up to 58% of all disease terms showed male-leaning association. Diseases including glioblastoma, cirrhosis, idiopathic pulmonary fibrosis, and schizophrenia emerged as critically understudied in females despite affecting both sexes comparably. These findings provide a principled, data-driven basis for prioritizing compensatory research efforts and offer a reusable framework for ongoing monitoring of sex representation in the biomedical literature. HighlightsO_LISkewed male and female study subject representation in biomedical research is the result of decades of studies conducted without adequate female representation. C_LIO_LIWe developed an automated, multimodal framework to estimate the sex imbalance across thousands of disease terms using metadata from [~]230,000 transcriptomics samples and their associated [~]9,000 studies and [~]5,000 publications. C_LIO_LIOur approach identifies non-sex-specific disease research areas that have been studied using an unbalanced sex demographic. These areas need compensatory and balanced studies to understand sex differences. C_LI

Primary neuronal cultures derived from mouse tissue serve as an essential model for investigating neuronal development and function. Despite this, comprehensive developmental and sex-specific transcriptomic profiles in primary neurons have not been defined. Here, we performed multiplexed RNA-sequencing of neurons derived from male and female cortices across time. We validated this approach by assessing established neuronal maturation genes and we identified highly stable genes to serve as controls across development. Next, using linear modeling and temporal regression, we defined developmentally regulated transcripts, longitudinal expression dynamics, and gene signatures associated with transition states throughout development. Unexpectedly, this also revealed sex-specific effects on autosomal genes that emerge only after neuronal maturation even in the absence of in vivo cues. Most notably, neuropeptide genes Cortistatin and Neurokinin A are more highly expressed in female neurons. Furthermore, exposure to these neuropeptides elicited distinct transcriptional responses in male-versus female-derived cultures. These findings provide a valuable resource and reveal sex-specific autosomal transcriptional signatures that emerge in neurons maintained ex vivo. HighlightsO_LIMultiplexed RNA-sequencing of primary cultured neurons across neuronal maturation provides a new resource for the field. C_LIO_LIGene signatures associated with transition states are identified through linear modeling. C_LIO_LISex-specific regulation of autosomal genes encoding neuropeptides emerge even in the absence of in vivo cues. C_LIO_LIExposure to neuropeptides elicit distinct transcriptional responses in male and female primary neurons. C_LI

Sex hormones are essential regulators of skeletal maintenance, but the cell-specific mechanisms by which osteocytes mediate the skeletal consequences of sex hormone deficiency remain incompletely understood. Osteocyte estrogen receptor {beta} (Ot-ER{beta}) has been implicated in sex-specific regulation of bone mass, particularly in male mice, yet its role in coordinating bone morphology and mechanical competence following sex hormone withdrawal is unclear. In this study, male and female mice with osteocyte-targeted ER{beta} deletion (ER{beta}-dOT) and littermate controls were subjected to orchiectomy (ORX), ovariectomy (OVX), or sham surgery at 20 weeks of age. Four weeks later, vertebral and tibial bone morphology were assessed by micro-computed tomography, and tibial mechanical behavior was evaluated using strain gauge-calibrated, microCT-based finite element modeling. ORX induced substantial cancellous bone loss in the lumbar vertebra and proximal tibia of male mice regardless of genotype. In cortical bone, however, ORX reduced tibial cortical area and minimum moment of inertia in male littermate controls, whereas these cortical deficits were attenuated in male ER{beta}-dOT mice. Consistent with these morphological changes, ORX increased finite element-predicted peak tensile and compressive strains in tibial cortical and cancellous compartments and reduced whole-bone stiffness in male controls, but these mechanical deteriorations were largely prevented by Ot-ER{beta} deletion. In contrast, OVX produced modest changes in female tibial cortical geometry and increased cancellous bone strains, but these responses were not strongly dependent on Ot-ER{beta}. Together, these findings reveal that Ot-ER{beta} mediates the skeletal response to sex hormone withdrawal in a sex- and compartment-dependent manner. Specifically, Ot-ER{beta} contributes to ORX-induced deterioration of tibial cortical morphology and mechanical competence in male mice, whereas it is largely dispensable for OVX-induced skeletal changes in female mice. This work highlights osteocyte ER{beta} as a sex-specific regulator linking hormonal status, bone morphology, and load-induced strain environments.

BackgroundMenarche is a critical developmental milestone, with earlier onset associated with adverse long-term health consequences. Despite a reported global decline in age at menarche over the last century, this trend and its determinants remain insufficiently studied in Spain. ObjectiveTo assess secular trends in age at menarche and its determinants in the Valencian Community, Spain. MethodsThis population-based study included 417,260 participants born between 1931 and 2008. First, secular trends in age at menarche were assessed using time-series models across 5-year birth cohorts for the overall population. Then, participants were categorized as either women (born 1931-1985) or girls (born 1990-2008), and Bayesian linear regression models were fitted for each group, adjusting for birth cohort and continent of birth in all models, and additionally for educational level in women and body mass index (BMI) in girls. ResultsMean age at menarche decreased by 1.9 years, from 13.1 to 11.1, between the 1931-1935 and 2006-2008 birth cohorts, with a steeper decline after 1975. Compared to Europeans, women born in South/Central America ({beta}[95% CI]: 0.33[0.30, 0.36] years) and Africa (0.52[0.45, 0.58] years) experienced later menarche, while girls from South/Central America experienced earlier onset (-0.18[-0.28, -0.09] years). In girls, lower BMI was associated with later menarche (0.96[0.74, 1.18] years) and higher BMI with earlier onset (-0.53[-0.57, -0.48] years). ConclusionThere was a marked decline in age at menarche in the Valencian Community, with no evidence of leveling off. Key determinants included continent of birth (with cohort-specific effects) and BMI.

Orofacial clefts (OFCs), including cleft lip (CL), cleft palate (CP), and cleft lip with cleft palate (CLP), are among the most common craniofacial malformations in humans, with a birth prevalence of approximately 1 in 1,000 live births globally. Non-syndromic forms of OFC are predominantly genetic, with significant variability in prevalence across populations. Understanding the genetic underpinnings of OFCs remains a key public health priority, given the substantial medical and societal burden of these conditions. Recent genome-wide association studies (GWAS) have implicated numerous genetic loci, but challenges remain due to genetic heterogeneity and complex gene-environment interactions. This study aimed to identify sex-specific genetic risk factors for cleft lip with or without cleft palate (CL/P) through a meta-analysis of whole genome sequencing (WGS) data from 1,922 case-parent trios across eight diverse cohorts. Our approach revealed four SNPs in three distinct regions that showed genome-wide significant sex-specific effects. However, despite each of these SNPs passing standard quality control filters, follow-up analyses showed that these signals most likely were technical artifacts caused by sequencing errors, in particular mis-mapped reads due to sequence similarities with the sex chromosomes. These findings highlight the necessity for careful scrutiny when studying differences between the sexes in genetic association studies.

Purpose: Gonadotropin releasing hormone (GnRH) agonists are clinically used to delay pubertal progression by suppressing the hypothalamic-pituitary-gonadal (HPG) axis. While GnRH agonists have long been used clinically, the developmental characterization of HPG axis suppression during puberty remains incompletely understood. Thus, we examined the effects of GnRH receptor agonism in juvenile rats. Hypothesis: Sustained GnRH receptor agonism will result in lower gonadal mass, blunt peripheral pubertal landmarks, and alter hormonal signaling dynamics within the HPG axis. Methods: Animals received a single injection of extended-release leuprolide acetate depot (LA) or vehicle control on postnatal day (PND) 23. Animals were assessed for body mass and peripheral markers of puberty. On PND 44, animals were euthanized and tissues were evaluated to assess additional markers of pubertal maturation, pituitary gene transcript levels, and hormone concentrations in serum and gonads. Results: In females, LA treatment resulted in a smaller gonad size, increased body mass, and less vaginal openings. In males, LA treatment resulted in smaller gonads but did not significantly alter body mass or preputial separation. In the pituitary, LA-treated rats had lower Gnrhr, Fshb, and Lhb transcript levels regardless of sex, while females exhibited higher Cga and Nr5a1. Serum FSH and ACTH were lower in LA-treated animals, and treated females also had lower progestins and androstenedione, and higher LH. Conclusions: LA treatment reduced aspects of pubertal maturation and HPG axis output, with sex specific outcomes. These findings highlight the need for integrated, multi-level approaches to understand how altered GnRH signaling impacts pubertal and long-term physiology.

Introduction Menopause is a central marker of reproductive ageing, but national evidence on menstrual cessation among Nigerian women in the late reproductive ages remains limited. This study examined the prevalence and socio-demographic correlates of prolonged amenorrhea/possible menopausal transition among Nigerian women aged 30-49 years. Methods The study used the women's individual recode file from the 2024 Nigeria Demographic and Health Survey. The analytic sample was restricted to women aged 30-49 years, excluding women who were currently pregnant, currently or postpartum amenorrheic, and those with invalid or special responses on time since last menstrual period. The final sample comprised 14,223 women. The outcome combined women whose last menstrual period occurred 12 or more months before the survey, and women reported as being in menopause. Weighted descriptive statistics, design-adjusted bivariate tests and survey-weighted binary logistic regression were used. Results The weighted prevalence of prolonged amenorrhea/possible menopausal transition was 7.6%. Prevalence rose from 1.2% among women aged 30-34 years to 23.6% among women aged 45-49 years. In the adjusted model, women aged 35-39 years (OR=1.64; p=0.030), 40-44 years (OR=6.20; p<0.001) and 45-49 years (OR=24.51; p<0.001) had higher odds than women aged 30-34 years. Primary education (OR=1.65; p=0.004), middle wealth status (OR=1.37; p=0.043) and poorest wealth status (OR=1.60; p=0.024) were associated with higher odds. Muslim affiliation (OR=0.72; p=0.024) and traditional contraceptive use (OR=0.24; p<0.001) were associated with lower odds. Conclusion Prolonged amenorrhea/possible menopausal transition among Nigerian women aged 30-49 is strongly age-patterned and socially differentiated. The findings support the need to make midlife menstrual health more visible within reproductive, family planning and primary healthcare services. Because the measure is based on survey-reported menstrual recency, it should not be interpreted as clinically confirmed natural menopause.

Background Preterm birth (PTB) rates among Hispanic/Latina individuals in the United States have risen over the past decade. Data suggests this rise may be driven in part by psychosocial stress. Leukocyte telomere length (LTL), a marker of cumulative cellular aging that shortens under chronic stress, may capture stress-related biological vulnerability, but has not been examined as a potential population-level contributor to PTB in Hispanic/Latina pregnancies. Objective To examine the association between mid-pregnancy maternal LTL and PTB in a population-based Hispanic/Latina cohort. Methods In a case-control study nested within a California singleton birth cohort (n = 436 Hispanic/Latina individuals; 215 PTB, 221 term births), LTL was measured by quantitative PCR from biobank specimens collected from 15 to 20 weeks of gestation. Covariates from linked birth certificate and hospital discharge records were included. Logistic regression estimated ORs and 95% CIs of PTB by LTL examined continuously and by percentile category (<=10th, 11th-89th, >=90th) with and without adjustment for covariates. Results Mean and median LTL did not differ between PTB and term births. LTL at or below the 10th percentile was associated with elevated odds of PTB relative to full-term birth (12.6% versus 4.3%; ORc = 3.2, 95% CI 1.3-7.9), persisting after partial (ORadj1 = 3.2, 95% CI 1.3-8.3) and full covariate adjustment (ORadj2 = 3.4, 95% CI 1.3-9.3). Subgroup analyses showed consistent directional patterns across PTB subgroups and for early term birth (ORadj2 = 5.1, 95% CI 1.5-17.0). Conclusions Mid-pregnancy maternal LTL <=10th percentile was associated with more than three times the odds of PTB, with risk concentrated at the extreme low tail of the distribution. Consistent with a cumulative allostatic load model, markedly short LTL at mid-gestation may reflect elevated stress-related biological risk for preterm delivery. These findings support upstream investment in stress reduction and prospective LTL research in high-burden populations.

Here we present a preclinical longitudinal developmental dataset spanning pre-puberty (juvenile) to early adulthood in Wistar rats. Thirty-six rats (18 female) were scanned during five sessions at approximately postnatal day 28, 35, 49, 70 and 91. A standardised consensus protocol was used for animal sedation and MRI data acquisition (structural MRI and resting-state fMRI). The dataset also includes daily body weight measurements, day of puberty onset, and daily cytological smear images for oestrous tracking. This openly available dataset addresses the need for sex-balanced developmental preclinical datasets spanning puberty and enables researchers to investigate longitudinal brain functional developmental trajectories and Sex As a Biological Variable (SABV).

Alzheimers Disease and Related Dementias (ADRDs) are linked to reduced bone integrity and increased fracture risk, but the mechanisms that underlie this risk remain poorly defined. Current research suggests that environmental factors, such as diet, sleep, and light exposure can modulate the brain-bone axis, increasing susceptibility to bone loss and fractures. Circadian disruption (CD) associated with ADRDs may exacerbate the effects of disease and aging in the bone. In particular, regulation of bone marrow progenitors may be acutely susceptible to disruption along this axis. Here, we explore the interplay among genetic and environmental factors that influence bone structure, marrow progenitor cell activity, and monocyte-derived macrophages. The APP/PS1 transgenic mouse model (AP) is used as an in vivo model of amyloid-beta deposition. High-resolution micro-computed tomography (CT) identified sex- and genotype-specific responses in trabecular morphometry. Follow-up analysis with Raman spectroscopy (RS) found accumulation of non-enzymatic modifications of the organic matrix and notched three-point bending identified concomitant loss of bone toughness due to both CD and AP. Single-cell RNA sequencing (scRNA-seq) confirmed the presence of oxidative stress signals in the cellular populations of the bone marrow. We further mapped significantly differentially expressed genes (DEGs) from monocytes in the bone marrow to circadian-regulated proteins in monocyte-derived macrophages, revealing dysregulation of circadian timing in macrophages in vitro. These findings offer new insights into how environmental disruptions can exacerbate the progression of neurodegenerative disease and bone degradation. LAY SUMMARYPatients with Alzheimers disease have an increased bone fracture risk, but the biological link between brain and bone disease is not well understood. Everyday factors such as altered light exposure (shift work, screens late at night, etc.) can worsen outcomes in the brain and skeleton. Using a mouse model of Alzheimers disease, we found that both genetic risk and circadian disruption contribute to weaker bone and altered bone quality. We also identified inflammation and stress responses in bone marrow cells, suggesting that bone marrow may play a key role in linking brain disease to bone fragility.

Background: Sexual and gender minorities (SGM), including men who have sex with men (MSM) and transgender women, often face stigma, legal constraints, and limited access to sexual and reproductive health services. These conditions restrict prevention and care, increasing vulnerability to HIV and human papillomavirus (HPV) infections. While strong HIV-HPV interaction is documented in high-income settings, evidence from low- and middle-income countries remains limited. This study examines the burden, co-infection dynamics, and progression of HPV infection and anal dysplasia among MSM and transgender women in Pakistan. Methods: A cross-sectional study was conducted between September 2015 and October 2016 among men who have sex with men (MSM) and transgender women recruited from sexual health and antiretroviral therapy centers in Karachi. Eligible participants were aged [&ge;]18 years and self-reported anal sex within the past 6 months (N=298). Two anal specimens were collected for HPV DNA detection and genotyping using PCR, and anal squamous intraepithelial lesions (ASIL) were assessed cytologically using the Bethesda classification. Associations were estimated using Cox proportional hazards regression algorithms to derive prevalence ratios (PRs). Results: Among participants, 44% (n=133) were living with HIV. Overall HPV prevalence was 65.1%, rising to 87% among HIV-positive individuals compared to 48% among those without HIV ({chi}{superscript 2}p[&le;]0.001). Likewise 28.9% of participants living with HIV were infected with two or more than two types of HPV as compared with 18.8% participants without HIV ({chi}{superscript 2}p[&le;]0.001). HIV infection was strongly associated with HPV acquisition (adjusted PR 2.81, 95% CI 2.16-3.82). Among HPV-positive participants (n=194), 58.8% were co-infected with HIV. High-risk HPV was highly prevalent among those living with HIV (83.2% vs. 35.3% ({chi}{superscript 2}p[&le;]0.001)), with HPV16 as the dominant oncogenic type. Multiple HPV infections were more common among HIV-positive individuals ({chi}{superscript 2}p[&le;]0.001), and HIV seropositivity was 3.43 (95% CI: 2.55-3.51) times higher among those with high-risk HPV. Co-infected participants demonstrated prolonged smoking, longer duration of sex work, high-intensity sex work with limited condom negotiation, and higher prevalence of anal warts (all p<0.05). Anal dysplasia (ASIL) was present in 35% of participants and was higher among HIV-positive individuals (42.4% vs. 28.1%, p<0.001). HIV-HPV co-infection was independently associated with ASIL (adjusted PR 1.75, 95% CI 1.07-2.88), while high-risk HPV further amplified this risk (PR 3.04, 95% CI 1.75-5.26). Conclusion: These findings demonstrate a biological continuum in HIV-positive MSM and transgender women, where HIV increases HPV acquisition, persistence, and multiplicity, accelerating progression to anal dysplasia. This reflects a syndemic shaped by biological interaction and structural vulnerability. Integrating HPV screening and vaccination within HIV services is essential to interrupt progression to cancer in this high-risk population.

BackgroundWomen are disproportionately affected by multimorbid depression and type 2 diabetes (T2D), with prevalence peaking during midlife (40-64 years), a biologically dynamic timeframe due to changes associated with reproductive aging. Yet, phenotypic and mechanistic factors contributing to midlife womens disproportionate risk for co-occurrence remain poorly defined. We previously identified co-expressed microRNAs (miRs) in midlife women with prediabetes that increased odds of assignment to a high psychometabolic risk phenotype. Here, we extend these findings by characterizing putative mRNA targets of these co-expressed miRs and pathways overrepresented among mRNAs, providing insights into potential mechanisms underlying psychometabolic risk in midlife women. MethodsThis study included baseline data from midlife women (ages 40-64 years) with prediabetes who participated in the Diabetes Prevention Program (DPP) (n = 603). In silico analyses were performed using miRTarBase to identify mRNAs regulated by 3 or more of the miRs that most prominently loaded a principal component previously identified to increase odds of assignment to a high psychometabolic risk phenotype defined in this sample. Pathway enrichment analysis was conducted to assess for overrepresentation of KEGG pathways among predicted mRNA targets. To enhance interpretability, pathways were thematically clustered based on their evidenced role in human physiology. ResultsWe identified a total of 13 mRNAs targeted by co-expressed miRs associated with increased odds of assignment to a high psychometabolic risk phenotype in midlife women with prediabetes. Pathway enrichment analysis revealed a total of 71 KEGG pathways with overrepresentation of identified mRNA targets. Four overarching biological themes emerged, reflecting involvement of metabolic, inflammatory, endocrine, and stress/biological weathering-related processes. ConclusionsExperimentally validated mRNA targets related biological pathways were identified, providing multisystem insights into potential mechanisms underlying risk for multimorbid depression and T2D in midlife women. Findings offer mechanistic targets for experimental validation and future precision health research focused on this high-risk population. Overall, this work positions the utility of miRs as context-sensitive biomarkers in the characterization of risk for complex, multimorbid conditions in women during biologically dynamic timeframes.

Bioengineers strive to recreate in vivo microenvironments in vitro to reduce our use of animal models and provide insights into human biology. While liver models show promise, sex differences in liver biology remain largely neglected in preclinical studies. Despite the 2014 EU mandate for the inclusion of women in clinical trials, decoupling of research data by sex is historically rare, with only 11% of papers disaggregating data by sex. This gap contributes to women being more susceptible to drug-induced liver injury (DILI) and being underserved in drug development, as well as to costly drug attrition levels. Here we present a novel approach to modelling sex differences in vitro. Human induced pluripotent stem cells (iPSCs) from both male (XY) and female (XX) donors, were differentiated into hepatocyte liver spheroids and exposed to in vivo-mimicking levels of testosterone, progesterone, and oestrogen in high-throughput microwell format. We successfully recapitulated sex-specific metabolic profiles and demonstrated significant differences in CYP1A2 and CYP3A4 drug metabolism and gene expression patterns consistent with reported in vivo observations, without compromising cell viability. These findings validate the utility of sex-differentiated microenvironments in early-stage research, offering a pathway to refine animal and clinical trials and improve therapeutic outcomes for all sexes.

Aberrant changes in circulating cell-free mitochondrial DNA (ccf-mtDNA) across gestation are associated with adverse pregnancy outcomes. Given the inflammatory properties of ccf-mtDNA via pattern recognition receptors such as Toll-like receptor 9 (TLR9), we hypothesized that extracellular mtDNA induces placental inflammation via TLR9 signaling and that this response differs by fetal sex. Pregnant Sprague-Dawley rats were treated intravenously with purified mtDNA (300 g/kg), nuclear DNA (nDNA), saline, and/or the TLR9 antagonist ODN2088 across five studies. Placental responses were evaluated 4 h (Studies 1-3) and 24 h (Study 4) post-treatment; pregnancy and neonatal outcomes were assessed at delivery (Study 5). Exposure to mtDNA, but not nDNA, increased placental il1{beta}, tnf, and il10 mRNA (p < 0.05), establishing response specificity. mtDNA-induced placental inflammation was fetal sex-dependent: mtDNA increased il6 and il1{beta} mRNA in male placentas (p [&le;] 0.0004) but not female placentas, whereas ifn{gamma} was selectively induced in female placentas (p = 0.0004). TLR9 and MyD88 abundance increased in female but not male placentas, and TLR9 antagonism modified selected inflammatory responses with sex-specific patterns. The 4 h inflammatory transcriptional signature resolved by 24 h, whereas mtDNA exposure was associated with a sex-specific shift in antioxidant enzyme expression persisting to 24 h. Despite no effects on gestational length or neonatal biometrics, mtDNA exposure was associated with a higher estimated stillbirth count per litter (IRR = 4.23, 95% CI [0.89, 20.1], p = 0.069). These findings establish extracellular mtDNA as an acute, sex-differentiated placental inflammatory stimulus with partial TLR9 dependence and a potential impact on fetal viability. New & NoteworthyThis study demonstrates that acute exposure to extracellular mtDNA induces placental inflammatory responses in vivo. This response is specific to mtDNA, fetal-sex dependent, and partially mediated by TLR9, with male and female placentas engaging distinct inflammatory signals within hours of exposure. The biological effects extend beyond the initial inflammatory window, with mtDNA exposure producing lasting, sex-specific changes in antioxidant enzyme expression. mtDNA-exposed dams had higher expected stillbirth counts, suggesting extracellular mtDNA may affect fetal viability.