Cell Metabolism

Intermuscular adipose tissue (IMAT) expansion is closely associated with cardiometabolic disease, yet its cellular organization and regulatory mechanisms remain poorly defined. Here, we define a human IMAT gene signature using bulk transcriptomics and identify candidate regulators for IMAT function including adipogenic transcription factor early B-cell factor 2 (EBF2). To determine how these programs are organized in situ, we mapped this signature in a mouse model of diet-induced CMD using spatial transcriptomics. We found that IMAT expansion occurs within discrete stromal niches surrounding muscle fibers, characterized by coordinated activation of adipogenic, extracellular matrix, inflammatory, and metabolic pathways. Spatial analyses showed that fibro-adipogenic progenitor (FAP) abundance does not predict adipocyte formation, supporting a model of localized and context-dependent lineage transitions. Cross-species comparison revealed partial conservation of human IMAT gene programs, validating the mouse model and highlighting species-specific features. Functional experiments in human primary myoblasts showed that EBF2 is sufficient to induce adipogenic reprogramming. Our findings establish IMAT as an active, spatially organized remodeling niche and identify lineage plasticity as a central mechanism driving its expansion in metabolic disease

Despite decades of biochemical study, a comprehensive map of the mammalian metabolome remains elusive. Mass spectrometry-based metabolomics detects thousands of small molecule-associated signals in mammalian tissues, but it is currently unclear how many of these reflect products of endogenous metabolism. Here, we leverage systematic in vivo isotope tracing to infer the biosynthetic origins of unidentified metabolites. We administered 26 different isotopically labelled nutrients to mice, measured circulating and tissue metabolite labelling by mass spectrometry, and developed a statistical framework to infer the number of carbon atoms incorporated from each of these precursors into more than 4,000 putative metabolites. We show this information can be harnessed for biosynthesis-aware structure elucidation using a multimodal AI model that co-embeds isotopic labelling patterns with chemical structures. This approach revealed several previously unrecognized families of mammalian metabolites, including cysteine-derived alkylthiazolidines, dithioacetal mercapturic acid derivatives, short-chain N-acyltaurines, acylglycyltaurines, and N-oxidized taurines. It further uncovered a family of mevalonate-derived isoprenoid metabolites that includes 2,3-dihydrofarnesoic acid, which is markedly depleted in both mouse and human aging. Age-related depletion of these isoprenoids is driven by impaired coenzyme A synthesis. Our work establishes the biosynthetic precursors for thousands of unidentified metabolites and reveals multiple previously unrecognized branches of mammalian metabolism.

Aging arises from interconnected molecular defects, yet upstream regulatory mechanisms that coordinate these hallmarks remain incompletely defined. While epitranscriptomic regulation has emerged as a critical layer of gene control, the contribution of tRNA-specific modifications to aging remains largely unexplored. Here, we systematically profile tRNA modifications across multiple organs, species, and senescence models and identify mannosyl-queuosine (manQ), a wobble-position modification of tRNAAsp, as the first tRNA-specific modification that consistently declines with age. ManQ depletion is evolutionarily conserved and tightly correlates with functional deterioration. Mechanistically, loss of manQ impairs translational fidelity, leading to proteome imbalance, collapse of proteostasis, and aberrant expression of senescence-associated proteins, including GPNMB. These translational defects intersect with established aging hallmarks and accelerate cellular and organismal aging. We further demonstrate that circulating queuine, a microbiota-derived precursor required for manQ biosynthesis, declines with age in rodents and humans. Queuine deficiency promotes senescence, whereas supplementation restores manQ levels, improves translational accuracy, suppresses p16/p21-driven senescence programs, and re-establishes proteostatic balance. Across species, queuine supplementation extends lifespan and enhances healthspan. In Drosophila, it increases median lifespan by 47% and improves stress resistance and memory. In naturally aging mice, long-term oral administration extends lifespan by 15.3%, reduces DNA methylation age, improves cognitive and motor performance, strengthens antioxidant defenses, remodels the gut microbiota, and alleviates inflammation and metabolic dysfunction without detectable toxicity. Collectively, these findings establish tRNA epitranscriptomic remodeling as a previously unrecognized layer of aging regulation and identify restoration of manQ through queuine supplementation as a multi-system strategy to delay aging.

Dietary fat composition modulates host physiology and the gut microbiome, but the long-term effects of specific fat sources and the extent to which these changes resolve after dietary reversal remain incompletely defined. Here, we present a longitudinal multi-omic resource of mice maintained for one year on a purified control diet, seven high-fat diets differing in predominant fat source, or reversal regimens in which animals were switched from high-fat to control diet after 4 or 9 months. We further incorporated two cohorts with distinct pre-existing microbiome configurations to determine how baseline community structure shapes diet-induced remodeling of the gut microbiome ecosystem. By integrating longitudinal phenotyping, fecal metagenomics, fecal metabolomics, plasma metabolomics and lipidomics, and intestinal single-cell RNA sequencing, we defined the shared and dietary fat-specific responses across host and microbiome compartments. Baseline microbiome composition strongly influenced microbial responses to diet, indicating that pre-existing community structure is a major determinant of dietary ecosystem remodeling. Although many altered features shifted toward baseline after dietary reversal, only approximately half of diet-associated microbial changes recovered within the study window. A subset of taxa exhibited persistent alterations, including sustained depletion of Lactobacillus johnsonii and Bifidobacterium pseudolongum and sustained enrichment of Alistipes finegoldii, consistent with a "microbiome memory" of prior high-fat diet exposure. This memory effect is mirrored in the host, by sustained suppression of major histocompatibility complex class II (MHC-II) gene expression in intestinal epithelial cells after dietary reversal. These findings indicate that dietary fats leave a lasting imprint on the host-microbiome interactome that survives dietary intervention. Together, these data establish a resource for defining how dietary fat source, baseline microbiome composition, and dietary history shape host-microbiome states. The entire resource is available online as an RShiny app.

Beyond its role in digestion and barrier function, the intestine is an energy-responsive organ that actively regulates molecular metabolism. Whether and how lifestyle interventions regulate intestinal metabolism at both tissue and molecular levels remain unclear. Here, we show that both chronic exercise and dietary energy density drive robust, segment-specific intestinal remodeling. Voluntary wheel running in ad-libitum chow fed mice, induced elongation of the small intestine and colon, alongside pronounced, region-specific, transcriptional changes in the proximal, mid, and distal small intestine, particularly within immune and stress-related pathways. Caloric dilution diet also increased intestinal length in mice but elicited transcriptional adaptations, prominently in the proximal small intestine, directly linking energy density and intake to structural and molecular plasticity. In contrast, voluntary wheel running in control-fed and caloric-diluted-fed mice subtly modulated immune-associated gene expression, highlighting that diet and physical activity induce complementary and mechanistically distinct effects on the gut. We further identified an exercise-induced state of intestinal preconditioning. Upon refeeding, sedentary mice mounted robust, segment-specific activation of apoptotic, proliferative, and immune pathways. Similarly, acute treadmill exercise acted as a transient intestinal stressor in sedentary animals by shortening the length of the small intestine and rapidly activating epithelial stress, apoptosis, proliferation, and immune signaling. However, these responses were attenuated in chronically active mice despite higher basal expression of key genes, consistent with adaptive epithelial remodeling. The results suggest that habitual physical activity buffers acute nutritional stress and restrains excessive intestinal immune activation. Finally, translational plasma analyses in humans demonstrate that acute moderate-intensity exercise increases circulating markers of monocyte activation and epithelial stress, including CD14, IL-32, Reg-3-alpha and I-FABP, in both lean and obese individuals. Collectively, these findings suggest that the intestine plays a role as a metabolic organ that integrates energy-sensing signals from diet composition and physical activity.

Adaptive thermogenesis requires coordinated activation of mitochondrial oxidation and metabolic remodeling, yet the signals driving this coordination are incompletely understood. Here, we show that cold exposure and {beta}3-adrenergic receptor ({beta}3-AR) stimulation upregulate the high-affinity copper (Cu) importer CTR1 and promote Cu accumulation in thermogenic adipose tissues. Adipocyte-specific Ctr1 knockout (ACKO) mice exhibit markedly reduced energy expenditure and develop severe hypothermia during acute cold challenge. Proteomic analysis of brown adipose tissue (BAT) from ACKO mice reveals coordinated suppression of oxidative phosphorylation and thermogenic metabolic programs, accompanied by attenuation of lipolytic pathways. Cu deficiency also impairs cold- and {beta}3-AR-induced lipolytic activation, including reduced HSL phosphorylation and lipid clearance in both BAT and inguinal white adipose tissue (iWAT). Although BAT-specific Ctr1 deletion (BCKO) leaves acute {beta}3-adrenergic responses largely intact, these mice still exhibit cold intolerance, indicating that BAT Cu homeostasis is indispensable for sustaining thermogenic capacity during cold challenge. Treatment with the Cu ionophore elesclomol partially restores mitochondrial oxidative capacity and improves cold tolerance in ACKO mice. Together, these findings identify CTR1-dependent Cu import as a dynamically regulated component of the {beta}3-adrenergic thermogenic program and establish intracellular Cu availability as a key determinant of thermogenic capacity during adaptive thermogenesis.

Immune elimination of chronic infection or cancer requires cytotoxic CD8+ T cells that adopt and maintain an effector phenotype. Cytotoxic T cell function is a bioenergetically demanding process and T cells subjected to chronic antigen exposure have compromised effector function despite high rates of glycolysis. Here we report the ability of the short-chain -hydroxy acid, D--hydroxybutyrate, to act as a signaling molecule that increases mitochondrial ATP production and drives the conversion of proliferating T cells into cytotoxic effector cells. DAHB signaling switches ATP production from glycolysis to oxidative phosphorylation supported by fatty acid oxidation, even in glucose-replete media. This conversion suppresses both AMPK phosphorylation and the integrated stress response (ISR) in activated T cells while significantly elevating the level of the phosphagen, phosphocreatine (PCr). Both the PCr bioenergetic reserve and oxidative phosphorylation were required for T cell effector differentiation. DAHB-induction of CD8-effector gene transcription was coupled to bioenergetics by enhanced ATP-dependent remodeling of chromatin accessibility at effector gene loci. DAHB enhanced CD8+ T cell antitumor activity both in vitro and in vivo, and DAHB treatment of transferred T cells led to persistent in vivo antitumor effects. Together, these findings link cellular bioenergetics to the regulation of chromatin accessibility and gene expression required to support effector function.

Semaglutide is often optimized for weight loss, but whether longer-term cardiovascular benefit tracks achieved weight loss or therapeutic exposure levels remains unclear. Using a federated deidentified U.S. electronic health record network of 29 million patients, including 505,874 semaglutide-treated individuals, we leveraged multimodal AI technologies to analyze 47,199 patients with baseline cardiovascular disease. We quantified dose escalation and weight change during the 0-2-year period after semaglutide initiation (landmark period) and assessed cardiovascular outcomes during the 2-4-year period (post-landmark). In propensity-matched comparisons during the landmark period, semaglutide was associated with lower cardiovascular events than metformin, DPP-4 and SGLT2 inhibitors. Higher maximum semaglutide dose was associated with greater weight loss during the landmark period (3.15% additional weight loss per 1 mg increase; r=0.97, P<0.001), and lower post-landmark risk of all-cause mortality (RR 0.42, p<0.001), composite cardiovascular events (death, myocardial infarction, or stroke; RR 0.51, p<0.001), cerebrovascular disease (RR 0.50, p<0.001), heart failure (RR 0.55, p<0.001), and valvular/rheumatic heart disease (RR 0.71, p=0.025). In contrast, greater achieved weight loss during the landmark period did not show a consistent monotonic association with lower post-landmark cardiovascular risk (All-cause mortality p-value=0.14, composite cardiovascular endpoint p-value=0.55). Integrating insights from a single cell GLP1R expression atlas was used to infer how semaglutide pharmacology may tie into heart-specific signaling, beyond what is reflected by body-weight reduction alone. The strongest prevalence-weighted GLP1R signal was observed in the pancreas, followed by the heart, where GLP1R engagement potential (GEP) was considerable across cardiomyocyte, cardiac endothelial, and rarer immune cell populations. Together, semaglutide cardiovascular benefit appears organized more by maximum dose attained than by achieved weight-loss magnitude, setting the stage for beyond-obesity trial designs that integrate whole-body spatial intelligence.

Type 2 diabetes (T2D) and cardiovascular disease are major global health burdens. Branched-chain amino acid (BCAA) metabolism has been implicated as a potential therapeutic target, but it remains unclear whether its associations with disease risk are independent of traditional risk factors such as obesity and dyslipidemia. We leveraged genomic structural equation modeling of large-scale genome-wide association studies (GWAS) from European and East Asian populations, including the largest East Asian GWAS of BCAA levels (n = 42,826). We identified a genetic factor influencing BCAA metabolism independently of body mass index and circulating lipid levels. A cross-population polygenic score derived from this factor was associated with hemoglobin A1c, blood glucose, and the onset of both T2D and coronary artery disease. These findings provide the first genetic insight in humans that BCAA metabolism is involved in T2D and CAD beyond traditional risk factors, highlighting its clinical relevance and therapeutic potential.

Cells maintain metabolite homeostasis (metabolostasis) by buffering fluctuations in metabolite levels, yet the limits of this buffering and the mechanisms underlying metabolic toxicity remain poorly understood. To study this, we systematically overfed metabolites in Saccharomyces cerevisiae and quantified associations with growth inhibition, intracellular aggregation, and multiomic perturbations. We identify metabolite-specific failure thresholds at which amyloid-like aggregates are observed, with graded growth inhibition detectable at sub-threshold concentrations, suggesting toxicity mechanisms beyond transporter saturation. Metabolites with higher network influence and broader pathway participation are associated with higher failure thresholds and smaller pathway disturbances. These patterns are associated with chemical properties and solubility: more soluble metabolites, while broadly tolerated, are associated with localised aggregates at their failure thresholds, whereas less soluble metabolites are associated with larger systemic pathway disruptions. Multiomic integration identifies a two-tiered translational regulatory architecture characterising cellular resilience to metabolic overfeeding. General resilience is associated with transcriptional commitment to resource conservation via attenuation of anabolic pathways. Metabolite-specific defense is characterised by high-magnitude translational regulatory events; for example, engagement of aromatic catabolism under phenylalanine overfeeding and energetic control pathways under glycine overfeeding. Together, our results operationally define metabolostasis as a cellular system associated with constraint of metabolite concentrations, coordination of network and pathway-level regulation, and buffering against amyloid-like aggregation, highlighting how network topology, pathway architecture, and chemical properties are associated with metabolic resilience and toxicity thresholds.

Chemoresistance is the leading cause of poor prognosis in triple-negative breast cancer (TNBC), yet the underlying mechanisms remain unknown. To reveal metabolic drivers of de novo chemoresistance in TNBC, we analyzed pretreatment primary tumor biopsies, employing quantitative proteomics and metabolomics. Chemoresistant TNBCs exhibit hallmarks of oxidative phosphorylation (OXPHOS) and altered nucleotide metabolism linked to overexpression of the mitochondrial sirtuin, SIRT5. Through gain- and loss-of-function studies and stable isotope tracing, we demonstrate that SIRT5 induces a coordinated metabolic switch that redirects glycolysis to the pentose phosphate pathway, thereby augmenting nucleotide pools, while enhancing glutaminolysis to support OXPHOS. Mechanistically, SIRT5 enhances conversion of 6-phospho-D-gluconate to ribulose-5-phosphate through demalonylation of 6-phosphogluconate dehydrogenase (6-PGD), and coordinately activates oncogenic c-MYC to promote glutamine utilization and dependence. Concurrently, SIRT5-induced nucleotide deregulation induces replication stress and hypersensitivity to ATR checkpoint activation, and ATR inhibition synergistically reverses chemoresistance in TNBC. Thus, elevated SIRT5 orchestrates a coordinated metabolic switch to expand nucleotide pools and drive chemoresistance, while producing ATR checkpoint dependence that represents a metabolic vulnerability of SIRT5-overexpressing TNBC. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=182 HEIGHT=200 SRC="FIGDIR/small/716852v1_ufig1.gif" ALT="Figure 1"> View larger version (45K): org.highwire.dtl.DTLVardef@1c7a27corg.highwire.dtl.DTLVardef@17cb22borg.highwire.dtl.DTLVardef@1956670org.highwire.dtl.DTLVardef@1786dee_HPS_FORMAT_FIGEXP M_FIG C_FIG

While cold exposure drives lipid flux from adipose tissue to the liver, this enhanced inter-organ crosstalk does not result in sustained hepatic steatosis during prolonged acclimation, indicating that factors beyond lipid flux shape metabolic outcome. To interrogate this adaptation, we performed integrated lipidomic and metabolic profiling across tissues and circulating lipoproteins over the course of cold acclimation. We showed that cold acclimation induces systemic reprogramming of lipid quality in mice, characterized by enrichment of n-3 highly unsaturated fatty acids (HUFAs) as a consequence of upregulation of fatty acid desaturases (FADS1 and 2) in the liver and white adipose tissue, thus increasing hepatic n-3/n-6 ratio. Cold-induced increase in n-3 HUFAs cause the suppression of SCD1-mediated desaturation, thus yielding a depletion of monounsaturated fatty acids (MUFAs) in the liver, along with the suppression of lipogenic markers. Notably, this high-HUFA/low-MUFA lipid signature is present in both hepatic free fatty acid and triglyceride pools, indicating that lipid remodeling occurs upstream of triglyceride synthesis. Lipidomic analysis revealed that the remodeled triglycerides are incorporated into very-low-density and intermediate density lipoproteins (VLDL and IDL), thereby propagating hepatic lipid reprogramming to the circulation. Thus, by selectively increasing endogenous n-3 HUFA availability, cold adaptation suppresses hepatic DNL and MUFA-driven triglyceride assembly, buffering lipid accumulation despite sustained fatty acid influx and reshaping systemic lipid distribution with potential cardiometabolic impact.

Metabolomics provides a direct readout of physiological state and is increasingly used in evolutionary and systems biology. In small organisms such as Drosophila melanogaster, metabolomic analyses typically require pooling individuals to obtain sufficient material, yet pool sizes vary widely across studies with little justification. How pooling and biological replication influence metabolome characterization and the detection of biological signal remains poorly understood. Here, we evaluate the effects of pool size and biological replication on metabolomic profiles and signal detection using two complementary experimental designs. In the first, we assess how pooling (5, 50, or 100 individuals) influences metabolomic structure and reproducibility in inbred and outbred populations. In the second, we test how pool size interacts with systematic variation in replicate number to affect detection of diet-associated metabolite changes under a high-sugar perturbation. Pool size strongly influenced metabolomic profiles, with samples pooled at five individuals consistently differing from larger pools, while profiles from 50 and 100 individuals were more similar. Larger pools improved reproducibility in a dataset-dependent manner. In the dietary experiment, smaller pool sizes substantially reduced sensitivity, leading to loss of true diet-associated metabolites without increasing false discoveries. Replicate downsampling further revealed that both pool size and biological replication jointly determine signal retention, with smaller pools accelerating the loss of detectable metabolites under reduced replication. Across all analyses, the ability to detect metabolite signals was strongly dependent on effect size and variability. Metabolites with larger and more stable effect estimates were consistently retained, whereas those with smaller or more variable effects were rapidly lost under reduced sampling. Linear mixed-effects modeling confirmed that detection probability is governed by a balance between biological signal strength and measurement variability, with pool size and replication jointly modulating this relationship. More broadly, our results demonstrate that metabolomic inference is governed by the interplay of signal, noise, and sampling design, with pool size and replication jointly shaping the detectability, stability, and interpretation of biological signals.

Brown adipose tissue (BAT) exhibits exceptional metabolic plasticity, rapidly increasing energy expenditure to sustain thermogenesis during cold exposure. This high metabolic activity imposes substantial demands on cellular systems, requiring robust adaptive mechanisms to maintain homeostasis and prevent cellular stress. Yet, the pathways that support and coordinate these adaptive responses in brown adipocytes remain incompletely understood. Here, we identify a cold-induced adaptive program in BAT characterized by the formation of endoplasmic reticulum-plasma membrane (ER-PM) contact sites and the activation of store-operated calcium entry (SOCE), which is essential for maintaining brown adipocyte health during thermogenic activation. Cold exposure enhances ER-PM contacts and upregulates the expression of STIM and Orai proteins, key mediators of SOCE. Loss of STIM in brown adipocytes disrupts intracellular Ca{superscript 2} homeostasis and induces aberrant aggregation of ER membranes. STIM deficiency also impairs cold-induced mitochondrial fission resulting in hyperfused mitochondria with reduced oxidative capacity, independently of UCP1 abundance. Importantly, mice lacking STIM in BAT exhibit impaired lipid oxidation, are cold intolerant and develop exacerbated peripheral insulin resistance when challenged with a high-fat diet. Together, these findings identify ER-PM remodeling and STIM-mediated SOCE as a central regulator that links organelle architecture to brown adipocyte function and contributes to whole-body metabolic homeostasis.

Early events in the lung that shape protective immune responses to M. tuberculosis (Mtb) infection are not well understood but are critical for developing better vaccines and immunomodulatory therapies for tuberculosis. Here, we used high-dimensional flow cytometry, single-cell transcriptomics, and untargeted metabolomics to define the early lung immune environment that precedes the development of protective versus pathogenic outcomes following aerosolized Mtb infection of mice. We show that Mtb induced sustained glycolysis in the lung while restricting oxidative phosphorylation (OXPHOS) and impairing mitochondria, in part through the Mtb serine protease Hip1, leading to low energy output and suboptimal macrophage-T cell interactions that promoted pathogenic immunity. However, robust induction of mitochondrial OXPHOS, amino acid metabolism, and fatty acid oxidation in the early lung resulted in high ATP output and enhanced innate-T cell signaling networks that stimulated protective immune responses. Moreover, we identified a novel mitochondrial immunometabolic lung signature associated with protective outcomes to Mtb infection in animal models and humans. Our studies identify induction of mitochondrial dysfunction as a mechanism employed by Mtb to manipulate lung immunometabolism to its benefit and reveal that maintenance of intact mitochondrial metabolism in the early lung is pivotal for generating protective outcomes to Mtb infection.

GLP-1 receptor agonists induce substantial weight loss, but the extent to which lean tissue and physical function are preserved in routine care remains poorly understood. Using an EHR-linked body-composition digital phenotyping pipeline with LLM-based extraction, we performed a large-scale longitudinal analysis of 670,422 first-episode GLP-1RA users, including 456,742 treated with semaglutide and 213,680 treated with tirzepatide. Among these, 7,965 individuals with paired pre- and post-initiation body-composition measurements were analyzed over 12 months. Tirzepatide was associated with greater relative lean body mass (LBM) loss than semaglutide at each measured time point, with excess LBM losses of 1.1%, 1.5%, 1.3% and 2% at 3, 6, 9 and 12 months, respectively. A Depletive GLP-1 metabotype, defined as >20% total body weight (TBW) loss with >5% LBM loss, was significantly more frequent with tirzepatide than semaglutide during the first year of therapy (10.3% versus 6.7%, p<0.001). By contrast, a Prime GLP-1 metabotype, defined as >10% TBW loss with <5% LBM loss, was numerically more frequent with semaglutide than tirzepatide, but not significantly so (12.3% versus 11.8%, p=0.66). Higher drug dose and longer exposure were associated with progressively greater LBM decline in both treatment groups (both p<0.001). Among 3,746 examined EHR phenotypes, baseline musculoskeletal pain emerged as the most significant correlate of greater LBM loss (BH-adjusted q<0.001): cervicalgia (semaglutide, -4.1 percentage points; tirzepatide, -14.3 percentage points) and knee pain (semaglutide, -4.8 percentage points; tirzepatide, -13.4 percentage points), consistent with mobility-limited patients being more vulnerable to lean-tissue depletion during incretin therapy. Analysis of EHR notes for on-treatment functional features showed reduced exercise tolerance was the strongest correlate of greater LBM loss, increasing by 7.2 and 11.1 percentage points in semaglutide- and tirzepatide-treated patients, respectively. An independent analysis of all available Single-cell RNA-seq data from human musculature showed broader GIPR+ cellular distribution than GLP1R+ cells across immune, stromal, vascular, and contractile compartments, providing plausible biological context for the greater LBM loss observed in routine care with tirzepatide (dual GLP1R-GIPR agonist) relative to semaglutide (GLP1R-specific agonist). In this observational study, greater weight-loss efficacy did not necessarily translate into more favorable body-composition outcomes, underscoring the need for clinical decision-making and trial designs that maximize each patient's likelihood of achieving a Prime GLP-1 metabotype.

Declines in nicotinamide adenine dinucleotide (NAD+) are linked to mitochondrial dysfunction, genomic instability, and metabolic stress that accompany aging and associated processes. While precursor-based approaches elevate systemic NAD, their clinical translation can be constrained by biosynthetic bottlenecks and first-pass metabolism. RENEWAL-NAD+ (ClinicalTrials.gov NCT07336836; retrospectively registered 01/04/2026) was a double-blind, randomized, placebo-controlled Phase 0/1b trial in healthy adults aged 45-75 years (60 randomized; primary analysis n=50) evaluating 5 days of oral LathMized NAD+ (LNAD+), a proprietary physiochemically modulated formulation designed to alter the supramolecular organization and solution behavior of NAD+ while preserving its native molecular structure. The primary endpoints were change in intracellular NAD (icNAD), measured in whole blood, and circulating NAD (cirNAD), measured in separated plasma, relative to baseline. At Day 6, icNAD increased by 53% versus placebo (p=5.48e-14; Hedges g=3.66), while cirNAD was unchanged (p=0.60), demonstrating compartment-selective intracellular NAD+ delivery. Plasma NAD catabolites increased substantially (1-methyl-nicotinamide, MeNAM p=5.39e-13; N1-methyl-2-pyridone-5-carboxamide, 2PY p=2.95e-16), consistent with engagement of downstream NAD metabolic flux. Exploratory analyses identified non-overlapping correlates for the two compartments (cirNAD tracking inflammatory and metabolic markers, icNAD tracking red blood cell indices and NAM). Treatment was very well tolerated: symptom incidence was comparable between groups (p=0.68), only one mild adverse event (nausea, Grade 1) occurred in the LNAD+ arm, and no secondary clinical laboratory, vital sign, wellbeing, or wearable-derived endpoint survived multiplicity correction. These data demonstrate rapid intracellular NAD augmentation after oral LNAD+ dosing with pharmacodynamic evidence of downstream metabolism, compartment-specific physiological signatures, and a favorable short-term safety profile.

Endurance (END) or resistance exercise (RE) training results in adaptations that give rise to distinct skeletal muscle phenotypes. Hallmarks of RE include increases in muscle fibre and muscle cross-sectional area and strength, whereas END increases mitochondrial content. Such distinct phenotypes arise from differential metabolic and mechanical signal transduction, transcriptional, and protein translation pathways, culminating in exercise mode-specific adaptations in the muscle proteome. However, little empirical data exist on the protein-specific dynamic responses underlying training-mode-specific adaptations in humans. Using a model of unilateral exercise combined with stable isotope labelling with deuterium oxide, we measured changes in synthesis and abundance from baseline and during early (week 1) and later (week 10) periods of adaptation to END and RE training in young healthy adults (n = 14; 8 female, 6 male; 20 {+/-} 1 y, 70 {+/-} 10 kg). We quantified changes in the abundance (n = 1146 proteins) and synthesis (n = 247 proteins) profiles of skeletal muscle across a 5-day pre-training baseline period and during early and later adaptation to RE and END. Abundance profiling revealed mode-specific proteome remodelling, whereby RE increased ribosomal and contractile protein networks, whereas END increased mitochondrial inner membrane proteins after 10 weeks of training. The protein-specific synthesis rates of 119 proteins showed training-induced differences (P < 0.1 and log2 fold change > 1), including subsets of structural proteins that responded differently to RE and END training modes. Notably, distinct Z-disc proteins, such as XIRP1 (RE-specific) and LDB3 (END-specific), exhibited mode-specific regulation despite sharing a similar subcellular localisation. We report, for the first time, that divergent phenotypic adaptations to RE and END extend beyond changes in bulk fraction-specific synthesis rates and are regulated by training-mode-specific adaptations in distinct protein subsets within similar subcellular protein locations.

The transcription coregulator OCA-B promotes CD4+ T cell memory recall responses and autoimmunity. OCA-B T cell deletion prevents spontaneous type-1 diabetes (T1D) onset in non-obese diabetic (NOD) mice and blunts T1D in a subset of more aggressive models. However, the role of OCA-B in diabetes induced by treatment with immune checkpoint inhibitors (ICIs), and the role of OCA-B in the control of tumors with and without ICI treatment, has not been studied. Here we show that islet and pancreatic lymph node T cells from T1D individuals express measurable POU2AF1 mRNA. Deletion of OCA-B in T cells fully insulates 8-week-old non-obese diabetic (NOD) mice against ICI-induced diabetes and partially protects 12-week-old mice. Salivary and lacrimal gland infiltration and inflammation were also reduced. Protection was associated with a block in the differentiation of progenitor exhausted CD8+ T cells (TPEX) into terminally exhausted CD8+ T cells (TEX). We show that OCA-B T cell loss preserves anti-tumor immune responses following PD-1 blockade in different tumors and mouse strains. These findings point to a potential therapeutic window in which pharmaceuticals targeting OCA-B could be used to block the emergence of both spontaneous and ICI-induced autoimmunity while sparing anti-tumor immunity. We develop first-in-class small molecule inhibitors of Oct1/OCA-B transcription complexes and show that administration into NOD mice also blocks diabetes emergence following PD-1 blockade. These results identify OCA-B as a promising therapeutic target for the prevention of autoimmunity and immune-related adverse events (irAEs).

Neurons and glial cells are biochemically coupled through the exchange of nutrients, but our knowledge of which metabolites are transferred between them remains limited due to technical challenges. Here, we introduce a strategy to label specific cell types with isotopic tracers so that metabolite transfer can be measured directly in the intact brain. By engineering neurons in mice to metabolize 13C-labeled cellobiose, a glucose dimer that wild-type cells cannot catabolize, we selectively track neuron-derived metabolites by using mass spectrometry-based metabolomics. Applying this approach enabled us to identify myo-inositol as a critical metabolite synthesized by neurons and transferred to oligodendrocyte progenitor cells (OPCs) via the SLC5A3 transporter. The transfer of myo-inositol from neurons to OPCs promotes OPC proliferation and differentiation by enhancing phosphatidylinositol synthesis and upregulating expression of myelin-associated genes. During demyelination, deficient nutrient transfer can be rescued by dietary supplementation of myo-inositol, which accelerates myelin repair. These findings establish a generalizable technology for tracing intercellular metabolite transfer in vivo and identify a previously unrecognized mechanism of myo-inositol transfer from neurons to glial cells in support of CNS regeneration, revealing a potential metabolic target for therapeutic intervention in neurodegenerative disease.