Cell Reports Medicine

The role of antigen-specific T cells responding to antigen is a topic of intense studies, and critical for mechanistic insight of diseases and development of therapeutic strategies. Methods for broad-scale detection of antigen-specific CD4 T cells are lacking, while such methods have demonstrated great value in exploring CD8 T cell response in health and disease. Furthermore, major histocompatibility complex II (MHCII) assays are technically challenging due to high HLA diversity, lower binding affinities, low frequencies of ex vivo antigen-specific CD4 T cells and several bottlenecks in production and peptide exchange of MHCII monomers. Here we use peptide-loaded MHCII (pMHCII) proteins multimerized on a barcode- and fluorophore-labelled dextran backbone to provide a method for the detection of peptide-specific CD4 T cells by using a large display of MHCII-associated peptides. We have established a protocol for MHCII production and peptide-exchange suitable for the generation of large libraries of peptide-MHCII complexes. We validate the use of such pMHCII complexes in the form of barcode-labelled MHCII multimers to detect antigen-specific CD4 T cells. We demonstrate that we can identify antigen specific CD4 T cells, using these DNA barcoded peptide-MHCII multimer. The multimer bound CD4 T cells were selected based on the fluorochrome signal, and the co-attached DNA barcodes were hereafter amplified and used to identify the peptide-MHCII response/binding. In cases where the peptide-specific CD4 T cells frequencies are very low, we expanded the cell population with peptide-pools and in the presence of IL2. The given CD4 T cell populations hereby reach a cell number allowing for the DNA-barcoded pMHCII multimers to detect responses otherwise missed out. Applying this technology, we utilized a panel of 150 peptides derived from human cytomegalo virus (CMV), Epstein barr virus (EBV), Influenza (Flu), SARS CoV 2 and SARS CoV1, Hepatitis B virus (HBV), and Hepatitis C virus (HCV) loaded onto HLA-DRB1*01:01 and DRB1*04:01 to screen peripheral blood mononuclear cells (PBMC). We assessed ex vivo responses in 16 participants with HCV infection, and successfully detected naturally occurring viral-specific CD4 T cells at frequencies as low as 0.004% of total CD4 T cells. The low-frequency responses, identified via the barcode screen, were rigorously validated using individual fluorophore-labelled tetramer staining after a peptide-driven expansion in 15 participants. Furthermore, we assessed the recognition of novel HCV epitopes in 11 additional participants. Through this, we identified a total of 12 distinct HCV epitopes, including 9 that have not been previously utilized in assays to detect CD4 T cells. Overall, this barcoded-multimer platform provides a powerful tool for the large-scale discovery of class II epitopes and the broad profiling of CD4 T cell specificities. This method will allow for in-depth analyses of immune interactions, provide a better understanding of the antigen-driven associations between CD4 and CD8 T cell responses, and help dissect the complexities of CD4 T cell protection in HCV infection.

The X-linked G-protein coupled receptor GPR174 is highly expressed in T and B lymphocytes and has immunoregulatory roles in mice, but its function in humans is unknown. We describe a cohort of six individuals who have function-disrupting variants in GPR174 and a clinical phenotype of lymphadenopathy and autoimmunity. Histological analysis of two patient lymph nodes revealed necrotizing lymphadenitis and lymphoproliferation resembling Kikuchi-Fujimoto disease. In-depth analysis of three patients and related carriers revealed overaccumulation of CD8 terminally differentiated effector memory cells re-expressing CD45RA (TEMRA). Patient cells and GPR174-deficient CD8 T cells generated from controls showed less repression of proliferation by the GPR174 ligand lysophosphatidylserine (lysoPS) and an effector-biased gene expression program. GPR174-deficient CD4 T cells were resistant to lysoPS-mediated suppression of IL2 production. In mice, chronic viral infection led to over-accumulation of GPR174-deficient effector CD8 T cells. We describe an inborn error of immunity associated with dysregulated lymphocyte responses that we propose predisposes to exaggerated lymphoproliferation and autoimmunity following viral infection.

Background: Ovarian cancer (OC) exhibits substantial heterogeneity in response to platinum-based chemotherapy, resulting in variable clinical outcomes and frequent recurrence. Current biomarkers, including serum CA-125 kinetics and BRCA mutational status, incompletely predict therapeutic response. We investigated whether patient-derived organoids (PDOs) could functionally stratify chemotherapy sensitivity and better reflect patient-specific clinical behaviour. Methods: Twenty patients with OC treated between January 2024 and May 2026 were included, from whom fourteen PDO lines were successfully established. Eight PDOs with robust low-passage expansion and comprehensive longitudinal follow-up underwent functional profiling against carboplatin, paclitaxel, olaparib, and doxorubicin. Drug responses were assessed using half-maximal inhibitory concentration (IC50) and area under the curve (AUC) analyses and integrated with radiological response, serum CA-125 kinetics, BRCA status, and progression-free survival (PFS). Results: Clinical outcomes varied considerably despite similar platinum-taxane regimens. Although post-treatment CA-125 reduction was associated with prolonged PFS, neither CA-125 kinetics nor BRCA mutational status consistently predicted therapeutic response. PDO-guided functional stratification segregated tumours into four clinically relevant platinum-taxane response phenotypes: dual-sensitive, platinum-sensitive/taxane-resistant, platinum-resistant/taxane-sensitive, and dual-resistant. These functional categories closely mirrored radiological response, CA-125 normalisation, and disease progression patterns. PDOs exhibiting low IC50 and AUC values were associated with durable clinical benefit, whereas resistant PDOs tracked with persistent disease and early recurrence. Conclusions: PDO-guided functional stratification captures clinically meaningful therapeutic heterogeneity in OC and complements conventional biomarkers by directly measuring tumour-specific drug susceptibility. Prospective integration of PDO testing may facilitate patient-specific therapeutic selection and support functional precision oncology approaches in ovarian cancer.

Glucocorticoids (GCs) remain the fastest-acting anti-inflammatory agents but are constrained by systemic exposure that suppresses the hypothalamic pituitary adrenal (HPA) axis, silences adaptive immunity, and drives chronic toxicities. Chronic inflammatory diseases are sustained by long-lived CD206+ macrophages containing immune-resistant pathogenic material not cleared physiologically. We developed 101-PGC-005 ('005), a macrophage-targeted type 1a dexamethasone prodrug engineered for low-affinity, recycling-compatible uptake via CD206, with intracellular release triggered by acidic endosomes. We evaluated '005 in mechanistic assays, pathogen-diverse preclinical models, three human pharmacokinetic (PK) studies, and an adaptive-design randomized Phase II/III trial in 309 hospitalized patients with moderate COVID-19. In two completed Phase I human studies, a first-in-human dose-escalation and repeated-dose study and a dedicated single/multiple-dose PK and safety study; '005 circulated as intact prodrug with rapid systemic clearance (Tmax ~0.5 h; terminal half-life ~1.9 h), with no measurable free dexamethasone after single dosing and only low, clinically non-significant free dexamethasone after repeated dosing, and intact prodrug recovered unchanged in urine. Morning cortisol and ACTH were preserved after 30 mg once daily for three consecutive days (1.5 times the intended therapeutic dose). A cerebrospinal fluid PK study is evaluating central-compartment penetration. In the Phase II/III trial, powered for non-inferiority, conducted across six sites in India under GCP with Ministry of Health approval and independent DSMB oversight; '005 (20 mg IV daily for 3 days) was superior to dexamethasone (6 mg IV daily for 3 -10 days) on the primary endpoint of time to > a 2-point improvement on the WHO ordinal scale (HR 2.31; 95% CI 1.83-2.93; p < 0.0001; median 3 vs. 4 days). '005 was also superior on viral clearance (HR 1.47; 95% CI 1.17-1.84; p = 0.0001), hospital discharge rate, SpO2; recovery, and fever resolution. Zero patients in the '005 arm received investigator-initiated corticosteroid supplementation despite protocol allowance. All 309 randomized patients completed the study (ITT = per-protocol). Safety profiles were equivalent (TEAEs 54.8% vs 54.5%; p = 0.958), with no Grade 3+ events, SAEs, deaths, or discontinuations in either arm. Mechanistically, '005 delivered dual benefit: acute debulking of inflammatory macrophages and selective depletion of chronically activated pathology-sustaining macrophages, while preserving CXCL10 antiviral signaling and physiologic HPA control. Critically, HPA preservation is not merely a safety feature, it is a core efficacy mechanism: by clearing the pathogenic macrophage burden that was overriding HPA regulation, '005 restores the conditions for endogenous cortisol to resume its pulsatile, demand-responsive anti-inflammatory role across all GR-expressing cells, lymphocytes, endothelial cells, neurons, and newly differentiated macrophages, that '005 itself cannot reach. These findings support regulatory-grade evidence for macrophage-targeted corticosteroid therapy and provide the foundation for further development across acute inflammatory indications (sepsis, viral pneumonia, cytokine-release syndromes) and chronic macrophage-driven diseases (atherosclerosis, metabolic steatohepatitis, neurodegeneration, tumor-associated macrophages).

Wilms tumor, i.e., nephroblastoma, is rare in adults and lacks standardized treatment, complicating clinical decision-making. Within the functional precision medicine study (DEDUCER), we profiled two spatially distinct tumor regions (T1 and T2) of an adult Wilms tumor patient using integrated histopathology, whole-exome sequencing, FFPE transcriptomics, and ex vivo drug screening of short-term cultured patient-derived cancer cells (PDCs) with 528 compounds. Genomic profiling revealed a truncal ASXL1 frameshift and shared F7, UBA1, COL21A1, and ATM variants alongside region-specific alterations: a TP53 mutation and broad copy-number (CN) gains in T1, versus ARID1A and KMT2D stop-gains in copy-neutral T2. Transcriptomics of tumor areas identified convergent activation of the G2/M checkpoint, E2F targets, and mitotic spindle programs across regions, consistent with high proliferation and partially comparable biomarker signatures to those observed in an open-source pediatric Wilms tumor dataset (n = 130). Functional assays uncovered distinct and shared drug vulnerabilities: although ATM alterations were present in both tumors, T1 PDCs showed selective sensitivity to topoisomerase I and BCL-2 inhibition in the context of an additional T1-specific TP53 alteration, while broader single-agent sensitivity and stronger drug synergies were observed in T2. Pathway-centric data integration indicated that differential gene expression and copy-number gains, rather than single mutations alone, better predicted ex vivo drug responses, revealing actionable shared dependencies despite pronounced spatial heterogeneity and establishing a translational framework for individualized management in this rare disease. HIGHLIGHTS- In the adult Wilms tumor, multi-region genomics revealed a truncal ASXL1 frameshift together with F7, UBA1, COL21A1 and ATM mutations across two tumor regions (T1 and T2), as well as region-specific alterations: TP53 mutation and widespread copy-number gains in T1, versus ARID1A and KMT2D stop-gains in copy-neutral T2, illustrating spatial heterogeneity. - Transcriptomics showed convergent activation of E2F targets, G2/M checkpoint, and mitotic spindle programs in both regions, consistent with high proliferation and aligning with Wilms tumor signatures (TARGET dataset); these pathways were associated with higher ex vivo drug sensitivity scores. - Functional drug sensitivity testing of patient -derived cancer cells ex vivo uncovered distinct and shared vulnerabilities: Although both tumors shared an ATM mutation, T1-specific TP53 alteration and death-pathway/stress-response alterations may underlie selective sensitivity to topoisomerase I inhibitors and BCL-2 inhibition. - Clinically relevant combinations, including vincristine plus dactinomycin and doxorubicin plus dactinomycin, showed ex vivo synergy. These findings are consistent with the patients more than five-year relapse-free outcome following vincristine, doxorubicin, and dactinomycin treatment combined with surgery, supporting the translational relevance of the ex vivo drug testing approach. - Pathway-centric integration (copy-number gains and differential expression) predicted drug response better than single-gene biomarkers. Overall, pathway-level dependencies provide robust, actionable targets despite genomic and phenotypic heterogeneity in adult Wilms tumor.

Background. Plasma and serum metabolomic studies of myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) have repeatedly implicated hypometabolic, lipid, mitochondrial, redox and tryptophan-kynurenine pathways, but prior cohorts have been modest in size and have used heterogeneous case definitions. Whether similar pathway-level signals are detectable at scale in dried blood spots (DBS), across questionnaire-derived fatigue constructs and across orthogonal LC gradients in the same individuals remains unresolved. Methods. We profiled DBS extracts from 1,784 community-cohort adults by reverse-phase LC-MS using paired 5 min and 15 min gradients. Six questionnaire-derived endpoints captured a pragmatic self-reported PEM-like phenotype, a DSQ-derived PEM-like construct, high or review clinical status, temporal fatigue state, comorbid fatigue and self-reported chronic fatigue. The locked primary endpoint for Phase 1 was pragmatic_fatigue_pem with 226 cases and 914 controls after excluding major metabolic comorbidity. We tested a biology-first panel comprising 22 literature-curated metabolites represented by four participant-level descriptors each, and evaluated three discovery extensions: a targeted m/z search of additional literature candidates, a hypothesis-free univariate screen across 4,553 5 min and 5,625 15 min consensus features, and pairwise z-difference ratios. Endpoint-specific Ridge classifiers were evaluated by five-fold out-of-fold AUC with bootstrap stability filtering. Cross-gradient agreement was assessed by per-metabolite AUC concordance between paired 5 min and 15 min profiles. Severity was modelled as an ordinal grade derived from the number of fatigue criteria met and chronic-fatigue-form status. Results. The biology-first DBS panel achieved out-of-fold AUC 0.81 for the pragmatic self-reported PEM-like endpoint (226 cases / 914 controls). The DSQ-derived PEM-like construct reached AUC 0.60 (57 cases / 201 controls) on the un-filtered set and AUC 0.778 (SD 0.013, twenty seeds) in a post-hoc signature-decomposition follow-up restricted to participants without a self-declared major-metabolic-history tag (29 cases / 230 controls); both are treated as construct-validity anchors rather than as provoked or clinically adjudicated PEM. An optimised operationalisation of the same construct (panel-self normalisation, restriction to non-comorbid participants and demographic covariates) reached AUC 0.71 (95 % CI 0.55 to 0.76), and an exploratory age-stratified signature decomposition suggested age-dependent pathway composition that requires confirmation given small per-stratum case counts. Stable contributors mapped to carnitine-shuttle, TCA-cycle, redox-thiol and tryptophan-kynurenine pathways. Cross-gradient analysis of 22 matched metabolites yielded Pearson r = 0.62 for signed univariate effects (p = 0.002; 68 % directional agreement). The metabolomic score increased with severity grade (Spearman rho = 0.45, p = 4 x 10^-91; median scores 0.24, 0.51 and 0.75 across grades 0, 1 and 2). Sensitivity analyses on the covariate-complete subset (n = 565; 138 cases / 427 controls) showed that the DBS signal was robust to adjustment for age, sex, BMI and medication burden (DBS-only AUC 0.76, DBS plus covariates 0.78, covariates only 0.64), and produced a metabolomic-specific lift of approximately 0.13 AUC over the strongest anti-leak declarative cross-form questionnaire baseline (AUC 0.63). DBS-only AUC was stable across sex, age and BMI subgroups, and a 1:4 nearest-neighbour matched analysis on age, sex and BMI yielded AUC 0.72 (95 % CI 0.67 to 0.77). The observed pattern supported pathway-level convergence with prior ME/CFS metabolomics literature, including carnitine shuttle, fatty-acid beta-oxidation, TCA cycle, redox-thiol, urea cycle, glycerophospholipid and tryptophan-kynurenine axes. In contrast, the hypothesis-free 15 min screen produced high-AUC features that mapped predominantly to environmental or technical signals, including pesticide, industrial-amine and mobile-phase artifact annotations; only one of eight top leads, a truncated oxidised phospholipid, was biologically plausible, and none had tandem-MS support. Conclusions. In this large community cohort, a literature-curated DBS metabolomic panel captured pathway-level biology associated with a questionnaire-derived PEM-like fatigue phenotype, showed directional concordance across LC gradients, scaled with symptom severity and remained robust to key demographic, anthropometric and anti-leak questionnaire baselines. The findings converge with several metabolic axes previously reported in ME/CFS plasma and serum studies, including carnitine-shuttle, TCA-cycle, redox-thiol, urea-cycle, glycerophospholipid and tryptophan-kynurenine pathways. They should not be interpreted as clinical validation of a diagnostic test, screening tool or objective provoked-PEM biomarker. Rather, they support at-home-compatible DBS metabolomics as a biologically grounded platform for future clinically adjudicated validation, decision-support development and longitudinal monitoring in fatigue and PEM-like syndromes. Because DBS contains cellular and plasma-derived components, matrix effects must be considered when comparing individual metabolites with venous plasma or serum studies, and hypothesis-free screening at this scale can preferentially surface exposome or technical variance unless molecular identification is enforced before biological interpretation.

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a major complication after CAR T cell therapy, but its underlying mechanisms remain poorly understood. We performed longitudinal immune profiling of paired whole blood and serum samples from patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL) treated with CD19 CAR T cells. At peak neurotoxicity, high-dimensional mass cytometry and serum proteomics identified the expansion of CD163 monocytes and immature CD10lowCD101low neutrophils correlated with elevated serum ST2 and IL-2RA concentrations. Integrative immune module analysis identified these features among the strongest predictors of ICANS severity. Independent single-cell transcriptomic profiling validated the emergence of immunoregulatory CD163 monocytes and identified CD177 as a biomarker of ICANS-associated immature neutrophils. Together, these findings reveal a coordinated myeloid inflammatory network associated with ICANS and nominate candidate biomarkers and therapeutic targets for improving the safety of CAR T cell therapy. Significance: We demonstrate that immunoregulatory CD163+ monocytes and immature, activated CD177hiCD10lowCD101low neutrophils emerge in patients with moderate to severe ICANS at peak toxicity following CD19 CAR T cell therapy. These findings identify an uncharacterized myeloid network potentially contributing towards ICANS pathogenesis.

Immunotherapy with Nocardia rubra cell wall skeleton (Nr-CWS) can clear human papillomavirus (HPV) and induce regression of cervical precancerous lesions, yet many patients do not respond. The cellular and molecular basis for this heterogeneous clinical outcome remains unknown. Using high-resolution spatial transcriptomics, we profiled squamous intraepithelial lesions (SIL) from patients stratified by their subsequent response to Nr-CWS therapy. We discovered that non-responders were characterized by an immunosuppressive epithelial phenotype, defined by aberrant expression of the pro-inflammatory alarmin S100A9 in squamous epithelial cells (SECs), which was associated with poorer overall survival in cervical cancer. Non-responding lesions were enriched in proliferative (MKI67+) and pro-angiogenic (VEGFA+) SEC subpopulations and spatially organized into a pro-tumorigenic cellular neighborhood (CN-10) overexpressing S100A9 and ANXA1. In contrast, responders exhibited protective glandular-cell-enriched neighborhoods (CN-13) and supportive spatial interactions between lymphatic endothelial cells and fibroblasts. The unfavorable microenvironment was further defined by an immunosuppressive cloak of VCAN+ stromal cells and CD163+ M2 macrophages encircling SECs. Thus, response to Nr-CWS is determined by a pre-existing spatial network of epithelial-stromal-immune interactions, providing a roadmap for patient stratification and rational combination therapies.

Colorectal cancer (CRC) screening remains limited by patient adherence and sub-optimal sensitivity for early-stage disease. While liquid biopsy has revolutionized cancer diagnostics, cfDNA-based methods often struggle with early-stage detection due to low analyte levels. Here, we present a robust cell-free RNA (cfRNA) platform for the early detection of CRC. Using a retrospective cohort of 255 healthy controls and 250 CRC patients, we implemented an optimized workflow featuring a RUVg-based normalization strategy to remove platelet-driven transcriptomic noise. We identified differentially expressed genes enriched in key CRC-associated biological pathways, including inflammation, EMT, and metabolic dysregulation. An XGBoost classifier trained on these features achieved a mean AUC of 0.92 in cross-validation and 0.89 in a validation cohort, demonstrating 67% sensitivity at 90% specificity. Notably, our platform showed particular efficacy in identifying early stage cancer (stage I and II), achieving 73.7% sensitivity at 90% specificity. These findings suggest that cfRNA profiling offers a powerful, non-invasive orthogonal approach to CRC screening, capable of overcoming the sensitivity limitations of DNA-based assays in early-stage disease.

Functional ex vivo assays using live tumor tissues have demonstrated strong predictive accuracy for response to immune checkpoint inhibitors (ICIs) but are not scalable, requiring manual processing of large resections collected at academic centers. Here, an ex vivo live tumor fragment (LTF) platform was developed using standard-of-care biopsies from 228 patients with suspected malignancy collected across prospective, multicenter observational trials and biobanks. Hierarchical clustering of ICI-mediated changes in cytokine production identified two groups: responders and nonresponders. A binary classifier (elive index) using 8 cytokines achieved an AUC of 0.99 for cluster prediction. elive index correctly predicted clinical benefit in 93% (26/28) of patients (P = 3.2x10-5) and accurately identified 83% (10/12) of objective responders. Critically, elive responders were identified among biomarker-negative patients, highlighting the platform as a scalable approach that complements existing companion diagnostics and expands the population of patients identified to benefit from ICI therapy.

Chronic infection with hepatitis B virus (HBV) is characterized by persistent expression of hepatitis B surface antigen (HBsAg), which is associated with profound immune tolerance. Although nucleos(t)ide analogue therapy effectively suppresses viral replication, it neither eliminates HBV nor reverses virus-specific immune dysfunction. Here, we report the results of two parallel first-in-human, dose-escalation studies evaluating a single infusion of mAb19-LS, a long-acting IgG1 monoclonal antibody targeting HBsAg, in individuals with chronic HBV infection receiving nucleos(t)ide analogue therapy. mAb19-LS was generally safe and well tolerated and induced a mean 11-fold increase in antigen clearance. The magnitude and duration of HBsAg suppression were dependent on both baseline antigen levels and mAb19-LS dose, with suppression maintained for more than 36 weeks in individuals receiving the highest dose. Reduction of circulating HBsAg was associated with uptake of HBsAg-IgG immune complexes by monocytes and dendritic cells and inflammatory reprogramming of these antigen-presenting cells. Notably, proliferation of both CD4+ and CD8+ T cells, as well as interferon-{gamma}; and TNF-; production in response to HBV antigens, were significantly increased 24 weeks after infusion. Together, these findings demonstrate that mAb19-LS is generally safe and effectively accelerates HBsAg clearance while activating antigen presenting cells and enhancing antiviral T cell responses.

BackgroundRenal cell carcinoma (RCC) is a highly heterogeneous disease in which distinct molecular subtypes exhibit characteristic genomic, metabolic, and microenvironmental features that influence therapeutic response. Substantial inter-patient variability exists within each subtype, resulting in markedly different clinical outcomes even among tumours of the same histological category. Proteomics provides a direct readout of tumour biology and pathway activity, complementing genomic information and enabling the identification of patient-specific actionable vulnerabilities. We applied a Total Protein Approach (TPA)-based prescriptomics framework that integrates absolute quantitative proteomics with curated drug-target knowledge to nominate patient-specific drug-repurposing options, positioned as coadjuvants to the prevailing standard of care. MethodsSeventeen human kidney tissue specimens, seven clear cell RCC (ccRCC), five papillary RCC (pRCC), and five normal adjacent tissues (NAT), were retrieved from the publicly available PRIDE repository (PXD023296) and reanalysed by TPA-based absolute quantification applied to previously acquired label-free LC-MS/MS data. Differential expression analysis between each tumour subtype and NAT identified subtype-specific upregulated proteins, wich were intersected with Therapeutic Target Database (TTD) to nominate FDA-approved drugs targeting dysregulated proteins as candidate repurposing strategies. ResultsccRCC and pRCC produced distinct proteome-wide upregulation profiles consistent with their known biological drivers. TPA index stratification nominated bempedoic acid (ACLY inhibitor) and tipiracil hydrochloride (TYMP inhibitor) as patient-stratified candidates for ccRCC, and auranofin (TXNRD1 inhibitor), bempedoic acid, and mipomersen (APOB-directed antisense oligonucleotide) for pRCC. ACLY was the only top-priority target shared across both subtypes, pointing to a candidate cross-subtype metabolic vulnerability. Secondary candidates emerged from protein-protein interaction network analysis in both subtypes.. ConclusionsThis study presents a quantitative proteomics framework for translating individual-patient proteomic dysregulation into coadjuvant drug-repurposing hypotheses across the principal RCC subtypes. By combining the TPA for absolute protein quantification with prescriptomics-guided drug-target mapping, we show that ccRCC and pRCC harbour distinct, individually stratifiable therapeutic vulnerabilities. These findings provide a proof-of-concept for proteomics-based treatment stratification in RCC and establish a scalable framework that, pending functional validation, could inform personalised therapeutic decision-making across RCC subtypes.

Melanoma is the deadliest form of skin cancer, and improved non-invasive approaches to monitor tumor burden and immune dynamics are needed. Although extracellular vesicles (EVs) are increasingly explored as cancer biomarkers, how distinct EV subpopulations reflect dynamic tumor states induced by immune pressure remains insufficiently understood. Using proteomic analyses, we identified the melanoma-associated antigens gp100 (PMEL) and GPNMB in EVs derived from B16F10 melanoma cells and incorporated them into sandwich enzyme-linked immunosorbent assays (ELISAs) that capture total EVs while selectively detecting gp100 and GPNMB EV subpopulations. We subsequently evaluated these EV populations in murine models of anti-tumor vaccination and in plasma samples from melanoma patients. In vivo, melanoma-associated EV subpopulations increased in the serum of tumor-bearing mice and were further augmented following antigen-specific anti-tumor vaccination, whereas total CD81 EVs accumulated more gradually. Notably, gp100 EV levels, but not GPNMB EVs, correlated with tumor-infiltrating lymphocyte densities across multiple time points and treatment conditions. In vitro, TNF/IFN{gamma} stimulation preferentially increased total CD81 EV release, whereas gp100 EVs were promoted by IL-1{beta} stimulation. In contrast, GPNMB EVs accumulated more gradually and broadly across inflammatory, hypoxic, and cytotoxic stress conditions. Together, these findings indicate that immune and stress signals differentially remodel melanoma-associated EV composition. The assay translated to humans, revealing elevated gp100 EV levels in the plasma of melanoma patients compared with healthy donors, whereas GPNMB EVs identified a subset of melanoma patients. We describe a clinically feasible approach that enables direct detection of melanoma-associated EV subpopulations from blood without prior EV isolation. Conceptually, our findings suggest that immune and stress signals dynamically shape circulating EV composition, generating distinct EV signatures that reflect tumor state.

Background and Aims: Fatigue is a prevalent and disabling symptom in inflammatory bowel disease (IBD), yet its underlying biological mechanisms remain poorly understood. We aimed to characterize fatigue-associated molecular signatures in IBD patients by integrating DNA methylation and mRNA expression analyses. Methods: Peripheral blood was collected from 40 patients with Crohn's disease (CD), 29 with ulcerative colitis (UC), and 10 healthy controls. Fatigue severity was assessed continuously using the Multidimensional Fatigue Inventory (MFI). Epigenome-wide DNA methylation profiling and mRNA sequencing were performed, identifying differentially methylated regions (DMRs) and differentially expressed genes (DEGs) for active and quiescent CD and UC, adjusting for age, sex, and smoking status. Pathway enrichment analysis was performed on genes with differential methylation and expression. Results: In active CD, more severe fatigue was associated with transcriptional suppression of immune and metabolic pathways (246 DMRs; 1,090 DEGs), versus upregulation of mitochondrial and metabolic processes in quiescent CD (200 DMRs; 1,619 DEGs). In active UC, fatigue was associated with anabolic pathway upregulation and epigenetic silencing of neuroactive pathways (6,927 DMRs; 343 DEGs; 56 concordant genes). Quiescent UC showed transcriptional changes without significant epigenetic pathway enrichment (1,710 DMRs; 3,224 DEGs). Healthy controls exhibited a distinct profile spanning metabolic, immune, and neuronal pathways (8,621 DMRs; 395 DEGs). Fatigue-associated signatures were largely non-overlapping across all five groups. Conclusions: Fatigue-associated molecular profiles differed substantially by disease subtype and activity state, highlighting the biological heterogeneity of IBD-related fatigue and laying the foundation for multi-omics approaches to identify biomarkers and potential therapeutic targets.

Background: The rising burden of metabolic dysfunction-associated steatotic liver disease (MASLD)-associated hepatocellular carcinoma (HCC) underscores the need for innovative therapeutic strategies. Methods: We integrated RNA-seq fusion detection, immunopeptidomics, and proteogenomics to systematically prioritize tumor-specific neoantigen candidates arising from gene fusions in MASLD-HCC. Results: We elucidated a landscape of private, clonally expressed fusions, and identified a previously unrecognized class of predicted phosphorylated fusion-neoepitopes. Cross-tumor proteomic analysis revealed that these phospho-motifs are present across malignancies, providing a broader context for their biological relevance. Importantly, fusion-positive tumors display immunosuppressive microenvironments, highlighting the need for future therapeutic strategies that combine fusion-targeted immunotherapy with approaches that overcome T-cell dysfunction. Conclusions: This study establishes a discovery pipeline and publicly available resource for fusion-derived phospho-neoepitopes in MASLD-HCC. The identified candidates provide a prioritized framework to guide and accelerate rigorous functional immunogenicity testing for future clinical validation.

Lung cancer is a highly heterogeneous disease and remains the leading cause of cancer-related mortality worldwide. While mouse models and patient-derived organoids have advanced our understanding of lung cancer, key interactions within the tumor microenvironment (TME) remain poorly characterized. We developed microtumor models from lung adenocarcinoma (LUAD) and small cell lung cancer (SCLC) using mouse and patient samples, including surgical resections and rapid autopsy specimens. Microtumors preserve structural, cellular, and molecular features of the native TME, enabling mechanistic studies of tumor progression ex vivo. Multi-omics analyses of LUAD microtumors revealed progression-associated changes, including increased epithelial-to-mesenchymal transition (EMT) and metabolic reprogramming toward fatty acid synthesis. Pharmacologic inhibition of fatty acid synthesis through ACC1/2 reduced proliferation in patient-derived microtumors, identifying a targetable vulnerability. This platform provides a robust system for studying tumor progression, therapeutic response, and resistance mechanisms in lung cancer, including culturing postmortem specimens that are not accessible in current models.

The COVID-19 pandemic has infected more than 778 million people worldwide. Roughly 7% of these patients progress to Long COVID (LC), suffering from persistent symptoms and cognitive impairment well past the acute stage. As the mechanisms of LC remain elusive, we utilized single-cell profiling (SCP) on 156,478 peripheral blood mononuclear cells (PBMCs) from 20 LC patients and 18 recovered controls (RC) to characterize the disease-associated immune dysregulation. Comparative analysis of LC and RC profiles revealed cellular heterogeneity along with differential abundances across B, T, and myeloid cell compartments. The focused analysis on the B-cell compartment showed that naive B cells in the LC exhibit elevated IL4R expression and BCR signaling, indicative of sustained antigen exposure and aberrant chronic activation. Concurrently, monocytes adopted heightened interferon signaling and enhanced migratory states, culminating into impaired myeloid differentiation. Furthermore, the T-cell compartment exhibited a functional dichotomy, maintaining sustained quiescence in the central memory compartment while displaying chronic exhaustion within effector memory populations. This dysregulation of effector immunity extended to the NK compartment, where terminally differentiated cells exhibited increased cytotoxicity yet compromised regulatory function, potentially contributing to poor viral clearance. Cellular communication analysis further supports this NK cell dysfunction that is likely driven by galectin and prostaglandin signaling involving monocytes and B cells. We stratified LC patients into mild and severe groups based on symptom and cognitive severity, identifying a distinct immune signature where severe disease is linked to chronic AP-1-mediated inflammation in NK cells and CD14+ monocytes. In contrast, patients with mild symptoms retain functionally competent NK cells with significantly lower exhaustion and apoptosis scores. Collectively, these insights into persistent immune remodeling provide a crucial framework for future biomarker discovery and the development of targeted therapeutic strategies. Abstract (Short)COVID-19 has affected >778 million worldwide, with [~]7% developing Long COVID (LC), characterized by persistent symptoms and cognitive impairment. The mechanisms of LC remain elusive; we utilized single-cell profiling on 156,478 peripheral blood mononuclear cells from LC and recovered controls. Comparative analysis revealed cellular heterogeneity and differential abundance across multiple immune compartments. B-cells exhibited hallmarks of sustained antigen exposure and aberrant activation. Concurrently, monocytes adopted heightened interferon signaling, enhanced migratory states, and impaired differentiation. T-cells exhibited chronic exhaustion within the effector memory populations. Dysregulated effector immunity extended to NK, with increased expression of cytotoxic genes yet compromised regulatory function, potentially contributing to viral clearance. LC patients with severe symptoms showed enhanced AP-1-mediated inflammation in NK cells and CD14+ monocytes, whereas mild cases had fitter NK cells with significantly lower exhaustion and apoptosis. Collectively, these insights provide a framework for biomarker discovery and the development of targeted LC therapeutic strategies.

Background & Aims: Immune-mediated liver injury from immune checkpoint inhibitors (ILICI) is a major immune-related adverse event that limits cancer immunotherapy, yet its tissue-level immunobiology is poorly defined and its management is largely extrapolated from autoimmune hepatitis (AIH). We previously identified a tri-cellular CD8+ T cell-macrophage-hepatocyte injury niche in a murine model of ILICI; here, we tested whether this niche is recapitulated in human disease. Methods: We applied imaging mass cytometry with a 32-marker panel to liver biopsies from patients with ILICI (n = 12), AIH as a disease comparator (n = 14), and healthy controls (n = 2), profiling approximately 297,000 single cells across 144 regions of interest with spatially resolved detection of apoptosis (cleaved caspase-3, cC3) and pyroptosis (cleaved gasdermin D, cGSDMD). Results: We detected histiocyte-rich granulomas in ILICI consisting of macrophages and CD8+ T cells, including activated memory-effector subsets. Permutation-based spatial analysis identified CD8+ T cell-macrophage co-localization as the most frequent significant interaction in ILICI, organizing into integrated innate-adaptive cellular neighborhoods that concentrated cC3- and cGSDMD-positive cells. Descriptively, this contrasted with AIH, in which immune cells and stroma were more spatially compartmentalized. CD8+ T-cell and macrophage densities correlated with Ishak necroinflammation scores, jaundice, and granuloma formation. Conclusions: These findings provide the first single-cell spatial proteomic characterization of human ILICI in situ; they recapitulate the tri-cellular CD8-macrophage-hepatocyte niche we previously defined in a murine model and characterize ILICI as a spatially organized innate-adaptive inflammatory process, nominating myeloid signaling and CD8-macrophage interactions as candidate liver-directed targets to uncouple hepatotoxicity from anti-tumor immunity.

Immune checkpoint inhibitors (ICI) are central to the treatment of metastatic clear cell renal cell carcinoma (ccRCC), yet only a subset of patients derive durable benefit, and clinically deployable predictive biomarkers remain an unmet need. RNA-based T-effector signatures capture cytotoxic immune biology and have been associated with ICI response in clinical trial cohorts; however, their clinical implementation is limited by the marked spatial heterogeneity of ccRCC, as well as cost, long turnaround time, sample quality requirements, and limited accessibility. Here, we developed a visually interpretable deep learning (DL) model that predicts a T-cell-enriched immune score directly from hematoxylin and eosin (H&E)-stained whole-slide images. To overcome the inability of H&E morphology alone to distinguish lymphocyte subsets, we trained the model using multimodal spatial supervision from CD8, PAX8, and ERG IHC, which respectively identified cytotoxic T-cell-rich regions, tumor cells, and endothelial cells, thereby constraining immune predictions to relevant tumor microenvironmental niches. The resulting H&E DL Immune score was validated by pathologist review, comparison with held-out CD8 IHC annotations, and independent datasets. The H&E DL Immune score correlated with T-effector RNA scores across independent institutional and IMmotion150 clinical trial cohorts (spearman correlations of 0.726; p=5.90x10-15 and 0.706; p=4.04x10-19). As a proof of principle, the score was used to characterize associations with key biological features across large cohorts, including sarcomatoid differentiation, BAP1 and PBRM1 mutation status, and additional transcriptomic signatures. In IMmotion150 clinical trial cohort, a median-dichotomized H&E DL Immune score, similar to RNA-based T-effector score, was significantly associated with clinical benefit from atezulumab therapy. In contemporary institutional cohorts of patients treated with frontline ipilimumab plus nivolumab or in initial 3 lines of nivolumab monotherapy, patients in the top quartile of H&E DL Immune score had significantly longer progression-free survival. Collectively, these findings support a scalable and interpretable H&E-based biomarker that captures T-effector biology and can help identify patients with ccRCC more likely to benefit from ICIs.

Context. Teprotumumab (TEP) is an emerging treatment for thyroid eye disease (TED), but real-world evidence outside the United States remains limited, and detailed changes in orbital components have not been fully clarified. Objective. To evaluate the effectiveness of TEP based on clinical manifestations and magnetic resonance imaging (MRI) findings, and compare it with that of intravenous glucocorticoid (IVGC) therapy. Methods: The TEP cohort included all 18 patients who started TEP therapy at Kyoto University Hospital by July 31, 2025. A historical IVGC cohort included 20 patients matched to the TEP cohort. Results: During 24 weeks of TEP therapy, proptosis measured using a Hertel exophthalmometer improved from 22 (20-22) to 19 (16-21) mm (p = 0.025), and clinical activity score decreased from 4 (3-5) to 1 (0-1) point (p < 0.001). Among 15 patients with diplopia, a reduction of at least 1 point in Gorman score was observed in 9 patients (60.0%). Thyroid-stimulating antibody titers decreased from 1,180% (349-4,710) to 282% (132-504) (p = 0.013). MRI-based comparisons with the IVGC cohort showed that TEP reduced both extraocular muscle and orbital fat areas, whereas IVGC reduced extraocular muscle area but conversely increased orbital fat area. Inflamed extraocular muscles identified on MRI were enlarged at baseline and showed marked shrinkage after both therapies. Conclusion: TEP showed robust effectiveness in Japanese real-world patients with TED. MRI-based analyses revealed distinct effects of TEP and IVGC on orbital fat and identified inflamed extraocular muscles as treatment-responsive components.