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Journal of Extracellular Vesicles

Wiley

Preprints posted in the last 7 days, ranked by how well they match Journal of Extracellular Vesicles's content profile, based on 55 papers previously published here. The average preprint has a 0.05% match score for this journal, so anything above that is already an above-average fit.

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Small-scale bioreactor cultivation of HEK293-based suspension cells increases extracellular vesicle yield

Woud, W.; Dilla, E. B.; Dits, N.; Keijzer, T.; Bernal, C.; van Royen, M. E.; Martens-Uzunova, E. S.; de Vrij, J.

2026-07-15 bioengineering 10.64898/2026.07.14.738239 medRxiv
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PurposeExtracellular vesicles (EVs) are increasingly explored as natural vehicles for drug delivery and gene therapy approaches. However, reproducible yield and scalability of EV production still pose major challenges in the clinical translation of EV-based therapies. In this study, we sought to quantify and characterize EVs released by suspension-cultured HEK293 cells (Expi293F cells) grown in shaker flasks or small-scale bioreactors, to investigate how the culturing environment affects EV production yield. MethodsExpi293F cells were cultivated (N=3) in either shaker flasks or a bioreactor system, and total cell density, viability, and size were monitored. Supernatants were drawn daily post-cell seeding and were analyzed for EV quantity, size, morphology, and CD63 expression. ResultsNo significant differences were observed in terms of total cell density, viability, and cell size between both cultivation settings. However, cultivation of Expi293F cells in the bioreactor environment significantly increased EV yield by 3-fold compared to shaker flask cultivation (p < 0.01). Other parameters such as average nanoparticle size, EV morphology, and CD63 expression remained comparable between both cultivation methods. ConclusionThese results demonstrate that Expi293F-derived EV yield can be increased by culturing cells in a scalable bioreactor system. These findings pave the way towards the production of therapeutic-based EVs in a scalable and reproducible manner suitable for future (pre-)clinical applications.

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Single-cell gene networks nominate IKZF1 as an Alzheimer's microglial regulator

Ozkurt, C.

2026-07-15 bioinformatics 10.64898/2026.07.14.738463 medRxiv
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BackgroundMicroglia drive neuroinflammation in Alzheimers disease (AD), yet no approved therapy targets this compartment. Human genome-wide association studies consistently implicate innate immune loci in AD risk, establishing microglial transcriptional programs as therapeutically relevant but pharmacologically underexploited targets. ObjectiveWe sought to identify transcription factors (TFs) governing microglial state transitions computationally and to nominate structurally tractable drug repurposing candidates. MethodsWe applied trajectory inference (PAGA), pseudobulk DESeq2, pySCENIC gene regulatory network (GRN) inference, CellChat, and virtual screening of 1,962 approved compounds to 236,002 microglial nuclei from 84 donors (SEA-AD atlas). ResultsIKZF1 was the sole target TF retained under cisTarget v10 motif constraints, with peak regulon activity in LateAD-DAM (pseudotime {rho} = +0.309) and replication in an independent bulk cohort (GSE95587; adjusted P value =.004). CellChat identified SLIT2[-&gt;]ROBO2 from multiple neuron subtypes (predominantly inhibitory interneurons) as the top predicted pathway to microglia. Tafamidis ([-&gt;]IRF8) and diflunisal ([-&gt;]PPARG) were top virtual screening hits; all evaluated compounds failed the pre-specified selectivity threshold. ConclusionsIKZF1 is prioritised as a candidate late-disease microglial TF, supported by six convergent evidence dimensions including independent bulk replication. Tafamidis and diflunisal are low-confidence repurposing hypotheses requiring experimental validation.

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High-Density Wild-Type IL-2 Nanoparticles Preferentially Enhance CD8⁺ T-Cell Expansion and Reprogram the Tumor Microenvironment

Wang, R.; Kumar, P.; Crumrine, N. A.; Watcharawittayakul, T.; Wallstrum, A.; Reda, M.; Mills, G. B.; Ngamcherdtrakul, W.; Yantasee, W.

2026-07-15 bioengineering 10.64898/2026.07.14.738558 medRxiv
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Low response rates to immune checkpoint inhibitors (ICIs) in solid tumors are often driven by insufficient tumor-infiltrating CD8 T cells and immunosuppressive tumor microenvironment (TME). Although interleukin-2 (IL-2) potently expands and activates CD8 T cells, its clinical use is limited by rapid clearance, dose-limiting toxicity, and regulatory T cell (Treg) stimulation. Engineered IL-2 variants have not yet achieved meaningful clinical efficacy. Here, polymer-modified mesoporous silica nanoparticles displaying dense, unmodified wild-type IL-2 on their surface (IL2-NP) are developed, conferring proteolytic stability and tumor retention. IL2-NP enables avidity-mediated CD8 T cell binding and enhances proliferation and effector function without increased Treg binding or proliferation. Intratumoral IL2-NP expands CD8 T cells, increases CD8/Treg ratios, and reprograms TME through dendritic cell activation and M1-like macrophage polarization. IL2-NP induces regression of both treated and untreated distant colorectal tumors in a CD8 T cell-dependent manner. IL2-NP synergizes with ICIs and leads to complete tumor regression and immunological memory that protect against rechallenge. Treatment is well tolerated, with strong efficacy also observed in triple-negative breast and metastatic ovarian cancer models. Overall, intratumoral IL2-NP elicits robust systemic antitumor immunity, offering a promising strategy to enhance ICIs, cancer vaccines, and adoptive T-cell therapies. Graphical abstractThis work introduces a nanoparticle platform that overcomes major shortcomings of IL-2 immunotherapy by presenting wild-type IL-2 at high density on the nanoparticle surface, thereby increasing binding avidity to effector T cells. The resulting IL-2 nanoparticles enhance cytotoxic T cell expansion, reprogram the tumor microenvironment, and augment responses to immune checkpoint blockade to achieve robust ant-tumor immune response in mouse tumor models. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=182 SRC="FIGDIR/small/738558v1_ufig1.gif" ALT="Figure 1"> View larger version (82K): org.highwire.dtl.DTLVardef@12f8c8corg.highwire.dtl.DTLVardef@b46b1forg.highwire.dtl.DTLVardef@e4efc5org.highwire.dtl.DTLVardef@3993e6_HPS_FORMAT_FIGEXP M_FIG C_FIG

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Integrative computational toxicology reveals PFOS and PFHxS associated inflammatory keratinocyte niches in psoriasis through exposure transcriptomics, single-cell spatial mapping and token-aware virtual perturbation

Ma, J.; Yu, Q.

2026-07-15 bioinformatics 10.64898/2026.07.09.737426 medRxiv
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Per- and polyfluoroalkyl substances (PFAS) are persistent toxicants with immunological, metabolic and epithelial effects, but their relevance to inflammatory skin disease remains unclear. We developed a computational toxicology framework to test whether perfluoroalkyl sulfonate programs, especially perfluorooctanesulfonic acid (PFOS) and perfluorohexanesulfonic acid (PFHxS), converge with psoriasis-associated keratinocyte inflammation. Exposure transcriptomes were derived from GSE236956, in which human embryonic stem cell-derived epithelial-lineage models were exposed to 10 M PFAS for 8-16 days. Six PFAS were prioritized using descriptors, Tanimoto similarity, toxicology evidence, adverse outcome pathway (AOP)-like key events, exposure differentially expressed gene burden and read-across support. PFAS signatures were integrated with psoriasis bulk transcriptomes, single-cell RNA sequencing, keratinocyte-state mapping, regulator and communication inference, spatial transcriptomics and token-aware Geneformer-compatible virtual perturbation. PFOS ranked highest in integrated prioritization, followed by PFHxS and perfluorooctanoic acid. PFHxS produced a smaller but directionally informative signature within a PFOS-dominant perfluoroalkyl sulfonate footprint. The shared PFOS and PFHxS program converged with psoriasis through inflammatory keratinocyte, epidermal-stress, cytoskeletal and lipid-related modules. Single-cell and spatial analyses localized the program to activated keratinocytes and inflammatory epidermal niches, with strong spatial co-localization with inflammatory keratinocyte and epidermal stress scores. Virtual perturbation prioritized S100A9, S100A8, KRT16, IL36G, CCL20, CXCL8, FABP5, KRT17, FOS, JUN and NFKBIZ as candidate effectors. These findings support an exposure-informed, experimentally testable hypothesis linking persistent perfluoroalkyl sulfonate programs to keratinocyte inflammatory niches in psoriasis.

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Longitudinal multiomic network rewiring at the complement coagulation interface in post-acute sequelae of COVID 19 (PASC)

Ward, B.; Belkhir, L.; Balligand, J.-L.; Cani, P. D.; De Greef, J.; Dewulf, J. P.; Gatto, L.; Haufroid, V.; Kabamba, B.; Vertommen, D.; Yombi, J. C.; Elens, L.; Bommer, G.; Bamps, L.

2026-07-16 infectious diseases 10.64898/2026.07.14.26358048 medRxiv
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Background. Post acute sequelae of COVID 19 (PASC) is clinically heterogeneous and mechanistically unresolved, and single-analyte studies have struggled to explain it. Methods. We profiled matched plasma proteomics, metabolomics and whole-blood transcriptomics at acute infection and convalescence (mean 86 days later) in a Belgian cohort, using linear mixed models, multiomic gene-set enrichment, and a degree-matched differential-correlation approach to quantify how each node's interactions were rewired between patients who developed PASC and those who recovered; seven axis proteins were additionally quantified by multiplex immunoassay as orthogonal validation. Findings. Single omic testing yielded few FDR significant features, yet multi-omic enrichment showed sustained complement cascade involvement from acute illness to follow-up in PASC. Correlation networks re-organised topologically toward C3 and lost the immunoglobulin V gene coexpression seen in recovery. The most rewired nodes, heparin cofactor II (SERPIND1), alpha 1 antitrypsin (SERPINA1), complement factor H related 5 (CFHR5), prothrombin/thrombin (F2) and immunoglobulin V gene transcripts (notably IGLV3 21), changed in their co-expression structure rather than in abundance. In multiplex validation, acute CRP was elevated in patients who developed PASC (FDR = 0.012), whereas the directly measured abundances of the network-nominated proteins were unchanged. Interpretation. These trajectory aware, cross omic networks nominate a thrombo inflammatory axis in which complement and coagulation regulation remain dysregulated in PASC at the level of wiring rather than abundance, providing a systems framework for validation and for exploring interventions at the complement coagulation platelet interface.

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Safety Transparency in Animal Cell-Cultured Ingredients for Pet Food: A Case Study Establishing the Standard for Public Disclosure

Tewari, R.; Soukup, R.; Hadjistylianou, L.; Manicone, M.; Serra, M.; Felbermair, M.; Falconer, S.

2026-07-15 cell biology 10.64898/2026.07.14.738473 medRxiv
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Animal cell-cultured ingredients are entering the EU and UK pet food markets under frameworks that do not require pre-market, ingredient-level safety assessments, creating an ethical need for transparent safety disclosure. We present the first public safety dossier for this sector, describing the proprietary mouse embryonic stem cell line PE25 and its derived, non-viable cellular and conditioned media ingredient produced in food and feed-grade media. PE25 characterization confirmed Mus musculus identity, sterility, absence of mycoplasma and replication-competent retroviruses, and stable growth. Doxorubicin-induced p53 stress testing, CD44/BMI1 profiling, and soft agar assays showed no cancer-like traits and a non-tumorigenic profile; the final ingredient contains no viable cells. Independent OECD TG 471 and 487 assays confirmed non-genotoxicity. Heavy metals, biogenic amines, solvents, and chemical residues were below regulatory limits. Given process variability, we recommend case-by-case safety evaluation and propose this dossier as a model for responsible commercialization.

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Bovine AAV - a promising vector for pulmonary gene therapy

Ivan, D. C.; Dubost, V.; Israel, L.; Weinmann, J.; Ungan, D.; Carbonetti, N.; Stuber, N.; Jivkov, M.; Erard, E.; Biglieri, E.; De Girardi, F.; Mittermeier, S.; Syed, M.; Tigani, B.; Ouali-Alami, N.; Dreessen, K.; Deniston, C.; Sankar, K.; Bollepalli, L.; Cornacchione, V.; Traggiai, E.; Brees, D.; Karle, A.; Carballido, J. M.; Cirillo, A.

2026-07-15 molecular biology 10.64898/2026.07.14.738418 medRxiv
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Efficient systemic delivery to the lung remains a major barrier for adeno-associated virus (AAV)-mediated pulmonary gene therapy, particularly when pre-existing immunity limits the use of conventional capsids. Here, we evaluated Bovine AAV, a phylogenetically divergent capsid, as candidate vector for lung-directed gene transfer. In adult C57BL/6J mice, intravenous delivery of Bovine AAV resulted in robust and preferential lung transduction comparable to AAV4, with predominant targeting of alveolar type I pneumocytes and pulmonary endothelial cells. In primary human lung-resident cells, Bovine AAV was particularly effective in microvascular endothelial cells, a target poorly transduced by AAV4 in vitro. Bovine AAV demonstrated scalable production with yield, purification performance, capsid quality, and genome integrity comparable to AAV9. In sera from healthy adults from the United States and Switzerland, Bovine AAV showed intermediate neutralization frequencies, lower than AAV2 and AAV4 but higher than AAV5 and AAV9. Of relevance, Bovine AAV maintained in vivo transduction efficiency in mice previously immunized with a pool of human and non-human primate-derived AAV capsids, including AAV4. Together, these results position Bovine AAV as a promising lung-tropic and immune-distinct vector for pulmonary gene therapy, with particular relevance for applications requiring systemic delivery in the presence of pre-existing immunity to conventional serotypes.

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Effects of acute intranasal allergen exposure on resident immune cells and sensory neurons in the mouse olfactory epithelium

Owens, R. E.; Matthews, B. E.; Mastrangelo, M. A.; Meeks, J. P.; Rowe, R. K.

2026-07-15 neuroscience 10.64898/2026.07.09.737488 medRxiv
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The main olfactory epithelium (MOE) is the primary site of olfaction and consists of multiple cell types including olfactory sensory neurons (OSNs), sustentacular cells, and immune cells. Neuroimmune interactions in epithelial tissues are critical in maintaining tissue function, but how OSNs and immune cells interact in the MOE in healthy and diseased states is largely unknown. Cellular responses in the MOE determine how and whether OSNs maintain olfactory function and are repaired or replenished following inflammatory environmental exposures. We hypothesized that acute nasal aeroallergen exposure alters immune cell function in the MOE to elicit a neuroprotective response, thereby preserving OSN function. We developed an environmental aeroallergen exposure consisting of one week of daily intranasal house dust mite extract (HDM) instillations. Spectral flow cytometry indicated only subtle changes in resident immune cells proportions and phenotypes in the MOE. Immunohistochemical evaluation did not reveal extensive changes in immune cell distribution in the sensory epithelium or lamina propria, but instead we observed increases in axonal olfactory marker protein (OMP) expression in the lamina propria, where resident immune cells are most abundant. To evaluate the effects of HDM exposure on OSN function, we performed live ex vivo Ca2+ imaging of MOEs from HDM- and sham-exposed transgenic mice using objective-coupled planar illumination (OCPI) microscopy. OSN responses to multiple odorants revealed increased chemosensory sensitivity and decreased across-trial adaptation in HDM-treated epithelia. These results indicate that short-term nasal aeroallergen exposure minimally alters immune cell phenotypes, and instead induces functional changes in OSN physiology that preserve olfactory function.

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Small-RNA Profiling Links 5'-tRNA Halves to Post-therapeutic Disease Persistence and Poor Patient Survival in Glioblastoma

Anam, M.; Schanel, T. L.; Dunlap, S.; Mohamed, M.; Ahn, E.-Y. E.; Willey, C. D.; Su, Z.

2026-07-15 cancer biology 10.64898/2026.07.14.738483 medRxiv
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Glioblastoma (GBM) is a highly lethal brain cancer with limited therapeutic durability, where the majority of patients develop recurrent or persistent disease after standard chemoradiotherapy. Meanwhile, tRNA-derived fragments (tRFs) have become increasingly relevant to cancer biology; however, their clinical relevance in GBM remains undefined. Here, we report that a specific family of tRFs, 5-tRNA halves (tiR5s) dominates the small RNA landscape of GBM patient tumors and associates with worse overall survival, post-therapeutic disease persistence, and pro-invasive proteogenomic pathways across two independent GBM patient cohorts. This association between elevated tiR5 levels and therapeutic resistance re-emerges in radiation-resistant GBM xenograft models. Our findings reveal that tiR5s are an underappreciated molecular feature of highly aggressive GBM tumors, supporting further investigation into their biological roles and prognostic utility in GBM. HighlightsO_LItiR5s are the predominant tRF family in primary GBM patient tumors C_LIO_LIElevated tiR5 expression distinguishes primary GBM tumors that develop persistent disease after first-line therapy C_LIO_LIRadiation-resistant GBM PDX models show elevated tiR5 expression C_LIO_LIElevated tiR5 expression associates with poor overall patient survival and pro-invasive molecular programs in GBM patient tumors C_LI Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/738483v1_ufig1.gif" ALT="Figure 1"> View larger version (54K): org.highwire.dtl.DTLVardef@184ddc1org.highwire.dtl.DTLVardef@1faadc2org.highwire.dtl.DTLVardef@a5ae02org.highwire.dtl.DTLVardef@1431506_HPS_FORMAT_FIGEXP M_FIG C_FIG

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Nuclear translocation of phosphorylated YB-1 via small extracellular vesicles contributes to the malignant phenotype of triple negative breast cancer

Santos, M.; Kim, Y.; Feng, Z.; Biebighauser, T.; Lorico, A.; Sossey-Alaoui, K.

2026-07-15 cancer biology 10.64898/2026.07.14.738446 medRxiv
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Despite continuous progress in diagnosis and therapy, breast carcinoma (BC) remains a major health problem. Triple-negative (Estrogen Receptor-/Progesterone Receptor-/HER2-) breast cancer (TNBC) is the most aggressive subtype due to its high metastatic potential and resistance to chemotherapy. The Y-box binding protein 1 (YB-1) transcription factor, a protein present in both cytoplasm and nucleus, is a driver of TNBC malignancy as it stimulates its cancer stem cell phenotype and disrupts cell cycle progression. Here, we hypothesized that YB-1-containing sEVs deliver YB-1 to the nuclear compartment of recipient cancer cells and play a major role in the activation of the metastatic process. We found a selective enrichment of YB-1 in sEVs from MDA and 4T1 cells, with [~]65% and 50% of all sEVs positive for YB-1 by d-STORM. Administration of sEVs from wild-type MDA and 4T1 to their YB-1 knockout counterparts resulted in nuclear translocation of sEV-associated YB-1 and increased tumorsphere formation. Pharmacological blockade of the nuclear transport machinery based on the inhibition of the formation of the "VOR" complex (VAP-A-ORP3-Rab7) by PRR851 impaired both nuclear translocation and the YB-1-induced increase in tumorsphere formation. YB-1 phosphorylation at S102 was required for nuclear localization. In fact, loss of YB-1 phosphorylation inhibited tumorsphere growth and stemness of cancer cells and YB-1-positive sEVs restored the oncogenic behavior of cancer cells expressing phospho-mutant YB-1. Moreover, PRR851 inhibited the nuclear translocation of the phosphorylated form of YB-1 and the oncogenic behavior of the TNBC cells. These data support the conclusion that the nuclear translocation of sEV-associated phosphorylated YB-1 is an important factor in the malignant behavior of TNBC and a potential therapeutic target.

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SH3KBP1/CIN85, a new actor of ER-phagy in muscle

Daura, M.; Vergara, E.; Andromaque, L.; Leddet, A.; Christin, E.; Malleval, C.; Gache, V.; Kretz-Remy, C.

2026-07-15 cell biology 10.64898/2026.07.15.737746 medRxiv
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The endoplasmic reticulum (ER) and its muscle-specialized form, the sarcoplasmic reticulum (SR), are crucial organelles in muscle cells, involved notably in protein synthesis, calcium regulation and muscle contraction. A well-known process involved in ER remodeling and homeostasis is ER-phagy, also called reticulophagy, a selective form of autophagic process in which ER-phagy receptors mediate the delivery of ER portions to lysosomes for degradation. SH3KBP1 is an adaptor protein involved in membrane trafficking. Recently, it was shown to control ER morphology and SR formation in striated skeletal muscle. In this study, we demonstrate that SH3KBP1 can bind to LC3B and CKAP4 proteins, bridging ER to autophagosome membranes, and is degraded by autophagy, in developing muscle fibers. Moreover, SH3KBP1 down-regulation impacts basal autophagy efficiency and ER-phagy stimulation; it also impairs the turnover of numerous ER-resident proteins. Our work highlights a new role for SH3KBP1 as a soluble ER-phagy receptor in striated skeletal muscle.

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Diversity and Utilization Patterns of Medicinal Plants Used in the Management of Diabetes Mellitus: An Ethnobotanical Study in Selected Communities in Sierra Leone

Kamara, S.; Jimmy, A. I.; Gary, L. P.

2026-07-21 pharmacology and therapeutics 10.64898/2026.07.18.26358386 medRxiv
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Background: Diabetes mellitus is an increasing public health challenge in Sierra Leone, where access to diagnosis, treatment, and long-term care remains limited. Traditional medicine continues to play a significant role in disease management; however, ethnobotanical knowledge related to diabetes remains insufficiently documented. Methods: A cross-sectional ethnobotanical survey was conducted among 40 informants, including traditional healers, herbalists, and knowledgeable community members in Waterloo, Pendembu, and Bo. Data were collected using structured questionnaires administered via Kobo Toolbox and paper-based tools. Information on medicinal plants, plant parts used, preparation methods, routes of administration, and knowledge transmission pathways was obtained. Quantitative ethnobotanical indices, including Frequency of Citation (FC), Relative Frequency of Citation (RFC), and Informant Consensus Factor (ICF), were calculated. Results: A total of 21 medicinal plant species were documented. The most frequently cited species were Moringa oleifera (FC = 9; RFC = 0.225), Vernonia amygdalina (FC = 7; RFC = 0.175), and both Cassia siberiana and Telfairia occidentalis (FC = 6; RFC = 0.150). Leaves were the most commonly utilized plant part (40.9%), and decoction was the predominant preparation method (76.2%), with oral administration accounting for 95.2% of use. The Informant Consensus Factor (ICF = 0.69) indicated a relatively high level of agreement among informants. Knowledge was primarily transmitted through apprenticeship and inherited family practices. Conclusion: Traditional medicinal plants remain an important component of diabetes management in Sierra Leone. The high level of consensus among informants and the repeated citation of specific plant species suggest structured and culturally validated therapeutic practices. The findings provide a foundation for future phytochemical and pharmacological investigations and highlight the need for documentation, preservation, and sustainable utilization of ethnobotanical knowledge.

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Nanobubble-Based Ultrasound Localization Microscopy through Interactive Adaptive Processing

Ilovitsh, T.; Shapiro, G.; Gershman, Y.; Bismuth, M.

2026-07-15 bioengineering 10.64898/2026.07.14.738435 medRxiv
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This study presents the use of sub-micron nanobubbles (NBs) as contrast agents for ultrasound localization microscopy (ULM), a super-resolution imaging technique that visualizes microvascular structure and flow beyond the acoustic diffraction limit. While ULM has traditionally relied on micron-sized microbubbles (MBs), the reduced dimensions and prolonged circulation times of NBs make them attractive candidates for localization-based imaging. However, their weaker acoustic responses present significant challenges for reliable detection and tracking. To address this challenge, we developed the ULM Master GUI, an interactive framework for optimization of the complete ULM processing pipeline. Using custom ultrasound-compatible wall-less gelatin flow phantoms containing vessel-mimicking channels and bifurcations ranging from 100 to 500 m, we demonstrate that NB-based ULM achieves velocity reconstruction and flow partitioning measurements comparable to conventional MB-based ULM. Across all investigated geometries, NBs faithfully reproduced the underlying flow patterns and hemodynamic behavior despite their substantially reduced acoustic scattering. These findings establish the feasibility of NB-based ULM, expand the range of contrast agents available for localization microscopy, and provide a foundation for future super-resolution ultrasound imaging using nanoscale acoustic contrast agents. The ULM processing GUI is publicly available at https://github.com/grisha1998/ulm-super-resolution-toolbox.

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Same Result, Different Price: Compounded versus Branded Tirzepatide

Erly, B.; Raja, S.

2026-07-16 pharmacology and therapeutics 10.64898/2026.07.14.26357505 medRxiv
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Background. Compounded tirzepatide is prescribed at scale as a cheaper substitute for branded Mounjaro and Zepbound, yet the cost case is almost always built by setting one compounded price against one branded list price. That framing ignores the question that actually decides the answer: cheaper than which branded price the patient can reach. Branded tirzepatide is now sold at sharply different tiers, namely insurance copay (often $25-$150/month), LillyDirect Self Pay ($299-$449/month), and retail cash price ($1,000-$1,200/month). Whether compounded saves money turns entirely on which of these a given patient faces. A second open question is whether the two formulations even produce comparable effectiveness, since observed differences may reflect selection on insurance, baseline characteristics, and adherence rather than the drug. Methods. We conducted a retrospective cohort study of tirzepatide users in the Mochi Health telehealth program, classified by formulation from their refills as branded-only (Mounjaro/Zepbound; 6,238), compounded-only (71,683), or switchers (4,996); switchers were excluded from the formulation contrast. Among single-formulation patients with a documented six-month weight observation, the analytic cohort was 7,271 (869 branded, 6,402 compounded). The primary outcome was six-month percent body weight loss; the secondary outcome was >=10% response. We used 1:1 nearest-neighbor propensity-score matching (0.25 SD caliper) on baseline covariates only - age, sex, baseline BMI, baseline weight, comorbid diabetes, hypertension, dyslipidemia, prior bariatric surgery, and self-reported insurance coverage - deliberately excluding post-treatment variables such as adherence and time in program, which are mediators of the formulation effect. We pre-specified an equivalence margin of +/-2 percentage points on mean loss and tested equivalence with two one-sided tests (TOST). A directed acyclic graph (DAG) makes the identifying assumptions explicit; metformin use could not be reliably ascertained and is treated as an unmeasured confounder. The cost comparison reports the savings or premium of compounded versus branded under five branded price scenarios: retail list, LillyDirect Self Pay (two dose tiers), and insurance copay (typical and low end). It is a cost comparison (cost-minimization under demonstrated similar effectiveness), not a formal cost-effectiveness analysis: we computed no ICER, QALY, or discounting. Results. Branded and compounded patients had similar outcomes even before adjustment (mean loss 11.7% vs 11.5%; >=10% response 60.9% vs 58.8%). The largest baseline difference between the groups was insurance coverage (branded patients far more likely insured; standardized mean difference 0.67), which matching balanced to 0.01. After 1:1 matching (718 pairs, all |SMD| < 0.04), mean loss was 11.4% vs 11.4% (difference +0.08 pp, 95% CI -0.70 to +0.80) and >=10% response 59.3% vs 57.2% (difference +2.1 pp, 95% CI -3.1 to +7.1). The two formulations were statistically equivalent within the pre-specified +/-2 pp margin (TOST p < 0.001). Cost depends on the branded scenario: compounded saves $6,000 over six months versus retail list price, $1,494 versus LillyDirect maintenance-dose (5-15 mg) Self Pay, and $594 over a low-dose (2.5 mg) LillyDirect prescription, while it costs $300 more than branded under a typical insurance copay ($150/month) and is more expensive still at lower copays (savings turn negative below $200/month). Conclusions. Branded and compounded tirzepatide were statistically equivalent in six-month effectiveness within a pre-specified +/-2 pp margin, so the choice between them is essentially a cost decision - and that cost advantage is real but conditional on the branded price the patient can access. It is large against retail list price and shrinks to zero or reverses against LillyDirect Self Pay or a low insurance copay. Whether compounded is the lower-cost choice for an individual patient is, therefore, a question about which price tier that patient faces.

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Bioimaging And Comparative Genomics Uncover Persistence-Associated Bacteria In A Blood Bank Environment

D Arpino, M. C.; Alonso-Reyes, D.; Grillo-Puertas, M.; Galvan, F. S.; Alvarado, N. N.; Martinez, L. J.; Marranzino, M. G.; Albarracin, V. H.

2026-07-21 health systems and quality improvement 10.64898/2026.07.19.26357333 medRxiv
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Blood banks represent highly controlled healthcare environments where microbiological surveillance has traditionally focused on blood products rather than environmental microbial reservoirs. Despite their critical role in transfusion safety, the ecology of surface-associated microorganisms and the persistence traits that enable their long-term survival remain poorly understood. Here, we combined scanning electron microscopy, culture-based microbiology, phenotypic characterization, MALDI-TOF mass spectrometry, and whole-genome sequencing to investigate whether surfaces within a public blood bank facility constitute reservoirs of environmentally derived bacteria with enhanced persistence potential. Samples collected from a public blood bank in Tucuman, Argentina yielded 37 culturable bacterial isolates, predominantly Gram-positive environmental taxa together with a limited number of opportunistic Gram-negative species. More than 30% of the isolates exhibited multidrug resistance, while several strains displayed strong biofilm formation, amyloid-like fiber production, motility, and hemolytic activity, indicating multiple phenotypic strategies associated with long-term surface persistence. Whole-genome sequencing of six representative isolates confirmed species identity, identified genes related to antimicrobial resistance, adhesion, biofilm formation, stress adaptation, and cytotoxicity, and revealed frequent genotype-phenotype discordance, highlighting the importance of integrating genomic and phenotypic analyses. Notably, one isolate exhibited less than 92% average nucleotide identity with publicly available genomes, suggesting the presence of a previously undescribed environmental species. Thus, blood bank surfaces function as selective ecological niches favoring bacteria with persistence-associated traits rather than simply reflecting contamination from blood products. These microorganisms may constitute latent biosafety hazards if environmental barriers fail, particularly in facilities handling biological materials intended for vulnerable patients. Our results support the incorporation of integrated bioimaging, phenotypic characterization, and genome-resolved environmental surveillance into infection prevention strategies and transfusion biosafety programs within a One Health framework.

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Necroptotic Signalling Diverts Keratinocyte Fate to Promote Differentiation and Slow Wound Healing

Anderton, H.; He, Y.; Silke, N.; Lynch-Godrei, A.; Gu, L. H.; Brown, S.; Shimada, K.; Bandala-Sanchez, E.; Cawthorne, W.; Chiou, S.; Hempel, A.; Samson, A. L.; Murphy, J. M.; Silke, J.

2026-07-15 cell biology 10.64898/2026.07.13.738083 medRxiv
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Necroptosis is best known as a lytic, proinflammatory cell-death pathway mediated by RIPK3 and MLKL. Effective wound repair requires the rapid resolution of inflammation, and ongoing necroptotic activity would only exacerbate tissue damage, delaying healing. However, damaged skin presents a trigger-rich environment for necroptotic signalling, an apparent paradox that remains unresolved. Using genetic ablation and pharmacological inhibition across multiple wound models, we show that inhibiting necroptosis accelerates wound closure, revealing that necroptotic signalling normally restrains repair. Surprisingly, we found that MLKL activation in wild-type keratinocytes induces differentiation and membrane repair rather than cell lysis. This adaptive, non-lethal mode of necroptotic signalling preserves barrier integrity but slows re-epithelialisation. Our findings redefine epidermal necroptotic signalling as a stress-responsive program that modulates keratinocyte fate in a trigger-rich environment. Temporarily dampening this pathway may enhance regeneration after barrier loss without compromising immune defence, revealing necroptosis as a tunable mechanism balancing tissue repair and inflammation.

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Hidden Structural Bias in Proteomics: Sonication-induced Selective Fragmentation of Intrinsically Disordered Regions

Narita, M.; Yamakawa, T.; Nishimura, R.; Iwasaki, M.

2026-07-15 cell biology 10.64898/2026.07.14.738389 medRxiv
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Sonication is a fundamental technique in proteome sample preparation, primarily used for protein solubilization and shearing of genomic DNA. Although the mechanical shearing of DNA is well-characterized, its unintended impact on protein structural integrity remains a significant "blind spot" in high-throughput analytical workflows. In this study, we systematically investigated sonication-induced protein fragmentation by combining gel-based fractionation (PEPPI-MS) with sequence-level compositional analysis and bioinformatic mapping. Our results demonstrate that sonication does not significantly alter overall proteome identification or the recovery of membrane proteins; however, it induces extensive and non-random protein fragmentation. Sonication caused an approximately three-fold increase in the abundance of >45 kDa protein-derived fragments migrating into the <40 kDa fraction, and 1,620 high-molecular-weight (MW) proteins were uniquely detected in the lower-MW fraction upon sonication, an eight-fold increase over non-sonicated controls. Peptide-level amino acid composition analysis revealed subtle but directional shifts in the sonication-derived fragments. This residue-level signature is reinforced by two orthogonal structural analyses (MobiDB peptide-level mapping and protein-level profiling using metapredict V3 software), which show that sonication-susceptible proteins harbor more than twice the disordered content of length-matched controls (median 40% vs. 18%). This study identifies a previously unrecognized "structural bias" whereby intrinsically disordered region (IDR)-rich proteins are selectively compromised during sample preparation. Because these fragments are indistinguishable from enzymatic digestion products in conventional bottom-up proteomics, the underlying structural damage is effectively masked in global quantitative datasets, potentially distorting biological interpretations related to protein size, isoforms, and stability, particularly for IDR-rich classes, such as transcription factors and signaling molecules. We propose that optimizing and standardizing sonication parameters is essential for ensuring the accuracy and reproducibility of quantitative proteomic analyses.

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The evolutionarily conserved APP-Spastin cooperation regulates endolysosomal homeostasis and apoptotic cell degradation

Zheng, Q.; Liu, F.; Yuan, L.; Liu, Z.; Lv, H.; Xiao, T.; Cui, Z.; Zhong, Q.; Wang, H.; Yin, Q.; Xiao, H.

2026-07-15 cell biology 10.64898/2026.07.14.738573 medRxiv
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Efferocytosis, the recognition, engulfment, and degradation of apoptotic cells by phagocytes, is essential for tissue homeostasis and development, and its failure contributes to chronic inflammation and neurodegeneration. The amyloid precursor protein (APP), a central pathogenic factor in Alzheimers disease, retains physiological functions independent of amyloid production that remain poorly understood. Here, we identify a conserved, non-amyloidogenic role for APP in regulating apoptotic cell degradation via the endolysosomal pathway. Using Drosophila APPL as a model, structure-function analysis demonstrated that the intracellular internalization domain of APPL, but not its secreted ectodomain, is required for efficient apoptotic cell degradation. Immunoprecipitation coupled with mass spectrometry revealed a physical interaction between APPL and the microtubule severing ATPase Spastin, mediated by the microtubule-interacting and trafficking domain of Spastin. APPL interacts with Spastin on endosomal microtubules and modulates the dynamics of the Spastin-ESCRT-III complex, enabling Spastin to sever microtubules and promote endosomal tubule fission. Loss of APPL disrupts this process, causing aberrant endosomal tubulation and impaired lysosome biogenesis. Furthermore, it compromises the function of residual lysosomes, characterized by reduced acidity, diminished proteolytic activity, and increased lysosomal damage, which ultimately impairs the degradation of engulfed apoptotic cells. Critically, this phenotype is evolutionarily conserved in C. elegans and mice. Together, these findings establish a conserved APP-Spastin axis that regulates endolysosomal homeostasis and apoptotic cargo digestion. This reveals a critical non-amyloidogenic function of APP in maintaining tissue homeostasis through efficient efferocytosis, with broad implications for inflammatory and neurodegenerative disorders that warrant further investigation.

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Characterizing the impact of plasma protein levels on human brain structure and disorders leveraging integrative multi-omics analysis

Ayubcha, C.; Dennis, E.; Bhattacharyya, U.; John, J.; Lam, M.; Lencz, T.; Ge, T.; Chen, C.-Y.

2026-07-15 genetic and genomic medicine 10.64898/2026.07.13.26358006 medRxiv
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With recent advances in high-throughput proteomic technologies, population-scale plasma proteomics datasets, often linked to extensive genetic and phenotypic information, have become increasingly accessible. Yet the relationships between circulating protein levels, brain imaging phenotypes, and risk for neurological and psychiatric disorders remain largely unexplored. Proteome-wide association studies offer a promising approach for elucidating biological mechanisms that connect genetic variation to complex brain-related traits and diseases. In this study, we integrated protein quantitative trait loci (pQTLs) from the two largest plasma proteomic resources (the UK Biobank Pharma Proteomics Project [UKB-PPP] and Ferkingstad et al. [deCODE]) with genome-wide association studies of brain imaging-derived phenotypes in UK Biobank using Mendelian randomization and colocalization analyses. We identified 120 cis and 20 trans associations between plasma proteins and imaging phenotypes and validated these findings using brain tissue-derived proteomic and transcriptomic datasets. Multivariable Mendelian randomization revealed eleven plasma proteins (coding genes APOE, ARL3, MICB, NSF, RHOC, RSPO3, ENPP2, BTN2A1, EIF2AK3, MRVI1, and OPLAH) with significant direct effects on the risk of Alzheimer's disease, Parkinson's disease, multiple sclerosis, bipolar disorder, and schizophrenia. Single-cell expression and pathway enrichment analyses further revealed cell-type-specific effects and distinct biological processes underlying these protein-disease associations. Together, these findings demonstrate robust links between plasma protein variation and brain structure, delineate protein-disease pathways, and highlight the cellular and molecular mechanisms that contribute to neurobiological diversity and pathology.

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5β-Dihydrotestosterone reveals a mutant androgen receptor vulnerability in prostate cancer

Adams, S.; Phelan, L.; Lewis, T.; Behm, J.; Law, A.; Shi, X.; Li, G. F.; Li, J.

2026-07-15 cancer biology 10.64898/2026.07.14.738538 medRxiv
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Bipolar androgen therapy (BAT) exploits the paradoxical vulnerability of castration-resistant prostate cancer (CRPC) cells to rapid cycling between castrate and supraphysiologic androgen concentrations, but clinical BAT uses testosterone, which can also activate wild-type androgen receptor (AR) in androgen-responsive tissues, causing systemic side effects. 5{beta}-dihydrotestosterone (5{beta}-DHT) is a naturally occurring testosterone metabolite generally considered androgenically inactive because it binds wild-type AR weakly, yet its activity against clinically relevant AR mutants has not been systematically evaluated. Here, we tested whether 5{beta}-DHT and related 5{beta}-reduced testosterone metabolites activate AR signaling and growth programs in prostate cancer models that carry AR mutations. In C4-2 cells, 5{beta}-DHT and 3{beta}-etiocholanediol (3{beta}-ecdiol) increased canonical AR target genes, including KLK3 and TMPRSS2, with weaker activity than testosterone, whereas other 5{beta} metabolites showed limited activity. In androgen-responsive LNCaP and C4-2 models, 5{beta}-DHT and 3{beta}-ecdiol promoted cell growth under androgen-depleted conditions, and this effect was suppressed by enzalutamide, supporting AR dependence. RNA-seq confirmed that 5{beta}-DHT and 3{beta}-ecdiol induced androgen-response gene sets substantially overlapping with testosterone, albeit at lower transcriptional magnitude. Further, we found that 5{beta}-DHT, but not 3{beta}-ecdiol, suppresses cell proliferation of LNCaP, C4-2, and PC-3 cells stably expressing the clinically relevant AR gain-of-function mutants W742C and H875Y through activating AR-induced senescence-like features after high-dose exposure, consistent with the therapeutic logic of BAT. These findings identify 5{beta}-DHT as an overlooked mutant-AR agonist capable of BAT-like tumor suppression and propose it as a testosterone surrogate in BAT with potentially reduced systemic androgenic side effects. HighlightsO_LI5{beta}-DHT and 3{beta}-ecdiol promote AR-dependent prostate cancer cell growth C_LIO_LIBoth are weaker AR agonists than testosterone by RNA-seq and qPCR C_LIO_LISupraphysiologic 5{beta}-DHT suppresses growth via AR-mediated senescence C_LIO_LIGrowth suppression extends to AR mutants W742C and H875Y C_LIO_LI5{beta}-DHT may be a lower-androgenicity testosterone surrogate for BAT C_LI