Journal of Translational Medicine

Purpose: Chemoradiotherapy (CRT) for human papillomavirus-related oropharyngeal cancer (HPV+ OPC) causes substantial treatment-related toxicity, with well-known adverse effects on quality of life (QoL), weight loss, and self-reported physical functioning. However, its impact on objectively measured cardiorespiratory fitness is unknown. This study examined changes in cardiorespiratory fitness, body composition, grip strength, and patient-reported outcomes in patients with HPV+ OPC undergoing CRT. Methods: We invited 20 patients with HPV+ OPC scheduled for CRT (age: 61.2 {+/-} 7.1 years, female: n=4) to complete assessments at three timepoints: pre-CRT (baseline), 2-weeks post-CRT, and 8-weeks post-CRT. Cardiorespiratory fitness was assessed using a maximal incremental cardiopulmonary exercise test (CPET). Body composition was estimated using segmental bioelectrical impedance analysis. QoL was assessed using the EORTC QLQ-C30 and QLQ-H&N43, and physical activity was self-reported using the International Physical Activity Questionnaire-Short Form. The primary outcome was change in oxygen consumption at the anaerobic threshold ([V]O2 at AT) measured during CPET; an objective, effort-independent marker of cardiorespiratory fitness. Results: Mean [V]O2 at AT declined from 16.0 {+/-} 3.8 ml/kg/min at baseline to 12.0 {+/-} 3.4 ml/kg/min at 2-weeks post-CRT (adjusted mean change: -4.2, 95% CI: -5.4 to -3.0 ml/kg/min) and remained low at 8-weeks post-CRT. Peak oxygen consumption ([V]O2peak: -7.4, -9.3 to -5.4 ml/kg/min), body mass (-8.5, -10.7 to -6.2 kg), fat-free mass (-6.4, -7.7 to -5.0 kg), grip strength (-4.1, -7.2 to -0.99 kg), global health status (-26.9, -39.2 to -14.6 points), fatigue (49.8, 33.7 to 65.8 points), and several disease-specific symptoms were also adversely affected at 2-weeks post-CRT and remained impaired at 8 weeks. Conclusion: This is the first study to estimate the impact of CRT on cardiopulmonary fitness in patients with HPV+ OPC. Cardiorespiratory fitness declined by ~25% following CRT and remained reduced at 8-weeks. Targeted interventions to mitigate these adverse physiological effects warrants further investigation.

BackgroundExercise-induced fatigue is a complex physiological phenomenon involving oxidative stress, inflammation, and metabolic disturbances. Ergothioneine (EGT), a naturally occurring amino acid with potent antioxidant properties, has garnered interest for its potential health benefits. This study aimed to evaluate the anti-fatigue effects of Gene III EGT in a mouse model of exhaustive exercise and to elucidate its underlying mechanisms. MethodsMale C57BL/6 mice were randomly divided into five groups: a control group (CTL), low-dose EGT (EGT-L, 10 mg/kg), medium-dose EGT (EGT-M, 30 mg/kg), high-dose EGT (EGT-H, 50 mg/kg), and a positive control group (Coenzyme Q10, 50 mg/kg). Mice were subjected to a 4-week treadmill training protocol, followed by an exhaustive running test. We measured exercise performance and collected blood and skeletal muscle samples at multiple time points to assess biochemical markers, inflammatory cytokines, antioxidant status, and key signaling proteins. ResultsGene III EGT supplementation, particularly at medium and high doses, significantly extended the time to exhaustion and running distance. Compared to the control group, EGT treatment significantly reduced post-exercise levels of lactic acid (LA), lactate dehydrogenase (LDH), and blood urea nitrogen (BUN). Furthermore, Gene III EGT suppressed the exercise-induced increase in pro-inflammatory cytokines, including IL-1{beta}, IL-6, and TNF-. The anti-fatigue effect of EGT was also associated with a reduction in malondialdehyde (MDA) and an increase in the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). Mechanistically, EGT promoted the phosphorylation of AMP-activated protein kinase (AMPK) and the expression of peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1) in skeletal muscle, while also increasing the Bcl-2/Bax ratio, suggesting enhanced mitochondrial biogenesis and reduced apoptosis. ConclusionsOur findings demonstrate that Gene III EGT effectively enhances exercise performance and alleviates fatigue. The underlying mechanisms involve the mitigation of oxidative stress and inflammation, as well as the activation of the AMPK/PGC-1 signaling pathway to promote mitochondrial function and cellular protection. These results highlight the potential of Gene III EGT as a nutritional supplement for combating exercise-induced fatigue.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID are complex chronic conditions that often follow infectious triggers with overlapping clinical features but poorly defined pathophysiological relationships. This study aimed to identify disease-specific immune signatures through multiparameter immunophenotyping of monocytes, dendritic cells, and T-cell subsets. A total of 207 participants were included (ME/CFS: n = 103; long COVID: n = 63; healthy controls: n = 41). Peripheral blood mononuclear cells were analyzed using multiparameter flow cytometry. Statistical analyses included non-parametric testing, age-adjusted ANCOVA, correlation network analysis, and principal component analysis (PCA). Long COVID was characterized by increased M2-like monocyte polarization, elevated CD80 expression across monocyte subsets, expansion of dendritic cells, and reduced expression of activation markers, indicating persistent immune activation with features of immune exhaustion. In contrast, ME/CFS exhibited reduced costimulatory molecule expression, impaired CCR7-mediated immune cell trafficking, and less coordinated activation patterns, consistent with a state of immune suppression. Correlation network analysis revealed more extensive and integrated immune interactions in long COVID, while PCA identified distinct immunophenotypic components and enabled moderate discrimination between the two conditions. These findings demonstrate that ME/CFS and long COVID are characterized by distinct immune profiles, supporting the concept of divergent immunopathological mechanisms. The identified signatures may contribute to biomarker development and guide targeted therapeutic approaches.

BACKGROUNDAs a GLP1 R agonist, semaglutide is known to exhibits pleiotropic health effects across the cardiometabolic spectrum in patients with type 2 Diabetes Mellitus (T2D). However, in depth and unbiased protein and phosphoprotein level evidence that reflects such effects of semaglutide in plasma remains elusive. OBJECTIVESThis pilot study applied an innovative plasma proteomics and phosphoproteomics technology to a sub-set of patients with T2D that participated in the Semaglutide Treatment effect on coronary atherosclerosis Progression (STOP) randomized trial. The aim of this study was to identify the systemic effects of semaglutide treatment in pathways that underpin its pleiotropic cardiometabolic spectrum health benefits. METHODSThe study applied a proprietary liquid biopsy discovery proteomics platform and its derivative cardiometabolic spectrum database (International patent PCT/US2021/063407) to 16 patients from the STOP randomized trial. Plasma samples from 8 patients in the active group and 8 patients in the placebo group at baseline and 52 weeks post treatment were analyzed. The methodology entailed the use of a unique liquid fixative chemistry to instantly solubilize and stabilize plasma proteins and phosphoproteins at room temperature followed by their direct microflow monolithic partition chromatography, dialysis purification, solution phase proteolysis, multiplex isobaric stable isotope labeling of proteotypic peptides, lab-on-chip TiO2/ZrO2 phosphopeptide enrichment and nanotechnology enhanced ultra-high resolution LC-MS analysis. To identify differentially abundant proteins (DAPs) and phosphoproteins (DApPs) in patients treated with semaglutide vs. placebo, the respective abundance ratio for each was considered repectively. Ratios were log2-transformed to normalize their distribution. A one-sample T-Test (paired) using the two-stage Benjamini Yekutieli Krieger step up method for multiple hypothesis testing FDR correction of the p-value was performed. The threshold of significance was set at q[less double equals]0.05. DAPs/DApPs were corrected for placebo. The expressed proteome and phosphoproteome were further interpreted with a multifactorial computational biology pipeline to deconvolute their underlying protein-level molecular pathways and their networks along with transcriptional factors and kinases that regulate them. RESULTSThis study achieved an extremely high depth-and-breadth in quantitative proteome and phosphoproteome coverage from only 20{micro}L whole plasma equivalent from each patient. Namely, a total of 13,173 proteins and 25,578 phosphopeptides were fully profiled (q[less double equals] 0.05). Of these, 1,040 were differentially abundant proteins (DAPs) and 1,064 were differentially abundant phosphoproteins (DApPs), in the semaglutide treated group after correcting for placebo, at an absolute log2-fold-change of [greater double equals] 0.5, CV [less double equals] 15%, q[less double equals] 0.05. Of interest, this study profiled over 85% of all proteins/phosphoproteins (6,700) reported to date based on the use of the well curated and up-to-date PaxDB database. Over 70% of these known proteins were of exosomal origin. Importantly, an additional [~]9000 plasma proteins and phosphoproteins of this study constituted entirely novel observations. Contextualization of the DAPS, DApPs, kinases and transcription factors for all statistically significant enriched canonical pathways (FDR-corrected q<0.001) revealed a wide array of pathophysiological processes attributed to semaglutide treatment. Furthermore, these pathways provided a molecular understanding to the reported imaging biomarkers against the same STOP trial patients. CONCLUSIONSThis feasibility study demonstrated how an effective plasma proteomics and phosphoproteomics platform can generate a treatment-adaptive companion diagnostic molecular signature that holistically captures the multiple cardiometabolic spectrum health effects of semaglutide in patients with atherosclerosis and T2D.

AimsTo explore exercise-induced fatigue (EIF)s effects on the male reproductive system and MXRA7s regulatory role herein. MethodsWe recruited EIF volunteers for semen/serum tests, established a mouse EIF model via weight-loaded swimming to assess epididymal segmental injury, and constructed pyroptosis models of PC-1/DC-2 cells. Public database transcriptomic analysis identified MXRA7 expression and enriched pathways in epididymitis; MXRA7s function was verified via its knockdown/overexpression in DC-2 cells. PKC-MXRA7 association was explored by phosphorylation assays and CO-IP, and sperm incubation experiments evaluated MXRA7s effect on sperm function. ResultsEIF impaired human sperm motility, reduced mouse sperm quality and induced epididymitis with segment-specific pyroptosis. MXRA7 expression differed in PC-1/DC-2 cells and correlated with pyroptosis; it was phosphorylated by PKC, inhibited the NF-{kappa}B pathway to alleviate inflammation, and mitigated pyroptosis-induced sperm motility damage. ConclusionEIF induces epididymal epithelial pyroptosis and epididymitis, and MXRA7 exerts a protective effect mainly in caudal epididymal cells by alleviating pyroptosis, thus reducing sperm quality damage.

ImportanceDigital Phenotyping (DP) utilizes digital technologies to assess observable phenotypic traits, enhancing our understanding of various disease states. It aims to support equitable interventions through diverse digital data, fostering inclusivity by integrating various digital devices. Central to DP is identifying digital biomarkers (DBMs), which offer real-time health monitoring and personalized insights into disease conditions. Applying machine learning (ML) techniques on non-invasive signals sets the ideal platform for precision medicine application, especially in rare diseases (RDs). People living with rare diseases (PLWRD) often face significant challenges in receiving timely and accurate diagnoses, leading to what is known as a diagnostic odyssey. Digital phenotyping (DP) offers a promising solution by leveraging advanced technology, such as 3D facial photography, to capture unique digital signatures associated with various rare diseases. This innovative approach not only aids in the identification of these conditions but also facilitates the detection of digital biomarkers (DBM). These biomarkers enable healthcare providers to monitor the progression of the disease over time, enhancing patient care and potentially shortening the duration of the diagnostic odyssey. By utilizing DP and DBMs, we can improve both the diagnosis and management of RDs, ultimately leading to better health outcomes for affected participants. ObjectiveTo identify whether DBMs can be identified by DP utilizing 3D facial imaging techniques in outpatient settings in participants with RDs. The primary objective of this study was to determine if specific facial measurements in participants with RD who experience transient episodes of facial swelling (oedema) differ from established ethnically matched norms. The secondary objective was to assess peri-orbital and/or facial swelling as a potential biomarker for identifying flare-ups in hereditary angioedema (HAE). Design, setting, and participantsThis multicentre observational study was conducted in 3 hospitals in Singapore. The eligible participants were male and female RD participants of various age groups. The study duration was 4 years and 8 months. Interventions: Twenty participants of Chinese genetic ancestry were photographed using a 3D camera. Additionally, two participants with hereditary angioedema (HAE) were photographed during acute stages of disease flare-ups. Main outcomes and measuresThe obtained facial scans of participants (that included participants with HAE in non-acute phase) were plotted using Artificial Intelligence-powered software - Cliniface. The growth curves and facial landmarks obtained were compared against the growth curves of normal RD-unaffected individuals of Chinese genetic ancestry. The two participants with HAE were photographed qualitatively over a longer period of time, and their scans were plotted, yielding growth curves. ResultsDistinct facial markers such as periorbital swelling were identified in two qualitatively assessed HAE participants during flare-up stages. This provides an opportunity to explore and validate further if these facial signatures in a disease condition can be assigned as DBM for HAE. Conclusions and relevanceThis study explores the utility of 3D facial analysis as a DBM in rare diseases such as HAE. Applying non-invasive signals coupled with AI may open new vistas for precision medicine in real-world settings. The individual measurements that yielded small p-values demonstrate significant relevance and potential utility. These findings offer preliminary objective evidence that supports existing subjective reports of facial features in the literature. Additionally, while DPs diagnostic capabilities may be limited, it successfully identified DBM, which could facilitate disease monitoring in conditions such as HAE. Author SummaryRare diseases pose a significant challenge to all stakeholders, including clinicians, patients families, care providers, and the healthcare system. Diagnostic delays are integral and impose a massive financial and emotional burden on everyone involved in care delivery, beyond the patients themselves. A universally acceptable, scalable, and replicable non-invasive mechanism to detect distinct biomarkers associated with a rare disease can help identify the diseases signs and symptoms far earlier and ease the burden. An easy-to-deploy approach could be 3D facial imaging of patients with rare diseases, which are associated with distinct or subtle facial changes at different stages of disease progression. A rare disease, such as hereditary angioedema, which is known to exhibit facial swelling in patients during the acute disease state, is a prime example. The facial changes can be identified and assigned as specific disease markers, also known as facial biomarkers. These facial biomarkers can be identified and measured using 3D facial imaging when patients present to the clinic. Subsequently, these initial signs can be correlated clinically to establish a firm diagnosis earlier than traditional approaches.

Background: Kidney transplantation is the preferred treatment strategy for end-stage kidney disease. Deceased donor kidneys usually undergo cold storage until kidney transplantation, leading to cold ischemia injury that may contribute to poor graft outcomes. However, the molecular characterization of potential mechanisms of cold ischemia injury remains incomplete. Results: To bridge this knowledge gap, we leveraged the 10x Visium spatial transcriptomic technology to perform full transcriptome profiling of murine kidneys subject to varying durations of cold ischemia typical in a deceased donor kidney transplant setting. We developed a computational workflow to identify and compare spatiotemporal transcriptomic changes that accompany the injury pathophysiology in a tissue compartment-specific manner. We identified proportional enrichment of oxidative phosphorylation (OXPHOS) genes with increasing duration of cold ischemia injury within the oxygen-lean inner medulla region, suggestive of atypical metabolic presentation. This was distinct in cold ischemia injury tissue compared to warm ischemia-reperfusion kidney injury tissue. Spatiotemporal trends were validated by qPCR and immunofluorescence in a larger cohort of mice. We provide an interactive online browser at https://jef.works/CellCarto-ColdIschemia/ to facilitate exploration of our results by the broader scientific and clinical community. Conclusions: Altogether, our spatiotemporal transcriptomic analysis identified coordinated molecular changes within metabolic pathways such as OXPHOS deep within the cold ischemic kidney, highlighting the need for increased attention to the inner medulla and potential opportunities for new insights beyond those available from superficial biopsy-focused tissue examinations.

PurposeDifferentially expressed genes (DEGs) between colorectal cancer liver metastasis (CRLM) epithelium and primary colorectal cancer (CRC) epithelium (LMR DEGs) identified based on single-cell RNA sequencing (scRNA-seq) data may become new biomarkers for CRC prognosis. MethodsAn scRNA-seq dataset was used to describe the cellular landscape of primary CRC and CRLM and identify LMR DEGs. Prognostic LMR DEGs were identified in the bulk RNA-seq dataset. Based on the prognostic LMR DEGs, multiple machine learning algorithm combinations were compared in terms of their C-index, and the best model was selected for the construction of the LMR score. ResultsAmong the 2070 LMR DEGs, 426 prognostic LMR DEGs were ultimately obtained. The combination of the randomized survival forest (RSF) model and ridge regression had the highest C-index and was therefore used to construct a 15-gene scoring system (LMR score). In the external validation set, the 1- and 5-year AUCs of the LMR score were greater than those of the AJCC stage and other scoring systems constructed with a similar dataset. In addition, the LMR score was closely associated with factors that influence CRC outcomes, such as immune infiltration. ConclusionThe LMR score may be a reliable new biomarker for predicting the prognosis of patients with CRC.

Bladder cancer (BC), particularly muscle-invasive and metastatic disease, remains a major clinical challenge despite recent advances in immunotherapy. In this study, we aimed to identify a promising antitumor compound from five candidate small molecules and to explore its potential roles in BC progression. Through antiproliferative screening, cryptotanshinone (CTS) was identified as the promising candidate. Using both two-dimensional BC cell lines and three-dimensional bladder tumor organoid models, we comprehensively evaluated the effects of CTS on cell proliferation, migration, apoptosis, and organoid growth. To further explore the underlying mechanisms, transcriptomic sequencing based on bladder cancer organoid models, protein-protein interaction network analysis, and public databases (TCGA-BLCA, TIMER, and TISIDB) were integrated to examine immune-related pathways and potential molecular targets associated with CTS. GeneMANIA network prediction and molecular docking analyses were subsequently performed to investigate upstream regulatory networks and the potential interactions between CTS and key components of the cGAS-STING-IFN-I-JAK-STAT signaling pathway. Integrative analyses suggested that IFIT1, IFIT2, and IFIT3 may function as immune-associated genes potentially linked to BC progression, patient prognosis, immune cell infiltration, and PD-1/PD-L1 expression. Molecular docking results suggested that CTS may interact with core regulatory proteins within the cGAS-STING-IFN-I-JAK-STAT pathway, potentially influencing IFIT transcriptional regulation. Collectively, these findings indicate that CTS exhibits measurable antitumor and immunomodulatory effects, which may be associated with modulation of the cGAS-STING-IFN-I-JAK-STAT-IFIT signaling axis, supporting its potential as a small-molecule candidate for bladder cancer.

AimWe investigated the heterogeneity of treatment effects in transcranial direct current stimulation (tDCS) with mindfulness-based meditation (MBM) and within each individual study group (tDCS alone, MBM alone, and sham) among individuals with symptomatic knee osteoarthritis. We also explored participant characteristics underlying this heterogeneity. MethodsThis secondary analysis drew on a double-blind, randomized, sham-controlled, phase II, parallel-group trial in which 200 participants were assigned to one of four groups: (1) active tDCS + active MBM, (2) active tDCS + sham MBM, (3) sham tDCS + active MBM, or (4) sham tDCS + sham MBM. Participants received ten 20-minute tDCS sessions (active or sham) administered concurrently with MBM (active or sham). Latent class growth analysis was used to identify subgroups with distinct treatment response trajectories (responders vs. non-responders) based on changes in clinical pain (Numeric Rating Scale) from baseline to post-intervention. Generalized linear models were then applied to determine baseline factors associated with participants response classification, including demographic, clinical, and psychological characteristics; quantitative sensory testing battery; and pain-related cortical hemodynamic activity measured using functional near-infrared spectroscopy (fNIRS) in response to punctate and thermal stimuli. ResultsResponders in the active tDCS + active MBM and active tDCS + sham MBM groups demonstrated greater improvements in clinical pain from baseline to post-intervention than non-responders (p < 0.001). In the active tDCS + active MBM group, greater cortical activation in the fNIRS channel S06-D06 of the left somatosensory cortex in response to punctate stimuli, identifying as white, and lower conditioned pain modulation (reflecting less efficient endogenous pain modulation), were significantly associated with being responders (p < 0.05). In the active tDCS + sham MBM group, younger age and lower heat pain tolerance at the knee were significantly associated with being responders (p < 0.05). No clear response patterns were observed in the remaining groups. ConclusionFactors underlying heterogeneity of treatment effects, including somatosensory cortical activation and pain modulatory profiles, may provide preliminary insights to inform the development of personalized neuromodulation (stimulation) protocols.

PurposeIntravesical interferon-alpha (IFN) gene therapy has shown promise in treating BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). Ongoing work in our lab aims to further improve its treatment efficacy by identifying resistance mechanisms and deploying targeted combination treatment strategies. Experimental designWe performed end-tumor RNA-seq analysis of MB49 murine tumors treated with IFN gene therapy, identifying the ErbB pathway as a resistance mechanism. We consequently hypothesized that a combination treatment involving an ErbB pathway blocker and IFN could yield improved outcomes. MB49 cells were treated in vitro with lentiviral IFN (LV-IFN) gene therapy, with/without Afatinib, a pan-ErbB inhibitor, and cell viability and migration assays were performed. Next, in vivo studies were conducted in the syngeneic MB49 orthotopic murine bladder cancer model. The mice were randomized into 5 treatment groups (n=10 each): saline (Ctrl), LV-Ctrl, oral Afatinib monotherapy, intravesical LV-IFN monotherapy, and the experimental intravesical LV-IFN + oral Afatinib combination therapy. Overall survival (OS) and drug toxicity were assessed. ResultsCombination therapy significantly reduced MB49 cell viability in vitro compared to all other treatment conditions (mean relative ATPase activity at 72 h for the combination treatment was 4%, compared to 100%, 26%, and 28% for Ctrl, LV-IFN, and Afatinib, respectively, p<0.001). This additive effect on cell viability appeared to be driven by a combination of early-cytostatic and late-cytolytic effects. The combination treatment also markedly inhibited cell migration (mean migrated cells/10x Boyden chamber assay at 36 h were: 92.3 for the combination therapy and 631.0, 600.4, and 270.3 for Ctrl, LV-IFN, and Afatinib, respectively, p<0.001). Finally, the in vivo studies demonstrated improved OS with combination therapy (median OS was 49 d in the combination group vs 15, 29, and 26 d in Ctrl, LV-IFN, and Afatinib groups, respectively, Log-rank p<0.001). No mice in the combination therapy group died of drug toxicity. ConclusionsOur preliminary findings suggest that the ErbB pathway may serve as a clinically significant resistance mechanism to intravesical IFN gene therapy, and when targeted concurrently, may improve treatment efficacy.

PurposePatient-reported outcomes (PROs) provide a quantitative measure of a patients quality of life, directly from the patient without external influence or interpretation. Prior studies have demonstrated correlations between individual PROs and cancer treatment response. However, this area of research is still highly understudied, and patient data often goes ignored. Our previous work has shown how changes in insomnia can be used to make binary decisions about a patients future volume response. Here, we expand upon that work to determine precisely when treatment progression will occur, providing an opportunity for clinicians to intervene sooner. Experimental DesignThis study analyzed PROs and tumor volume data collected from 80 NSCLC patients undergoing immunotherapy to determine how PRO dynamics could inform when volumetric treatment progression would occur. We calibrated the tumor growth inhibition (TGI) model to patient-specific tumor volume dynamics for all volume measurements using a leave-one-out cross-validation approach. Growth parameters were divided based on progression status and sampled depending on changes in patient-reported insomnia. A cutoff analysis was performed to determine the optimal cutoff for distinguishing between responders and non-responders. Predictions were made for the Nth patient and categorized using the cutoff. ResultsThis study demonstrated that incorporating patient-specific changes in insomnia with a mathematical model of volume changes can predict patient response with a 72.2% true positive rate and 71.3% overall accuracy, on average 6-8 weeks sooner. ConclusionUsing this innovative framework, we can predict precisely when progression occurs, giving clinicians the opportunity to intervene beforehand.

Outcomes from the COSMOS trial have reinforced the notion of flavanols as important plant-derived bioactives contributing to cardiovascular health. As discussions continue on whether specific dietary reference values for flavanols are warranted, it is possible that existing dietary guidelines emphasizing fruits and vegetables already yield sufficient flavanol intake levels. If this were the case, developing flavanol specific dietary reference values might be unnecessary. This study therefore aimed at assessing whether adherence to dietary recommendations for fruit and vegetable intake and overall diet quality achieves flavanol intake levels of 500 mg/day, the amount proven to mediate cardiovascular benefits in the COSMOS trial. Flavanol intake was objectively evaluated using two validated and complementary biomarkers, 5-(3{square},4{square}-dihydroxyphenyl)-{gamma}-valerolactone metabolites (gVLMB) and structurally related (-)-epicatechin metabolites (SREMB), in two geographically distinct studies: COSMOS (US; n=6,509) and EPIC-Norfolk (UK; n=24,154). The results showed that higher fruit and vegetable intakes and diet quality (assessed via the alternative healthy eating index-aHEI) were associated with increased flavanol intake in COSMOS. Nevertheless, fewer than 25% of participants meeting dietary guidelines achieved an estimated flavanol intake of [&ge;]500 mg/day. Similar findings were observed in EPIC-Norfolk as well as through flavanol intake simulations considering fruits and vegetables commonly consumed in the US diet. In conclusion, adherence to existing dietary guidelines does not yield flavanol intake levels comparable to those shown to provide cardiovascular benefits in COSMOS. Thus, specific dietary reference values for flavanols may still be necessary if aiming to increase the intake of these dietary compounds. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=101 SRC="FIGDIR/small/26346949v1_ufig1.gif" ALT="Figure 1"> View larger version (39K): org.highwire.dtl.DTLVardef@2966f5org.highwire.dtl.DTLVardef@269232org.highwire.dtl.DTLVardef@483edborg.highwire.dtl.DTLVardef@116a957_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundCardiac hypertrophy is a key pathological process in hypertensive heart failure, yet current antihypertensive therapies do not directly target it. Red yeast rice (RYR), rich in monacolin K {beta}-hydroxy acid (MKA), is known for lipid-lowering effects, but its potential to ameliorate cardiac hypertrophy is unreported. PurposeTo investigate the effects of RYR-derived MKA on cardiac hypertrophy in spontaneously hypertensive rats (SHR) and elucidate its molecular mechanisms. MethodsSpontaneously hypertensive rats (SHR) were treated with 0.6% red yeast rice for 8 weeks to assess its effects on blood pressure, cardiac function (echocardiography), cardiac hypertrophy and fibrosis (histopathology), and multi-organ toxicity (histopathology). A multigenerational study was conducted to evaluate protective effects in offspring. Network pharmacology and transcriptomic analysis were integrated to predict molecular targets, which were subsequently validated by molecular docking and experiments. ResultsEight-week RYR treatment significantly reduced blood pressure, inhibited cardiac hypertrophy and fibrosis, and improved cardiac function without gender differences. No pulmonary, hepatic, or renal toxicity was observed. Offspring from treated parents exhibited further reduced hypertrophy upon continued treatment. Mechanistically, MKA bound ERK1/2 with high affinity, inhibiting its phosphorylation and downstream c-Fos expression, thereby downregulating hypertrophy markers. ConclusionRed yeast rice improves hypertensive cardiac hypertrophy via MKA-mediated inhibition of the ERK1/2/c-Fos pathway. Its multi-organ safety and transgenerational effects offer a novel dual-therapy strategy for hypertension and cardiac hypertrophy. Graphic abstract O_FIG O_LINKSMALLFIG WIDTH=139 HEIGHT=200 SRC="FIGDIR/small/710945v1_ufig1.gif" ALT="Figure 1"> View larger version (57K): org.highwire.dtl.DTLVardef@cbb85org.highwire.dtl.DTLVardef@1eb399dorg.highwire.dtl.DTLVardef@13746dorg.highwire.dtl.DTLVardef@140c512_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background: Despite advances in organ-preserving strategies for rectal cancer, accurate restaging after neoadjuvant therapy (NAT) remains challenging due to the limited sensitivity of conventional MRI in differentiating residual tumour from treatment-induced changes. This limitation highlights the urgent need to develop better imaging tools that can accurately analyze the complex structure of the treated rectal wall. Purpose: To study the diffusion properties of different rectal wall components, including healthy layers and pathological tissue, using high-resolution ex vivo diffusion MRI (dMRI) on whole total mesorectal excision (TME) samples obtained after NAT, and to evaluate how advanced diffusion metrics improve tissue analysis compared to standard T2-weighted imaging. Materials and Methods: Five post-NAT TME specimens were prospectively collected at a single center and fixed (36h formalin, 4h PBS). Then, specimens were mounted in Fomblin and scanned using a 9.4T Bruker BioSpec (22{degrees} ; 86 mm Tx/Rx). Diffusion MRI was acquired using a 2D multi-shell sequence (TR/TE 11,000/24 ms; 130 slices; 0.5 mm3 isotropic voxel; b = 1500 and 3000 s/mm; 15 directions) alongside multi-echo T2;-weighted imaging (TR 25,000 ms; 8 echoes; TE 10-80 ms; fat suppression). Diffusion and kurtosis parametric maps were generated by voxelwise linear least-squares fitting; T2 maps by monoexponential fitting (MATLAB). Specimens were sectioned at 5 mm, stained with H&E and dual staining (for fibrosis and smooth muscle), digitized, and co-registered with MRI using morphological landmarks. Regions-of-interest (ROIs) - mucosa, submucosa, muscle layers, tumour, and fibrous tissue - were compared using a linear mixed-effects model with FDR correction (RStudio v2025.09). Results: The muscularis propria exhibited the highest FA values of all tissue components, reflecting the ordered fiber architecture of its inner circular and outer longitudinal layers, which were visually separable on direction-encoded colour FA maps. Focal disruption of anisotropy at the tumour-muscle interface corresponded histologically to tumour invasion of the muscularis propria. Tumour regions showed the lowest mean diffusivity (MD), reflecting high cellularity and restricted diffusion, and MD was comparatively higher in the residual scar. Kurtosis metrics - particularly MK and AK - were elevated in tumour, reflecting greater microstructural heterogeneity and complexity. T2 mapping provided limited contrast across tissue types due to formalin fixation effects. Conclusion: Diffusion MRI metrics quantitatively discriminated rectal wall tissue components ex vivo with histological validation, beyond T2-weighted contrast. DTI and DKI metrics characterized tumour, fibrous tissue, and muscularis propria invasion, supporting their potential as microstructural imaging biomarkers for treatment response assessment.

IntroductionNovel therapeutic options are urgently required to improve outcomes and survival for patients with lung squamous cell carcinoma (LUSC). In particular, understanding the unique histological features that define LUSC is essential to improving lung cancer mortality. Many pre-clinical models fail to accurately represent intratumour heterogeneity and recapitulate the tumour microenvironment. This is partly responsible for the poor translation of clinical findings to approved therapies. Our objective was to investigate whether patient-derived organoids, replicate the histological morphological, and structural features of keratinizing LUSC, a poor prognostic subtype of lung cancer. MethodsOrganoid cultures were established and maintained from two patients presenting with keratinizing lung squamous cell carcinomas. Immunofluorescent staining of individual organoids and confocal microscopy was performed to confirm expression of tumour markers. Whole organoid domes were fixed, and immunofluorescent staining and imaging was performed to investigate the structural features of the organoid cultures. Findings were compared with histopathological features of the original tumour tissue. ResultsPatient-derived organoids expressed tumour markers specific to the squamous cell carcinoma subtype of non-small cell lung cancer, which were confirmed to be expressed in the parent tissue. Within organoid cultures, keratin pearl structures spontaneously developed, matching the keratinizing pattern demonstrated by hematoxylin and eosin staining of the original tumour. ConclusionsPatient-derived organoids have the capability to replicate key histological features of their parent tumour. This high degree of fidelity makes these 3D models an important and valuable tool for understanding complex tumour biology and as a platform for preclinical drug testing to advance novel therapies into the clinic.

Background & AimsEarly identification of decompensation in patients with cirrhosis is important to enable timely detection, management of complications and for effective treatment. This study investigates the biology of decompensation and aim to identify protein biomarkers for identification of high-risk patients. MethodsThe primary analysis included plasma samples from 46 patients with metabolic dysfunction associated steatotic liver disease (MASLD) related cirrhosis. Plasma samples were depleted for the top 14 most abundant proteins and the proteome was measured by liquid chromatography tandem mass spectrometry. The dataset was divided into a training (14 compensated, 10 decompensated) and a test cohort of compensated patients (11 progressing to decompensation, 11 remaining compensated). Changes in protein levels were determined by ANCOVA and a prognostic model was developed using logistic regression. External validation was performed in an independent cohort of 120 patients with alcohol-related cirrhosis. Time-to-event analyses were conducted in this cohort using Cox regression. Results52 proteins involved in impaired hepatic function, fibrogenesis, immune activation, and metabolic changes were significantly different between compensated and decompensated patients. A prognostic model with four proteins (NBL1, LTBP4, APOC4, GHR), demonstrated predictive ability for future decompensation (AUC=0.93, 73% sensitivity, 100% specificity). In the external validation cohort, the model demonstrated generalizability (AUC=0.78, 72% sensitivity, 82% specificity). Validation cohort time-to-event analyses showed that higher baseline scores were associated with shorter time to liver-related events (HR 1.32; log-rank p = 0.027), underscoring the panels prognostic value. ConclusionOur study indicates that patients with decompensated cirrhosis are characterized by proteomic signatures of fibrogenesis and metabolic dysfunction. Capturing these signatures could help identify patients at risk of complications and potentially those eligible for aetiology directed treatment. Impact and ImplicationsAddressing a critical unmet need for early detection of cirrhosis decompensation, our proteomic study identifies a four-protein panel with predictive ability for decompensation. These findings hold significant implications for hepatologists, clinical researchers, and healthcare systems, offering a novel tool to enhance prognostication and refine treatment strategies, potentially facilitating targeted patient monitoring. However, considering the small discovery sample size and the distinct aetiology of the external validation cohort, further validation is essential before broad clinical integration. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=183 SRC="FIGDIR/small/709475v1_ufig1.gif" ALT="Figure 1"> View larger version (55K): org.highwire.dtl.DTLVardef@6620e2org.highwire.dtl.DTLVardef@f8dfe4org.highwire.dtl.DTLVardef@1331101org.highwire.dtl.DTLVardef@1a195ca_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundThe X-linked muscle wasting disorder Duchenne muscular dystrophy (DMD) is a progressive and ultimately fatal disease caused by loss of function mutations in the dystrophin (DMD) gene. Upregulation of utrophin (UTRN), an embryonic homologue of dystrophin, has been proposed as a therapeutic option that could ameliorate disease. We previously generated a bioluminescent screen for utrophin-upregulating compounds using a mouse reporter of endogenous utrophin expression and discovered that inhibition of ERK1/2 and EZH2, increases utrophin expression in myoblasts. MethodologyHere we extend this analysis to show that treatment of human myoblasts with the ERK1/2 inhibitor LY3214996 and the EZH2 inhibitor GSK503, increases UTRN expression in primary and immortalised myoblasts derived from healthy volunteers and DMD patients. ResultsShort-term (24 hours) inhibition of ERK1/2 and EZH2 resulted in increased expression of utrophin in proliferating myoblasts. Surprisingly, in patient-derived samples, but not healthy controls, increased UTRN expression was sustained following drug removal and in vitro differentiation. Furthermore, dystrophin deficient myoblasts have altered expression of myogenic transcription factors MYOD1 and MYOG and proliferation marker Ki67, signalling an altered regenerative capacity of these cells, while ERK1/2 inhibition, alone or combined with EZH2i, reversed this transcriptional signature. ConclusionsTreatment with ERK1/2 and EZH2 inhibitors could offer a therapeutic option for DMD by increasing UTRN and MYOD1 expression. We propose that this may compensate for DMD loss and help restore productive muscle differentiation and regeneration.

BackgroundEnhanced Recovery After Surgery (ERAS) optimizes perioperative management for colorectal cancer (CRC), improving short-term outcomes, but its impact on long-term outcomes remains inconclusive, supporting the need for this meta-analysis. This study evaluates the effect of perioperative ERAS (therapy-focused) on 1-, 2-, 3-, and 5-year postoperative survival in patients with CRC. MethodsWe conducted a systematic review and meta-analysis following a pre-registered protocol in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Embase, Medline Ovid, and Cochrane Library Wiley were searched up to December 31, 2025, for clinical studies reporting long-term postoperative survival outcomes of patients with CRC undergoing ERAS implementation. Of 1,063 retrieved reports, 10 studies (5,876 patients) were included in Kaplan-Meier-based meta-analyses and eight studies (5,556 patients) in aggregated data meta-analyses. Data extraction was performed independently by two reviewers, with study quality and risk of bias assessed using the Newcastle-Ottawa Scale (NOS) and RevMan software. Effect sizes were pooled using fixed- or random-effects models according to heterogeneity, with cross-validation and subgroup analyses examining the influence of tumor stage and ERAS adherence. The pre-specified primary outcome was postoperative overall survival (OS) [&ge;]12 months, and the secondary outcome was disease-free survival (DFS). ResultsERAS significantly improved OS at 1 year (93.2%, 95% CI: 92.3-94.2 vs. 90.2%, 95% CI: 89.1-91.2), 2 years (86.7% vs. 81.3%), 3 years (81.1% vs. 72.4%), 5 years (70.9% vs. 60.6%) (all P<0.01). The pooled HR for mortality was 0.72 (95% CI: 0.63-0.83, P<0.01), indicating a 28% reduction in long-term mortality. Stage I-II tumors and ERAS adherence [&ge;]70% conferred the greatest benefits. DFS did not show a statistically significant improvement (HR=0.90, 95% CI: 0.68-1.19, P=0.45). Included studies were of moderate to high quality (NOS score 6-9). ConclusionsPerioperative ERAS significantly improves 1- to 5-year OS and reduces long-term mortality in patients with CRC, with the greatest benefits in early-stage disease and high adherence. These findings support ERAS as a critical component of comprehensive CRC care.

Background and AimMASLD affects 30-38% of Indian adults, yet the contribution of genetic risk variants to disease susceptibility and fibrosis progression remains poorly characterised. We investigated the association of 12 candidate SNPs with MASLD susceptibility and fibrosis severity in North Indian patients, benchmarking allele frequencies against IndiGenomes and global populations. MethodsSixty-nine MASLD patients (75.4% male; median BMI 29.8 kg/m{superscript 2}) from a tertiary care liver clinic in New Delhi were genotyped for 12 SNPs using Illumina custom BeadChip array and Sanger sequencing. Patients were stratified by liver stiffness measurement (LSM): significant fibrosis ([&ge;]8 kPa, n=38) versus no significant fibrosis (<8 kPa, n=31). Allele frequencies were compared with IndiGenomes ([~]1,020 Indian individuals) and 1000 Genomes populations. ResultsPNPLA3 rs738409 G allele was the strongest within-cohort predictor of significant fibrosis (allelic OR 2.89, 95% CI 1.35-6.19, P=0.006; dominant model OR 3.94, P=0.008), with carriers demonstrating higher LSM (median 15.6 vs. 7.5 kPa, P=0.005). SAMM50 rs3761472 (OR 2.12, P=0.065) and FTO rs9939609 (OR 2.08, P=0.089) showed non-significant trends. In the population-level comparison, APOC3 rs2854116 T allele was the only variant significantly enriched after Bonferroni correction (64.0% vs. 47.9%; OR 1.93, 95% CI 1.35-2.77, P<0.001), followed by PNPLA3 (33.3% vs. 24.1%, OR 1.57, P=0.019) and SAMM50 (31.2% vs. 22.6%, OR 1.55, P=0.028). Notably, APOC3 showed no association with fibrosis (OR 0.96, P=1.000), suggesting a role in susceptibility rather than progression. All SNPs were in Hardy-Weinberg equilibrium. ConclusionsThis study reveals a dissociation between genetic determinants of MASLD susceptibility and fibrosis progression in North Indian patients. APOC3 rs2854116 predisposes to MASLD at the population level, while PNPLA3 rs738409 drives fibrosis severity within established disease, underscoring the need for ancestry-specific genetic risk stratification. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=112 SRC="FIGDIR/small/26347059v1_ufig1.gif" ALT="Figure 1"> View larger version (69K): org.highwire.dtl.DTLVardef@a07808org.highwire.dtl.DTLVardef@12882adorg.highwire.dtl.DTLVardef@9b33a1org.highwire.dtl.DTLVardef@15aa5e8_HPS_FORMAT_FIGEXP M_FIG C_FIG