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Abstract Background Acamprosate is an FDA-approved medication for the treatment of alcohol use disorder (AUD), however, only about 50% of patients will respond to acamprosate. Previously, we conducted an acamprosate trial (n=442), which is one of the largest acamprosate clinical studies ever conducted and currently the only study with multi-omics data. To date, no biological measures are utilized to predict response to acamprosate treatment. Aims & Objectives We set out to apply our established pharmaco-omics informed genomics strategy to identify potential biomarkers associated with acamprosate treatment response. Method Our open-label acamprosate clinical trial recruited 442 patients with AUD, all of whom were treated with acamprosate for three months. The primary outcomes were 1) relapse to alcohol use and 2) relapse to heavy drinking. Alcohol consumption was measured using the self-reported timeline follow back method. Plasma protein levels were measured using Olink proximity extension immunoassays. Results Our established “Pharmaco-Omics-informed genome-wide association study (GWAS)” research strategy identified 12 proteins, including interleukin-17 receptor B (IL17RB), that were associated with acamprosate treatment response. A GWAS for IL17RB concentrations identified several genome-wide significant signals. Specifically, the top hit single nucleotide polymorphism (SNP) rs6801605 with a minor allele frequency of 38% in the European American population mapped 4 kilobase (Kb) upstream of IL17RB, and intron 1 of the choline dehydrogenase (CHDH) gene on chromosome 3 (p: 4.8E-20). The variant genotype (AA) for the SNP rs6801605 was associated with lower IL17RB protein expression. In addition, we identified a series of genetic variants in IL17RB that were associated with acamprosate treatment outcomes. Furthermore, the variant genotypes for all of those IL17RB SNPs were protective against alcohol relapse. Finally, we demonstrated that the basal level of mRNA expression of IL17RB was inversely correlated with those of nuclear factor-κB (NF-κB) subunits, and a significantly higher expression of NF-κB subunits was observed in AUD patients who relapsed to alcohol use. Discussion & Conclusions This study illustrates that IL17RB genetic variants might contribute to acamprosate treatment outcomes. This series of studies represents an important step toward generating functional hypotheses that could be tested to gain insight into mechanisms underlying variation in acamprosate treatment response phenotypes.

Abstract Background The dorsolateral striatum (DLS) is predominantly associated with movement and habitual behaviors while the dorsomedial striatum (DMS) is primarily recognized for regulating goal-directed reward-seeking behaviors. Notably, activating striatal direct-pathway medium spiny neurons (dMSN) enhances reinforcement learning, whereas stimulating striatal indirect-pathway MSN (iMSN) induces avoidance behaviors and inhibits reinforcement. Although extensive research has compared the functions of DMS versus DLS or iMSN versus dMSN in reward-seeking, it remains unclear whether iMSN may exhibit distinct roles in suppressing compulsive alcohol-seeking within each specific striatal subregion. Aims & Objectives In this study, we sought to address this by selectively ablating iMSNDMS->GPe and iMSNDLS->GPe and trained mice to exhibit goal-directed and habitual reward-seeking behaviors using random ratio (RR) and random interval (RI) operant conditioning, respectively. We also aim to investigate whether circuit-specific partial ablation alters compulsive alcohol-seeking and drinking behaviors. Method To ablate the circuit in a targeted fashion, we employed a genetically engineered caspase 3, in which activation results in apoptosis. We also investigated compulsive ethanol-seeking behaviors using nose-poke operant alcohol-drinking experiments in a two-bottle choice (water versus alcohol) paradigm with or without quinine adulteration. Results Interestingly, caspase 3-mediated ablation of iMSNDMS->GPe resulted in an insensitivity to satiety-based reward devaluation in RR-trained mice, consistent with a shift toward habitual behavior. The ablation of iMSNDLS->GPe did not influence locomotor function in the open field test and accelerated rotor rod or anxiety-related behaviors, nor did it affect the expression of habitual or goal-directed seeking behavior during the devaluation of a random interval or random ratio operant schedule. However, when subjected to quinine adulteration, mice with iMSNDLS->GPe ablation exhibited increased compulsive alcohol-seeking behaviors in habitual and goal-directed operant conditioning paradigms. Consistently, in a separate cohort of mice, we found that the iMSNDLS->GPe ablated mice showed higher preference and consumption of alcohol than control mice in a two-bottle choice experiment, with increasing quinine concentration and exhibiting more compulsive-like behavior. The iMSNDLS->GPe ablated mice prefer more ethanol than control mice while still developing an aversion to seeking the reward. Discussion & Conclusions Altogether, our findings reveal an essential role of iMSNDLS->GPe in behavioral flexibility and inhibiting compulsive-like behavior, which may be a potential therapeutic target for alcohol and other addictive disorders. Our findings reveal a novel role of iMSNDLS->GPe in behavioral flexibility and constraining habitual reward-seeking, which may be a potential therapeutic target for alcohol use disorder and other compulsive disorders.

Abstract Background DNA methyltransferase 1 (DNMT1) is essential for DNA methylation and chromatin stability. DNMT1 on chromosome 19p 13.2 mutations in this gene lead to a dominantly inherited neurodegenerative phenotype with a triad of symptoms shared by all patients that includes: 1) Peripherally sensory neuropathy; 2) Sensorineural hearing loss; 3) Early on set dementia. Some patients also have seizure, narcolepsy, cerebellar ataxia, optic nerve atrophy. Importantly, almost phenotype mutations patients are can grow up until adulthood, symptoms begin at middle aged, and death typically occurs around age of 50 years. The initial clinical terms Hereditary Sensory and Autonomic Neuropathy type 1 E (HSAN1E: OMIM-614116). Aims & Objectives In DNMT1 mutations t he mutation in p.Tyr495 changing to cystaine (Y495C), the first discovard and common mutation of hereditary sensory neuropathy 1E, we producted the mutation knock-in mouse model of Y495C, verify the effect on homozygous and heterozygous mutant mice. To invastigate of impact phenotype changing the landscape of gene expression, compair wild -type littermate and tne mutant mouse. Method By using Gene knockin technichs, the process of tardeted insertion of the exogenous gene (Dnmt1 TAT>TGT) at a specific locus (Exon 19) in genomic Dnmt1, generate homozygous and heterozygouse mutant mouse. Experimental Design: To compair with wild-type littermate with mutant mouse model, parformed Rotor rod test as a neurophysiology and Nerve conduction study as a sensory test. Neuropathologically, we also parformed sciatic notch light microscopy epoxy-embedded methyl bluestained nerve. Results DNMT1 mutation knock in mouse model; Homozygous Y495C/Y495C mice were small and immatureness copaired to wt/Y495C heterozygpus one, were lethal 9.5 days during gestation. On the other hand heterozygous wt/Y495C mutant mouse catch up, give birth and grew up normally. At 9 month old Y495C mice, their sciatic notch light microscopy epoxy-embedded methyl bluestained nerve showed the characteristic fiber loss and axional degeneration. At 10-12 months and 16-18 months old, in nerve conduction study and Rotor-Rod testing, wt/Y495C mice decreased SNAP-Amplitude reduced, total running time of Rotor-Rod test dicreased with their ages. Discussion & Conclusions Heterozygous mutation in DNA metyrtransferase 1 (DNMT1) Y495C mice presented normal neural development and lifespan as well as the disease of human being (HSAN1E). Around 30's age, the patient's sensory loss become clearly present periferal sensory neuropathy. The gait disturbance is also gradually advanced with ataxia. Axonal degeneration at 9 month, deteriorating sensorimotor coordination manifested with age by Rotor-Rod test. Dementing status of DNMT1E shows FTD like symptons which advanced prominent around 40's. Reducing total ranning time by Rotre-Rod test may means loss of urge and attetion as a frontal lobe sign. Y495C homozygous mutant mice die during gestation. Homozygous genome methyration reduction cause newral hypogenesis of the fetus. The mutation in p.Tyr495 changing to cystaine (Y495C) are located in the middle part of TS domain which is hot spot mutant site, where a highly-conserved region has been identified essential for the binding of heterochromatin.

This study reveals a novel role for Treg-derived IL-6R in supporting epithelial repair. Despite preserved immune-suppressive capacity, deletion of IL-6R from Tregs impairs epithelial transcription and worsens injury in colitis. We demonstrate that human intestinal organoids preferentially respond to trans- over classic IL-6 signaling. These findings introduce a Treg-specific role in immune-epithelial cross talk relevant to mucosal healing and inflammatory bowel disease.

Abstract Objective: We investigated differences in cognition between variants of progressive supranuclear palsy (PSP) including PSP-Richardson (PSP-RS) and subcortical and cortical variants using updated diagnostic criteria and comprehensive neuropsychological assessment. Method: We recruited 140 participants with PSP (age = 71.3 ± 6.9 years; education = 15.0 ± 2.8 years; 49.3% female) who completed neurological and neuropsychological assessment. Participants received diagnoses of PSP clinical variants at their evaluation (or retrospectively if evaluated before 2017) according to the Movement Disorder Society PSP criteria. We grouped variants as PSP-RS (62 participants), PSP-Cortical (25 with PSP-speech/language and 9 with PSP-corticobasal syndrome), and PSP-Subcortical (27 with PSP-parkinsonism, 11 with PSP-progressive gait freezing, and 6 with PSP-postural instability). Analysis of covariance adjusted for age assessed for differences in neuropsychological performance between variants across cognitive domains. Results: PSP-Cortical participants performed worst on measures of visual attention/working memory (Spatial Span Forward/Backward/Total), executive function (Frontal Assessment Battery), and language (Letter Fluency). PSP-RS participants performed worst on verbal memory (Camden Words). There were no significant group differences for the MoCA or indices of visuospatial function. There were no sex or education differences between PSP groups; however, there were differences in age at visit and disease duration. Conclusions: In a large sample of participants with PSP, there were differences in cognition across PSP-RS, PSP-Subcortical, and PSP-Cortical variants, with PSP-Cortical and, to a lesser extent, PSP-RS, performing worse on tests of attention and executive function. These findings suggest cognitive distinctions among PSP clinical variants and highlight the value of neuropsychological assessment in differential diagnosis of PSP subtypes for more accurate and timely clinical classification.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are among the most prevalent causes of chronic liver disease worldwide, closely linked to the global rise in overweight and obesity, type 2 diabetes, and metabolic syndrome. Until recently, treatment options were limited to lifestyle interventions, with no approved pharmacologic therapies. Resmetirom, a liver-directed, selective thyroid hormone receptor beta (THR-β) agonist, is a promising disease-modifying agent that targets hepatic lipid metabolism, inflammation, and fibrosis. Clinical trials, including the pivotal phase 3 MAESTRO-NASH and MAESTRO-NAFLD-1 trials, have demonstrated significant improvements in liver fat reduction, lipid profiles, histological endpoints, and health-related quality of life, with a favorable safety profile. In March 2024, the FDA granted accelerated approval of resmetirom for adults with MASH and moderate-to-advanced fibrosis, marking a significant milestone in MASLD treatment. This review discusses the mechanistic rationale, preclinical data, and pivotal clinical trial outcomes supporting resmetirom’s role in MASLD/MASH management, while outlining ongoing research needs, including long-term safety, pediatric evaluation, and biomarker development for optimized patient selection.

Abstract Background One in five adults aged 40 will develop heart failure (HF) during their lifetime. Risk factors (e.g., hypertension, diabetes mellitus, coronary artery disease, etc.) lead to structural and functional changes in cardiomyocytes, resulting in HF. At the cellular level, these changes consist of mis/over‐expression of genes that regulate cardiac identity (e.g., CamK2δ, PKC, Stat3, etc.). The current paradigm for treating HF is pharmacological or device‐based intervention; however, with few exceptions, the condition worsens with time. We are proposing to implement a change in HF treatment, shifting from a drug‐centric system to a cardiac target‐specific molecular approach that would reverse hypertrophy and adverse remodelling of affected cardiomyocytes. Methods A cardiomyocyte targeting peptide (CTP) was reversibly linked to miRNA106a for delivery to a mouse model of HF. Reversal of morphological, signalling, and physiological HF parameters was measured. Additionally, CTP‐miRNA106a was introduced into a human cardiomyocyte cell line to identify mechanism(s) at play for reversing HF characteristics (e.g., hypertrophy). Results Bio‐distribution studies showed that intravenously injected CTP‐miRNA106 delivered its cargo specifically to the heart within 30 min, followed by clearance of CTP from the heart to the kidneys, and to a lesser extent, the liver by 35 h with persistence of miRNA106a in cardiomyocytes until day 7 (the latest tested time‐point). CTP‐miRNA106a reversed angiotensin2/isoproterenol‐induced hypertrophy in 90% of the treated mice. We also identified two potential HF intracellular signalling pathways/mechanisms (PLCβ1/PKC/IP3 and NF‐κB) targeted by CTP‐miRNA106a that could benefit many pathophysiologies underlying HF, including inflammation. Conclusions CTP‐miRNA106a, a first‐of‐a‐kind cardiac‐specific drug, downregulates genes involved in cardiac hypertrophy and inflammation through the PLCβ1 and CamKIIδ kinase pathways. CTP delivery of miRNA106a cargo is specific to cardiomyocytes both in vitro and in vivo, and once delivered, many HF parameters, including hypertrophy, are reversed. Key points Cardiac Targeting Peptide (CTP) delivers, specifically to the heart, reversibly linked miRNA106a. MiRNA106a targets genes in various pathways known to cause heart failure when they are over/hyper activated returning their expression to normal levels. In vivo analyses using a mouse heart failure model resulted in reversal of heart failure parameters in 19/20 mice.

ABSTRACTBackgroundDifferentiating metastatic melanoma from histologic mimics such as malignant gastrointestinal neuroectodermal tumor (GNET), malignant melanotic nerve sheath tumor (MMNST), and epithelioid malignant peripheral nerve sheath tumor (EMPNST) poses significant diagnostic challenges due to overlapping morphology and immunophenotypes. PRAME is a novel immunohistochemical marker increasingly used to distinguish melanoma from its mimics, but remains underexplored in these rare tumor types.MethodsPRAME immunohistochemistry was performed on four GNETs, seven MMNSTs, 10 EMPNSTs, 16 metastatic melanomas (including eight undifferentiated melanomas), and two MITF‐rearranged melanocytic tumors. PRAME expression was scored from 0 to 4+ based on the percentage of tumor nuclei showing moderate to strong staining.ResultsAll GNETs, MMNSTs, and MITF‐rearranged tumors were PRAME‐negative. EMPNSTs showed variable expression: six were negative (0–1), one equivocal (2+), and three positive (3–4+). Fifteen of 16 melanomas were PRAME‐positive. PRAME scores differed significantly among tumor types (p = 1.99 × 10−5). PRAME demonstrated high sensitivity and specificity for distinguishing metastatic melanoma from primary mimickers including GNET and MMNST, but low specificity in EMPNST (71.4%).ConclusionsPRAME reliably distinguishes metastatic melanoma from GNET and MMNST, supporting its use in this differential. However, its reduced specificity in EMPNST limits its standalone diagnostic value in this context, emphasizing the need for a multimodal approach.

Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Around-the-clock dosing of opioids can produce physiologic opioid dependence within 5 days. According to a 2001 consensus paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as “a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.” The experience of children undergoing iatrogenic withdrawal symptoms is variable and may be mild and go unreported or can be severe and even life threatening. Guidance on opioid withdrawal is available only for adults and primarily for adults with substance use disorders. This report will summarize existing literature and provide readers with information on how to screen for symptoms of iatrogenic opioid withdrawal as well as mechanisms for opioid withdrawal prevention.