Citations

Importance Tumor-infiltrating lymphocytes (TILs) are a provocative biomarker in melanoma, influencing diagnosis, prognosis, and immunotherapy outcomes; however, traditional pathologist-read TIL assessment on hematoxylin and eosin–stained slides is prone to interobserver variability, leading to inconsistent clinical decisions. Therefore, development of newer TIL scoring approaches that produce more reliable and consistent readouts is important. Objective To evaluate the analytical and clinical validity of a machine learning algorithm for TIL quantification in melanoma compared with traditional pathologist-read methods. Design, Setting, and Participants This multioperator, global, multi-institutional prognostic study compared TIL scoring reproducibility between traditional pathologist-read methods and an artificial intelligence (AI)-driven approach. The study was conducted using retrospective cohorts of patients with melanoma between January 2022 and June 2023 across 45 institutions, with tissue evaluated by participants from academic, clinical, and research institutions. Participants were selected to ensure diverse expertise and professional backgrounds. Main Outcomes and Measures Intraclass correlation coefficient (ICC) values were calculated for the manual and AI-assisted arms using log-transformed data. Kendall W values were calculated for Clark scores (brisk = 3, nonbrisk = 2, and sparse = 1). Reliabilities of ICC and W values were classified as moderate (0.40-0.60), good (0.61-0.80), or excellent (>0.80). AI TIL measurements were dichotomized using the 16.6 and median cutoffs. Univariable and multivariable Cox regression analyses assessed the prognostic value of TIL scores adjusted for clinicopathologic variables. Results There were 111 patients with melanoma in the independent testing cohort (median [range] age at diagnosis, 61.0 [25.0-87.0] years; 56 [50.5%] male) who contributed melanoma whole tissue sections. A total of 98 participants evaluated TILs on 60 hematoxylin and eosin–stained melanoma tissue sections. All 40 participants in the manual arm were pathologists, while the AI-assisted arm included 11 pathologists and 47 nonpathologists (scientists). The AI algorithm demonstrated superior reproducibility, with ICCs higher than 0.90 for all machine learning TIL variables, significantly outperforming manual assessments (ICC, 0.61 for AI-derived stromal TILs vs Kendall W , 0.44 for manual Clark TIL scoring). AI-based TIL scores showed prognostic associations with patient outcomes (n = 111) using the median cutoff approach with a hazard ratio (HR) of 0.45 (95% CI, 0.26-0.80; P = .005), and using the cutoff of 16.6, with an HR of 0.56 (95% CI, 0.32-0.98; P = .04). Conclusions and Relevance In this prognostic study of TIL quantification in melanoma, the AI algorithm demonstrated superior reproducibility and prognostic associations compared with traditional methods. Although the retrospective nature of the cohorts limits demonstration of clinical utility, the publicly available dataset and open-source AI tool offer a foundation for future validation and integration into melanoma management.

Tandem exposure to cannabinoids and nicotine during pregnancy poses significant risks to fetal development and health including low birth weight, preterm birth, and perinatal death. However, the effect of co-exposure with the most prominent cannabinoids found in Cannabis sativa (Trans-Δ-9- tetrahydrocannabinol (THC) and cannabidiol (CBD)) alongside nicotine on fetal lung development is not well understood. This study aims to investigate the combinatorial impact of CBD, THC, and nicotine, on human lung development through investigating cellular senescence and the potential role of senolytics in alleviating these effects. Human fetal lung explants from 10 to 16 weeks gestation were cultured on air-liquid interface and treated with various concentrations of nicotine (1µM), CBD, and THC (5µM, or 2.5µM each when used in combination), for 72 hours. To assess the effect of senolytics, the explants were also treated for 48 hours with a combination of CBD, THC, and nicotine. Subsequently, senolytics, Dasatinib (D, 250nM) and Quercetin (Q, 375nM), were added or not for an additional 24 hours. After the 72-hour treatment, explants were collected and either fixed for immunofluorescence staining (IF) analyses or used for RNA extraction and quantitative reverse transcription PCR (qRT-PCR). Additionally, the supernatants were used to evaluate the expression of the senescence-associated secretory phenotype (SASP), conducted by Eve Technologies Corporation-Canada. This study used Luminex xMAP technology for multiplexed quantification of 96 Human cytokines, chemokines, and growth factors. Our results demonstrated that co-exposure to CBD, THC, and nicotine increases the expression of the senescence markers CDKN1A (0.1163±0.02384, p=0.0094, n=8) and CDKN2A (0.005793±0.002157, p=0.0516, n=8) encoding P21 and P16 respectively. Moreover, the IF staining showed increased expression of the DNA damage marker γH2A.X following treatment with CBD+THC+nicotine (7.375±2.154% vs 2.245±0.8329%, p=0.0604, n=6). Furthermore, the lung explants treated with cannabinoids and nicotine released cytokines and chemokines involved in immune responses and inflammation among others IL-6, IL-8, M-CSF, MCP-3, MIP-1β, TNFα, MIP-3β, and TSLP (p<0.05). The addition of D+Q reduced SASP secretion and showed a decreasing trend in expression of the senescence genes CDKN1A and CDKN2A compared to the triple treatment. Taken together, our results showed that the combinatorial exposure to CBD, THC, and nicotine increases senescence, DNA damage, and the senescence-associated secretory phenotypes (SASP) secretion. The use of senolytics (D+Q) may prove to be a promising therapeutic option, alleviating several of the negative effects induced by the different substances. RO1HL171915-01A1 RO!HL155104 RO1HL158532-03 ROIHL160570 This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Importance SARS-CoV-2 infection has been linked to neurotoxic effects and cognitive deficits. Objective To determine whether decreases in cognitive function were accelerated after SARS-CoV-2 infection compared with individuals not infected. Design, Setting, and Participants Multicenter, prospective cohort study from 2016 to 2022 among 3525 participants alive on March 1, 2020, and enrolled in The Atherosclerosis Risk in Communities (ARIC) study and the Collaborative Cohort of Cohorts for COVID-19 Research study who completed a prepandemic cognitive assessment and a pandemic-era assessment of SARS-CoV-2 infection. Final analyses performed in November 2024. Exposure SARS-CoV-2 infection determined via self-report of a positive SARS-CoV-2 test or health care professional diagnosis of COVID-19, a positive SARS-CoV-2 antinucleocapsid antibody response, or presence of an administrative code for COVID-19 on medical records. Main outcomes and measures A neuropsychological battery assessed multiple cognitive domains, and a cocalibrated confirmatory factor analysis generated factor scores for global cognitive function. The primary outcome was the rate of excess change in cognitive function. Results The 3525 eligible participants had a mean (SD) age of 80.8 (4.7) years, 2085 (59.1%) were female, 752 (21.4%) were Black, and 2773 (78.6%) were White. SARS-CoV-2 infection was detected among 307 participants (8.7%), 103 of whom (33.6%) were hospitalized. Among uninfected participants, the mean annualized change in cognitive function was −0.09 (95% CI, −0.13 to −0.04). Compared with this rate, change was faster (β = −0.06; 95% CI, −0.09 to −0.02) among participants hospitalized for infection, but not different from participants who were infected but not hospitalized (β = 0.00; 95% CI, −0.02 to 0.03). The association among participants hospitalized for infection was evident in the cognitive domains of memory and executive function, but not language. Conclusions and relevance This cohort study of older participants found accelerated decreases in cognition among individuals hospitalized for SARS-CoV-2 infection, but not nonhospitalized infection, in comparison with individuals not yet infected.

Background and PurposeThe aryl hydrocarbon receptor (AhR) is a ligand‐activated transcription factor that maintains cellular homeostasis. AhR in airway fibroblasts, epithelial and immune cells inhibit inflammatory responses. Nevertheless, its expression and role in airway smooth muscle (ASM), an airway structural cell indispensable in asthma pathophysiology, are obscure. This study uncovers AhR expression, underlying mechanisms, and activity in ASM during inflammation and asthma.Experimental ApproachCultured primary human nonasthmatic and asthmatic ASM cells were treated with TNFα/IL‐13, with/without pharmacological inhibitors targeting PI3K, p38MAPK, JNK, NFkB, and AP1. AhR expression was analysed using RNA‐sequencing, confocal microscopy, qPCR, and immunoblotting. AP1 specific role was confirmed using c‐JUN (AP1) siRNA and ChIP‐qPCR. AhR activity was determined by Nano luciferase in AhR agonist‐treated cells.Key ResultsWe found ubiquitous expression of AhR in ASM with up‐regulation in asthmatic ASM. TNFα increased AhR expression, whereas IL‐13 did not. Furthermore, p38 and JNK inhibition significantly reduced AhR expression with TNFα exposure, whereas PI3K inhibition had no effect. AP1 inhibition and c‐JUN knockdown significantly down‐regulated AhR expression, whereas NFkB inhibition showed no effect. TNFα promoted c‐JUN binding to AhR promoter and increased AhR mRNA expression. Additionally, AhR agonists significantly increased the xenobiotic response element (XRE) activity, CYP1B1, and AhR nuclear expression. TNFα exposure reduced XRE activity and AhR nuclear expression.Conclusion and ImplicationsOur findings suggest inflammation and asthma transcriptionally up‐regulates AhR through the p38/JNK‐AP1 pathway in ASM, identifying a potential therapeutic target for modulating AhR and its downstream effects in asthma.

Purpose: Guidelines recommend serum estradiol concentrations of 100–200 pg/mL for transgender women prescribed oral, subcutaneous, or transdermal estradiol with or without adjunct antiandrogen as gender-affirming feminizing hormone therapy (HT). The purpose of this systematic review was to evaluate if the guideline range of 100–200 pg/mL for estradiol concentration is associated with indicators of adequate gender-affirming feminizing HT, specifically feminizing sufficiency, insufficiency, testosterone suppression, or toxicity in transgender women. Methods: The Populations/Intervention/Comparator/Outcome model was applied to the study question, whereby the target population included transgender, gender-diverse, and nonbinary adults using gender-affirming feminizing HT by any route of administration, with or without adjunct antiandrogen use. The comparator was defined as estradiol concentrations within (100–200 pg/mL or 367–734 pM) versus outside (</>100–200 pg/mL) the guideline range; evaluated outcomes were listed by the same clinical guidelines that recommend using the 100–200 pg/mL range. Embase, MEDLINE, and Web of Science were queried over a 24-year time frame (January 1, 1999–April 20, 2023); the search was restricted to English. The extracted outcomes were categorized as indicators of therapeutic insufficiency, sufficiency, toxicity, or hormone concentration. Results: There were 49 studies that met the inclusion criteria, of which 9, 42, 25, and 5 studies included indicators of therapeutic insufficiency, sufficiency, toxicity, or hormone concentration, respectively. The search did not identify articles demonstrating that the 100–200 pg/mL guideline range provides optimal feminizing outcomes or reduces adverse events. Conclusions : Evidence does not support using the guideline range of 100–200 pg/mL to indicate sufficient feminization in transgender women using gender-affirming feminizing HT.

Introduction: Throughout the lifetime of an asthmatic, the lung undergoes changes in the composition of its extracellular matrix (ECM) and becomes more fibrotic, a characteristic feature of airway remodeling. Due to this, lung functionality decreases as the lung becomes less elastic and airway resistance increases. The ECM proteins constantly network with their respective mechanosensory receptors and regulatory proteins on the cell membrane. These signaling interactions allow for continuous interactions and feedback between the ECM and airway smooth muscle cells (ASM). ASM cells are one of the major structural cells that regular airway remodeling and are the primary target for treating asthma. In this study, we investigated the specific alterations that occur in the ECM of ASM cells treated with TGF-β1. Methods: Human primary airway smooth muscle (ASM) cells were grown to confluency in DMEM/F-12 with 10% FBS and 1% AbAm in standard conditions. Cells were serum deprived for 48 hours prior to experiments. Cells were treated with TGF-β1 (2 ng/mL) in serum free media. Cells were harvested after 48 hours and 200 µg of protein lysate was prepared. Data-independent acquisition (DIA) mass spectrometry was performed at IDeA National Resource for Quantitative Proteomics. Fold changes for ECM class proteins were collected from DIA results. Pathway analysis was then done using Qiagen ingenuity pathway analysis. Furthermore, expression patterns of select proteins were confirmed via western blotting. Results: The effects of TGF-β1 on specific types of collagens, integrins, laminins, and additional ECM proteins were analyzed. Western blotting confirmed similar changes in expression as measured by DIA. TGF-β1 exposure upregulated LAMA4, LAMB2, and LAMC1 which is likely to increase the prevalence of Laminins 221 and 421. TGF-β1 augmented integrin signaling by upregulating ITGA7, ITGA11, ITGA1, ITGB1 and downregulating ITGA2 and ITGB8. TGF-β1 increased expression of TSP1, TSP2, TSP3, TNS-C, FB, Elastin and Versican while downregulating TNS-X. Several interactions between ECM proteins and their sensors and receptors were highlighted for their enrichment. Conclusion: The DIA analysis shows an upregulation of proteins involved in airway remodeling by TGF-β1 in ASM cells. These findings substantiate our previous results as well as provide insights into a more targeted approach in studying ECM-Cell interactions. NIH R01HL171245 (Venkatachalem), R01HL146705 (Venkatachalem), R01HL142061 (Pabelick, Prakash). and IDeA National Resource for Quantitative Proteomics (R24GM137786). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Rationale: Asthma is a chronic inflammatory disease of conducting airways characterized by airway hyperresponsiveness and remodeling. Airway smooth muscle (ASM) is a major structural cell in the airway that contributes to airway hyperresponsiveness and remodeling. Mitochondrial dynamics is a fission/fusion process crucial for optimal function and signal transduction. Inflammation alters the mitochondrial dynamics in ASM, thereby disrupt mitochondrial function and contributes to asthma pathophysiology. The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that regulates cellular homeostasis. Recently, we found upregulation of AhR in response to inflammation and asthma in ASM. Additionally, AhR activation inhibited inflammation-induced ASM proliferation and remodeling. However, the role of AhR in regulating mitochondrial dynamics in ASM during inflammation and asthma is obscure. Objective: The aim of this work is to unveil the role of AhR in regulating mitochondrial structure and function in human ASM during inflammation and asthma. Methods: Primary non-asthmatic and asthmatic human ASM cells isolated from surgical lung sections were cultured in DMEM-F12 medium supplemented with 10% FBS and 1% AbAm. Cells were serum deprived, treated with AhR agonist 6-Formylindolo[3,2-b]carbazole (FICZ: 10 nM) and antagonist CH223191 (10 μM), with/or without TNFα (20 ng/mL). Mitochondrial bioenergetics was determined by Seahorse XFp analyzer. Mitochondrial morphology was visualized using mitotracker dye. Expressions of fission and fusion mRNA and protein were determined by qPCR and immunoblotting. Additionally, AhR role in fusion and fission was confirmed in shRNA mediated AhR knockdown and AhR overexpressed ASM cells. Results: AhR activation by FICZ alleviated TNFα-induced disrupted mitochondrial bioenergetics in non-asthmatic ASM cells as well as in asthmatic ASM. Furthermore, TNFα-induced increased mitochondrial fission and reduced fusion was restored by AhR activation in both asthmatic and non-asthmatic ASM. AhR inhibition by CH223191 and knockdown promoted mitochondrial fission and blunted fusion in non-asthmatic ASM cells. Interestingly, AhR overexpression and activation by FICZ restored the mitochondrial dynamics altered by inflammation and asthma in ASM cells. Conclusion: Collectively, AhR activation promotes mitochondrial fusion and abolishes fission induced by inflammation and asthma in human ASM, thereby maintains mitochondrial structure and homeostasis. Therefore, AhR is a potential therapeutic target to mitigate altered mitochondrial dynamics in ASM during inflammation and asthma. Supported by NIH grants R01-HL171245 (Venkatachalem and Britt), R01-HL146705 (Venkatachalem), R01-HL155095 (Britt), R01-HL142061 (Pabelick, Prakash) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.