Citations

Introduction: Gastroesophageal reflux disease (GERD) plays an important role in lung transplant (LT) outcomes. This study aims to evaluate the impact of a novel sleep positioning device (SPD) on lung function in LT recipients with GERD. Methods: In this single-center cohort study, LT recipients (2014 to 2019) with GERD who were prescribed an SPD within 2 years of LT were included. A historical control group of LT recipients with GERD on PPI only (2011 to 2013) was selected to compare forced expiratory volume in 1 second (FEV1) as a marker of lung function. Results: Twenty LT recipients using SPD (cases) and 54 patients in the historical control group with proven GERD were included. Mean (SD) interval between LT and SPD prescription was 8.6 (5.7) months. Mean % predicted FEV1 was higher in SPD users than controls post-LT at 6 months (80% vs. 69%) and 1 year (80% vs. 71%), respectively. Among SPD users, post-SPD FEV1 was higher than pre-SPD FEV1 (82% vs. 70%). Conclusion: Use of a novel SPD can stabilize or improve pulmonary function in patients with GERD after LT. SPD may be a safe and cost-effective adjunctive therapy for the management of GERD after LT.

Abstract Background Measurement of cardiac troponin (cTn) using high-sensitivity assays is recommended for the diagnosis of myocardial infarction. We determined sex-specific and uniform 99th percentile upper reference limits (URLs) using the new Elecsys® Troponin T high-sensitivity Gen 6 assay in a global, healthy reference range cohort. Methods Lithium-heparin plasma and serum samples were prospectively collected from apparently healthy individuals aged ≥20 years across 34 global sites in the United States, Europe, China, and Japan. cTnT was measured using the Troponin T high-sensitivity Gen 6 assay on the Cobas® e 801 analyzer. Exclusion criteria were defined according to the 2022 IFCC guidance. Uniform and sex-specific 99th percentile URLs and nonparametric 95% CIs were determined in plasma and serum separately and combined. Results The final study population comprised 4147 participants (52.5% female) with a median (25th–75th percentiles) age of 48.0 (33.0–59.0) years; 45.8%, 47.9%, 5.2%, and 1.1% were White, Asian, Black, and other/unknown, respectively. For sample matrices combined (n = 8294), 81.0% and 99.2% of cTnT values were above the limit of detection in females and males, respectively. Sex-specific 99th percentile URLs (95% CI) were 18 (16–23) ng/L for females and 32 (28–35) ng/L for males; the uniform 99th percentile URL was 27 (24–31) ng/L. URLs were comparable in plasma and serum samples. Conclusions This study determined sex-specific and uniform 99th percentile URLs for the Troponin T high-sensitivity Gen 6 assay that were comparable irrespective of the matrix used in a large, global, healthy reference population.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Small Cell Lung Cancer provide recommendations for diagnostic workup, staging, and treatment. These NCCN Guidelines Insights highlight recent updates, with a particular focus on changes to systemic therapies and radiation treatment in the NCCN Guidelines for Small Cell Lung Cancer.

Acute myocardial infarction (AMI) is a significant factor leading to the death of patients with coronary heart disease. Both AMI and reperfusion therapy after AMI cause myocardial cell death, which plays a significant role in heart failure. Following the restoration of blood flow during reperfusion, myocardial cells generate a large amount of oxygen free radicals, causing various forms of myocardial ischemia–reperfusion (IR) injury (IRI), ultimately leading to multiple types of myocardial cell death, among which apoptosis and necroptosis are the two major types. Given the extremely limited regenerative capacity of myocardium, inhibiting myocardial cell apoptosis and necroptosis is a key strategy for reducing mortality in patients with AMI. Both apoptosis and necroptosis are regulated by the BCL2 family of proteins, which were modulated by multiple signaling pathways, converging at BAK/BAX-mediated mitochondrial outer membrane permeabilization (MOMP), as well as mitochondrial inner membrane permeabilization (MIMP). BAK/BAX double knock out (DKO) mice showed reduced cell apoptosis, necroptosis, and infarct size in AMI animal models compared to wild type. This review describes the role of BCL2 family proteins in regulating apoptotic and necroptotic myocardial cell death during AMI and IR, explores the upstream pathways modulating apoptosis and necroptosis, and summarizes the recent advances in targeting BAK and/or BAX for cardiac protection. In addition, targeted delivery of BAK/BAX inhibitors to cardiomyocytes during AMI or myocardial IR has the potential to reduce myocardial cell death and therefore lower the mortality and enhance long-term prognosis for myocardial infarction patients.

Abstract Purpose: Mutant IDH1 (mIDH1) defines a therapeutically targetable subtype of intrahepatic cholangiocarcinoma (ICC), with the mIDH1 inhibitor ivosidenib approved for advanced disease. A subset of patients experiences prolonged disease stabilization; however, the molecular basis for eventual progression remains poorly defined. Experimental Design: We performed molecular profiling of matched baseline and postprogression circulating tumor DNA (ctDNA) samples from patients with mIDH1 ICC enrolled in the ClarIDHy phase III trial. Functional studies were conducted to characterize candidate resistance mechanisms. Results: Longitudinal ctDNA analysis of 18 patients treated with ivosidenib for >6 months revealed emergent genomic alterations in multiple cases. Acquired mutations in mitogen-activated protein kinase (MAPK) pathway genes (KRAS, NRAS, MAP2K1, NF1) were identified in five cases, with instances of concurrent alterations and/or high variant allele fractions (VAF). Additional candidate resistance events included a secondary IDH1 mutation and a hotspot IDH2 mutation, detected at low VAF in the same patient. Functional studies showed that these IDH mutations conferred sustained 2-hydroxyglutarate production and ivosidenib resistance, whereas MAPK activation blunted gene expression induced by ivosidenib plus IFNγ, a key therapeutic output of mIDH1 inhibition. In parallel, baseline ctDNA profiling of 81 patients revealed that ARID1A mutations and elevated mIDH1 VAF were associated with reduced clinical benefit. Conclusions: MAPK pathway alterations represent a recurrent mechanism of resistance to mIDH1 inhibition in ICC, whereas emergent IDH1/IDH2 mutations appear infrequent. Functional data suggest that MAPK-mediated resistance may involve impaired IFN signaling. These results support MAPK-directed combination strategies and highlight the utility of ctDNA profiling to identify predictive and resistance biomarkers in mIDH1-driven ICC.

Abstract Despite a characteristic indolent course, a substantial subset of follicular lymphoma (FL) patients has an early relapse with a poor outcome. Thus far, efforts to identify factors that predict survival have been unsuccessful. However, we and others have demonstrated the prognostic relevance of CD4+ T cells in the tumor microenvironment (TME) of FL and developed a bio-clinical risk model (called BioFLIPI) that offers improved risk stratification (Mondello et al, BCJ 2021). However, the mechanisms defining different BioFLIPI scores remain to be fully understood. To identify the programs associated with the BioFLIPI scores, we first interrogated the RNA-seq of purified B cells from 67 newly diagnosed FL1-3A (BioFLIPI 1 n=21; BioFLIPI 2-3 n=36; BioFLIPI 4 n=10). We found 1,156 upregulated genes and downregulation of 930 genes in BioFLIPI 4 vs 1, including well-known immune molecules such as CD70, IL10RA, CD69, and CCR6 (FDR<0.05). Gene set enrichment analysis (GSEA) using the MSigDB confirmed a negative enrichment in multiple immune response and interferon gamma signatures and revealed striking positive enrichment for cell proliferation and antigen presentation pathways in BioFLIPI 4 compared to BioFLIPI 1 tumors. The same pathways were dysregulated in BioFLIPI 2-3 but a lower magnitude. To investigate the somatic mutations associated with different BioFLIPI scores, we performed WES of the same 67 FLs and further expanded this cohort for a total of 90 patients (BioFLIPI 1 n=26; BioFLIPI 2-3 n=51; BioFLIPI 4 n=13). We found enrichment for mutations in several regulators of the germinal center in BioFLIPI 4 and 2-3, such as MEF2B (p=0.029), FOXO1 (p=0.038) and IRF8 (p=0.035), suggesting the cooperation of multiple oncogenic events promoting lymphomagenesis. In contrast, BioFLIPI 1 tumors harbored a higher rate of mutations in TNFRSF14 gene, known to enhance anti-lymphoma immune response. To investigate whether BioFLIPI modulates immune signatures of the microenvironment, we performed TME deconvolution by applying CIBERSORTx to bulk RNA-seq of these 67 FLs. We found that FLs with BioFLIPI 4 and 2-3 were enriched for CD4+ Tcm exh (p=0.02), Tem exh (p=0.04), Tfhexh (p=0.07) and NK cells (p=0.01) compared to BioFLIPI 1. In line with this data, CyTOF performed on a subset of these patients (BioFLIPI 1 n=12; BioFLIPI 2-3 n=25; BioFLIPI 4 n=6) confirmed progressive increase of CD4+ Tcm exh (p=0.006), Tem exh (p=0.009) and Tfh exh (p=0.025) cells from BioFLIPI 1 to BioFLIPI 4. Single cell RNA/BCR-seq of 21 FLs (BioFLIPI 1 n=6; BioFLIPI 2-3 n=12; BioFLIPI 4 n=3) corroborated a higher abundance of Tem exh, cytotoxic (CTL) Tem exh, Tfhexh and NK cells in BioFLIPI 4 and 2-3. Conversely, CD8+ naïve T cells were prevalent in BioFLIPI 1 tumors. Differential gene expression in T cell clusters from BioFLIPI 4 vs BioFLIPI 1 FL revealed a marked upregulation of multiple immune genes involved in antigen presentation (e.g., HLA-DRB, HLA-DQA, HLA-DPA/B) and immune response (e.g., ETS1, TNFSF8, IL7R). GSEA showed a positive enrichment for antigen presentation signatures and negative enrichment for TNFα signaling and Oxphos metabolism. Similar findings were observed in BioFLIPI 2-3 FLs. Using CellChat analysis, we found a stronger interaction between malignant B cells and Tem exh and CTL Tem exh cells in BioFLIPI 4 and 2-3 vs BioFLIPI 1 tumors. This was linked to an increased strenght of MHCI-CD8 interaction and concordant decrease of MHCII-CD4. Notably, the suppressive BTLA-TNFRSF14 signaling axis was present in BioFLIPI 4 and 2-3 but not in BioFLIPI 1 FLs. This was accompanied by a decreased signaling through TNF/LTA-TNFRSF1B, CD80/CD86-CD28/CTLA4. Linking the BioFLIPI-specific immunogenicity to lymphomagenesis, we found that FL patients with BioFLIPI 4 had two-three folds higher risk of transformation to an aggressive lymphoma (12% vs 7%) or death (21% vs 3%) than those with BioFLIPI 1, suggesting that this immune dysfunction favors the expansion of a dominant tumor clone and promotes a more aggressive form of FL. Collectively, our findings demonstrate that BioFLIPI scores in FL reflect distinct patterns of tumor immunogenicity that shape the TME. Notably, high BioFLIPI scores are paradoxically associated with enhanced antigen presentation alongside a suppressed immune response. This suggests a sustained antigen-specific T cell response that may drive immune exhaustion, promote tumor progression, and ultimately lead to histologic transformation

Abstract Introduction Venetoclax combined with hypomethylating agents (VEN/HMA) is an approved frontline induction therapy for older or unfit patients with acute myeloid leukemia (AML). However, data comparing its efficacy and safety to intensive chemotherapy (IC) in intermediate-risk AML—characterized by molecular and cytogenetic heterogeneity—remain limited. Methods This multicenter, real-world retrospective study analyzed newly diagnosed intermediate-risk AML patients who received either VEN/HMA or IC. We evaluated composite complete remission (CRc) rates, transfusion and infection rates, long-term outcomes including overall survival (OS) and progression-free survival (PFS), and performed subgroup analyses to identify mutation-specific predictors of treatment response. Multivariable Cox regression was used to identify independent prognostic factors. Results A total of 229 intermediate-risk AML patients were included. VEN/HMA achieved a comparable CRc rate to IC (75.3% vs. 63.4%) with lower transfusion needs and fewer infections. Patients harboring FLT3-ITD, DNMT3A, or TET2 mutations showed greater benefit from VEN/HMA, while KIT-mutated patients responded more favorably to IC. Among patients who did not undergo allo-HSCT, VEN/HMA significantly improved 3-year OS (P = 0.001) and PFS (P = 0.008). No significant OS or PFS difference was observed in the allo-HSCT subgroup. In MRD-negative patients without transplant, those treated with VEN/HMA had superior OS compared to IC. Multivariable analysis identified VEN/HMA (HR = 0.613, P = 0.038) and allo-HSCT (HR = 0.11, P = 0.001) as independent predictors of better survival. Conclusions VEN/HMA is a safe and effective induction strategy for intermediate-risk AML, particularly in patients with BCL-2 inhibitor–sensitive mutations (FLT3-ITD, DNMT3A, TET2). These findings support a genotype-guided treatment approach in AML, complementing current risk stratification frameworks and informing individualized induction therapy decisions.

Abstract Description Common variable immunodeficiency (CVID) is a common inborn error of immunity, but a monogenic cause is rare. Biallelic loss-of-function pathogenic variants in the gene encoding BAFF-Receptor (TNFRSF13C) is one such cause. A common missense variant in BAFF-R, p.Pro21Arg, was proposed as contributing to the pathogenesis of non-monogenic CVID by Peiper et al. 2014 with an allelic frequency of 6.7% in controls versus 10.2% in CVID patients (OR 1.57, p = 0.0026) and Block et al. 2023 with an 11.36% allele frequency in CVID when compared to the Non-Finnish European population in the gnomAD database (OR = 1.316, p = 0.0145) and to an internal cohort of controls (OR = 1.316, p = 0.0458). Exact population composition matching is critical, as the frequency of this variant is highly variable even in Europe. We found the allelic frequency of BAFF-R p.Arg21Pro to be 10% from 90 non-familial CVID patients from the University of Utah Health Sciences Center, similar to Pieper et al. (10.2%) and Block et al. (11.36%), but comparing our Utah CVID patients to the 1000 Genomes project Utah Residents (CEU) with Northern and Western European Ancestry, which matches our CVID cohort (9.6% allelic frequency); we obtained an OR of 1.0468 (95% CI: 0.5309 to 2.0638; p = 0.8950). For further studies on BAFF-R p.Pro21Arg, we recommend closely matching the reference populations, and not using a broad European or other control populations. Topic Categories Translational and Interventional Immunology (TI)

ABSTRACT Suicidality contributes substantially to global morbidity and mortality, yet despite its heritability, its biological etiology remains largely elusive. We conducted multi-ancestry genome-wide association study meta-analyses of suicidal ideation (259,747 cases), suicide attempt (64,993 cases), suicide death (9,197 cases), and suicidal behavior (suicide attempt/ death, 75,300 cases), across 54 cohorts (e.g., the Psychiatric Genomics Consortium, Million Veteran Program, UK Biobank). We identified 77 significant loci across meta-analyses, including 59 previously unreported for suicidality. SNP-based heritability ranged from 2.0-6.7% and there were strong, yet incomplete, genetic correlations between suicidality phenotypes (0.70-0.88). Fine-mapping prioritized putative causal SNPs and 20 credible genes. Enrichment analyses implicated synaptic pathways and neuronal populations predominantly in subcortical brain regions (e.g., amygdala excitatory, medium spiny, hippocampal CA1-3). Together, these findings establish suicidality as a polygenic set of traits with both shared and distinct genetic influences, providing a foundation for future studies of suicide biology and etiology.

Abstract Background Acupuncture, a key modality in traditional Chinese medicine, is gaining global recognition as a complementary therapy and a subject of increasing scientific interest. However, fragmented and unstructured acupuncture knowledge spread across diverse sources poses challenges for semantic retrieval, reasoning, and in-depth analysis. To address this gap, we developed AcuKG, a comprehensive knowledge graph that systematically organizes acupuncture-related knowledge to support sharing, discovery, and artificial intelligence–driven innovation in the field. Methods AcuKG integrates data from multiple sources, including online resources, guidelines, PubMed literature, ClinicalTrials.gov, and multiple ontologies (SNOMED CT, UBERON, and MeSH). We employed entity recognition, relation extraction, and ontology mapping to establish AcuKG, with human-in-the-loop to ensure data quality. Two cases evaluated AcuKG’s usability: (1) how AcuKG advances acupuncture research for obesity and (2) how AcuKG enhances large language model (LLM) application on acupuncture question-answering. Results AcuKG comprises 1839 entities and 11 527 relations, mapped to 1836 standard concepts in 3 ontologies. Two use cases demonstrated AcuKG’s effectiveness and potential in advancing acupuncture research and supporting LLM applications. In the obesity use case, AcuKG identified highly relevant acupoints (eg, ST25, ST36) and uncovered novel research insights based on evidence from clinical trials and literature. When applied to LLMs in answering acupuncture-related questions, integrating AcuKG with GPT-4o and LLaMA 3 significantly improved accuracy (GPT-4o: 46% → 54%, P = .03; LLaMA 3: 17% → 28%, P = .01). Conclusion AcuKG is an open dataset that provides a structured and computational framework for acupuncture applications, bridging traditional practices with acupuncture research and cutting-edge LLM technologies.