Citations

BACKGROUND: Bicuspid aortic valve (BAV) is a frequent congenital heart defect with a high heritability. Despite this, only a limited number of genes have been associated with the disease, and the molecular mechanisms remain unexplained in most cases. This study aimed to further understand the genetic architecture of BAV. METHODS: A genome-wide association study meta-analysis including 9631 cases among 65 677 participants was performed. Genes were prioritized using transcriptomic analyses based on RNA sequencing in relevant tissues, including human fetal and adult aortic valves. The impact of the knockdown or knockout of 4 candidate genes on cardiac development was verified in zebrafish. A polygenic risk score was developed, its association with BAV was evaluated in an independent cohort, and its association with a wide range of phenotypes (n=976) was evaluated in UK Biobank (n=355 618 individuals). RESULTS: Thirty-six genomic loci were identified, including 32 that were not described previously. Among the prioritized genes, KANK2 and ERBB4 were identified as potentially causal through transcriptomic analyses, colocalization, and Mendelian randomization based on gene expression in human aortic valves (n=484), whereas PRDM6 and STRN were prioritized using similar analyses from aortic (n=326) and left ventricular tissues (n=326), respectively. Targeting 4 candidate genes ( WNT4 , LEF1 , STRN , and KANK2 ) in zebrafish led to disruption in cardiac development. A polygenic risk score was associated with an odds ratio of 2.07 (95% CI, 1.90–2.25; P =5.43×10 -62 ) per SD for BAV and significantly associated with thoracic aortic aneurysm and atrial fibrillation in UK Biobank. CONCLUSIONS: This study supports a significant polygenic contribution to BAV, where the combination of multiple common variants in genes involved in heart morphogenesis disrupts aortic valve development.

The immunosuppressive tumor microenvironment (TME) remains a major barrier to effective cancer immunotherapy. Among the central regulators of immune suppression, CD38, a multifunctional ectoenzyme and surface glycoprotein, has emerged as a pivotal orchestrator. CD38 is abundantly expressed on regulatory T cells (Tregs), regulatory B cells (Bregs), myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), and tumor-associated neutrophils (TANs), where it enhances survival, metabolic fitness, and suppressive activity. Invariant natural killer T (iNKT) cells, which can either promote or suppress antitumor immunity, also express CD38 upon activation, suggesting a role for CD38 in directing their context-dependent fate within the TME. Mechanistically, CD38 regulates immune suppression through NAD + hydrolysis, calcium signaling, and promotion of fatty acid oxidation (FAO) while impairing effector T-cell glycolysis and mitochondrial fitness under chronic hypoxia—conditions that favor exhaustion rather than enhanced cytotoxicity. By depleting extracellular NAD + , CD38 diminishes glycolysis and mitochondrial oxidative phosphorylation in effector T cells, while sustaining regulatory cell persistence through FAO. Its enzymatic products, cyclic ADP-ribose (cADPR) and NAADP, further mobilize calcium fluxes that reinforce suppressive function. CD38 also integrates with hypoxia-driven pathways; in CD38 + Bregs, stabilization of HIF-1α and induction of FAO-related genes such as CPT1A and PPARα/γ promote angiogenesis, immune-evasion, and therapeutic resistance. Therapeutically, targeting CD38 with monoclonal-antibodies, small-molecule inhibitors, or combinations with checkpoint blockade and macrophage-reprogramming agents has shown promise. Such interventions reverse immune suppression, restore effector T cell activity, and enhance tumor responsiveness to immunotherapy. In summary, CD38 functions as both a metabolic regulator and an immunologic checkpoint, coordinating suppressive networks and shaping iNKT cell fate. These multifaceted roles position CD38 as a transformative target for next-generation immunotherapies.

Abstract Background Previous studies demonstrated an association between tau pathology and the development of neuropsychiatric symptoms (NPS) in individuals with Alzheimer's disease (AD). However, the extent to which tau influences each specific NPS domain remains unclear. Here, we aim to investigate the association of tau and each NPS domain in the AD continuum. We hypothesized that tau plays a comparatively greater effect on the emergence of hyperactive and psychotic symptoms compared to other NPS domains. Method We assessed 385 individuals (216 cognitively unimpaired (CU), 128 MCI, and 41 AD dementia) from the HEAD study who underwent clinical assessments with the Neuropsychiatry Inventory Questionnaire (NPI‐Q) and had positron emission tomography (PET) for amyloid‐β (Aβ) ([ 18 F]AZD4694 or [ 11 C]PiB), and tau tangles ([ 18 F]MK6240) at the same visit. Tau SUVR values were tailored with a mask from Braak stages I‐VI, using the inferior cerebellar gray matter as a reference region. All individuals with dementia had a positive Aß‐PET. Voxel‐wise and Tobit censored regression tested the association between NPS domains and biomarkers accounting for age, sex, cognitive status, and study site. We used censored regression models to account for skewed data alongside a leave‐one‐out (loo) approach to identify which NPS domains most contributed to results. Result CI individuals had significantly higher NPI‐Q scores and Tau PET SUVR than CU (Figure 1A, 1B). NPI‐Q score was significantly associated with tau‐PET predominantly in fronto‐parietal regions. Removing irritability from the models strengthened this association (Figures 2A‐C). Regression loo models revealed that motor disturbances contributed most to the association between NPS and tau‐PET across all Braak stages. Notably, irritability had a negative effect on the association in all Braak stages, suggesting that tau does not play a role in the development of irritability and is highly associated with motor disturbances (Figure 3). Conclusion Our study suggests that tau contributes to the development of motor disturbances but has no effect on the development of irritability across the AD continuum. These findings provide additional rationale for the development of new therapeutics aiming to mitigate motor disturbances and irritability in AD patients.

Abstract Introduction Cannabidiol has been shown to exert significant anti-inflammatory effects and has demonstrated efficacy in murine models of autoimmune myocarditis, pericarditis, and heart failure. The ARCHER Study assessed whether a pharmaceutically produced cannabidiol formulation showed beneficial effects on cardiac magnetic resonance (CMR) endpoints known to predict prognosis in this patient population. Methods In a multicentre international double-blind placebo-controlled phase 2 study, we randomly assigned 109 patients within 10 days of CMR confirmed diagnosis of acute myocarditis to 12 weeks of pharmaceutically produced oral cannabidiol (active) or placebo. Dose was titrated up to 10 mg/kg of body weight twice daily. Primary endpoints were the difference in extracellular volume (ECV) and global longitudinal strain (GLS) measured by CMR at week 12. Other CMR endpoints included left-ventricular ejection fraction (LVEF), LV mass, intracellular volume (ICV), LV end-diastolic and end-systolic volumes (LVEDV, LVESV), and left-atrial end-systolic volume (LAESV). Results All randomized patients (56 active/53 placebo) completed the study with no loss to follow-up. Study drug appeared safe and well tolerated. Baseline mean ECV 38.9 ± 10.9 ml, GLS −15.3 ± 3.6%, and LVEF 60.6 ± 9.9% were consistent with mild to moderate myocarditis and predominantly intact LV function. Week 12 mean ECV was 33.6 ml in the active group and 37.3 ml in the placebo group, a difference of −3.7 ml, confidence interval (CI): −7.4 to 0.1; P = .0538; GLS was −16.0% in the active group and −15.9% in the placebo group, difference of −0.1, CI: −1.2 to 1.1; P = .90. Left ventricular mass was significantly reduced in the active group at 121.1 g compared to placebo 130.3 g, a difference of −9.2, CI: −16.4 to −2.1; P = .0117. In terms of remodelling, LAESV was significantly reduced in the active group (−8.1 ml; P = .0376) while the reduction in LVEDV failed to reach significance (−7.4 ml; P = .098). Conclusion In mild-to-moderate acute myocarditis, treatment with pharmaceutically manufactured cannabidiol was not associated with a statistically significant change in myocardial ECV or GLS, although a trend towards reduction in ECV was observed. In addition, improvement in other potential markers of myocardial recovery, including a significant reduction in LV mass, was seen in the active treatment group. Further investigation of the therapeutic potential of this therapy in inflammatory cardiac conditions is warranted.

Objective Dysautonomia affects many patients with Parkinson's disease and correlates with increased cardiovascular mortality. We describe the frequency and onset time of autonomic dysfunction relative to disease onset in early‐onset Parkinson's disease (EOPD) and explore its association with mortality. Methods We identified all incident Parkinson cases with motor‐symptom onset before age 50 years evaluated at the Mayo Clinic Health System (1990–2022) including sex‐ and age‐matched controls for each patient. Medical record review confirmed clinical diagnosis and assessed the presence and onset of autonomic symptoms, relative to Parkinson onset. Results We included 829 patients with EOPD and 829 healthy controls. The median age at disease onset was 42 years (interquartile range [IQR] = 37–46 years). Autonomic symptoms were present in 63.4% of patients, compared with 27.0% of unaffected controls, and proceeded motor symptoms in 91.4%. Forty‐seven percent of patients with early‐onset Parkinson's disease had constipation, 27.4% had bladder urgency, 19.3% had orthostatic intolerance, and 15.4% had sweat dysfunction. Among male patients, 36.8% had erectile dysfunction. In our EOPD population only, the presence of any autonomic‐impairment symptoms correlated with a 2.71‐fold increased mortality risk; each additional reported symptom increased the relative mortality risk by 50% ( p < 0.001). Patients with constipation or orthostatic intolerance had a 3.22‐ and 2.78‐fold higher mortality than patients without these symptoms. Interpretation Autonomic impairment affects 63.4% of patients with EOPD and carries a 3‐fold higher mortality risk, which increases with every additional autonomic symptom reported. In our cohort, autonomic symptoms appeared most commonly after motor onset, contrasting with prodromal autonomic impairment seen in late‐onset Parkinson's disease (LOPD). ANN NEUROL 2026;99:964–975

We describe an unusual case of a woman in her 30s who had recently undergone Roux-en-Y gastric bypass and presented to the emergency department with a 6-week history of intractable nausea and vomiting, accompanied by progressively worsening bilateral leg weakness. Examination revealed persistent upbeat nystagmus, paraparesis, areflexia in the lower extremities, brisk reflexes in the upper extremities and diminished sensation across all modalities in lower limbs. Brain and spine MRIs were unremarkable, there was no nerve root enhancement. Laboratory tests revealed thiamine deficiency, with a level of 28 nmol/L (reference range: 70–108 nmol/L). No gangliocyte antibodies were detected. Cerebrospinal fluid study showed no albuminocytological dissociation. Electrodiagnostic studies showed evidence of lumbosacral polyradiculopathy. The patient was eventually diagnosed with thiamine deficiency-related acute nutritional axonal neuropathy and Wernicke’s encephalopathy. After aggressive thiamine supplementation and 8 weeks of physical rehabilitation, her leg strength improved, but she still requires assistance to ambulate.

Background and importance Renal colic pain is typically managed using intravenous opioids, but the intranasal route has emerged as a less invasive and time-efficient alternative. Intranasal ketamine has shown promise as a safe and effective analgesic for acute pain in emergency settings. Objective To compare the efficacy and safety of intranasal ketamine versus intravenous opioids for renal colic pain management in the emergency department. Design, settings, and participants PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing intranasal ketamine to intravenous morphine or intravenous fentanyl in patients with renal colic. Intervention or exposure Intranasal ketamine as the primary intervention; comparators were intravenous morphine or fentanyl. Outcomes, measure, and analysis The primary outcome was pain intensity at various time points, measured using the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Secondary outcomes: need for rescue analgesia, incidence of adverse events, nausea, and dizziness. Data were pooled using random-effects models to calculate mean differences for continuous outcomes and risk ratios for binary outcomes, with 95% confidence intervals (CIs). All statistical analyses were performed using R Software, version 4.2.3. Main results We included four RCTs, involving 454 patients, of whom 230 (50.6%) received intranasal ketamine. There were no significant differences between groups in pain scores at 5 min (mean difference: −0.41 VAS/NRS, 95% CI: −1.88 to 1.07, P = 0.59), 15 min (mean difference: −0.20 VAS/NRS, 95% CI: −0.86 to 0.46, P = 0.56), and 30 min (mean difference: 0.53 VAS/NRS, 95% CI: −0.08 to 1.13, P = 0.09). No significant differences were found between groups in the need for rescue analgesia or in the incidence of adverse events, nausea, or dizziness. Conclusion Intranasal ketamine demonstrated analgesic efficacy comparable to intravenous opioids at 5, 15, and 30 min, with no increase in adverse events or rescue analgesia requirements.

Abstract Background Previous studies demonstrated an association between tau pathology and the development of neuropsychiatric symptoms (NPS) in individuals with Alzheimer’s disease (AD). However, the extent to which tau influences each specific NPS domain remains unclear. Here, we aim to investigate the association of tau and each NPS domain in the AD continuum. We hypothesized that tau plays a comparatively greater effect on the emergence of hyperactive and psychotic symptoms compared to other NPS domains. Method We assessed 385 individuals (216 cognitively unimpaired (CU), 128 MCI, and 41 AD dementia) from the HEAD study who underwent clinical assessments with the Neuropsychiatry Inventory Questionnaire (NPI‐Q) and had positron emission tomography (PET) for amyloid‐β (Aβ) ([ 18 F]AZD4694 or [ 11 C]PiB), and tau tangles ([ 18 F]MK6240) at the same visit. Tau SUVR values were tailored with a mask from Braak stages I‐VI, using the inferior cerebellar gray matter as a reference region. All individuals with dementia had a positive Aß‐PET. Voxel‐wise and Tobit censored regression tested the association between NPS domains and biomarkers accounting for age, sex, cognitive status, and study site. We used censored regression models to account for skewed data alongside a leave‐one‐out (loo) approach to identify which NPS domains most contributed to results. Result CI individuals had significantly higher NPI‐Q scores and Tau PET SUVR than CU (Figure 1A, 1B). NPI‐Q score was significantly associated with tau‐PET predominantly in fronto‐parietal regions. Removing irritability from the models strengthened this association (Figures 2A‐C). Regression loo models revealed that motor disturbances contributed most to the association between NPS and tau‐PET across all Braak stages. Notably, irritability had a negative effect on the association in all Braak stages, suggesting that tau does not play a role in the development of irritability and is highly associated with motor disturbances (Figure 3). Conclusion Our study suggests that tau contributes to the development of motor disturbances but has no effect on the development of irritability across the AD continuum. These findings provide additional rationale for the development of new therapeutics aiming to mitigate motor disturbances and irritability in AD patients.

Abstract Background & Aims: Alcohol is a leading global risk factor, over 200 diseases and injuries, but policy adoption varies. We updated the Alcohol Preparedness Index (API) to track global and regional policy trends from 2010–2019. Methods: Using WHO GISAH data for 141 countries, we scored five domains (policy frameworks; production/pricing/taxation; marketing/availability; drink-driving; monitoring/surveillance). The primary endpoint was % change in API. Trends were summarized by WHO region and correlates tested in adjusted regression. Results: In 2019, <25% of countries had a strong national alcohol plan and 40% had none. Production/pricing/taxation increased most (27%→78%); monitoring/surveillance reached strong levels in 47.5%. Median API increased from 57.0 [39.0–82.0] (2010) to 74.8 [58.3–83.5] (2016) and stayed above baseline in 2019 (67.8 [51.2–83.8]). Larger population predicted less API gain (β=−19.1, p<0.05); HDI and per-capita consumption did not. Conclusions: Global alcohol policy preparedness increased from 2010–2019.