Citations

Dynamic fluid and solute transportation across the arachnoid barrier in the meninges of healthy participants was measured by tracking intravenous gadolinium-based contrast agent entering cerebrospinal fluid from dural blood vessels using dynamic dual-spin-echo perfusion MRI.

Abstract Background Oxidative phosphorylation (OXPHOS) is a central function and a key indicator of mitochondrial fitness, yet studies in human tissue remain limited. Inclusion body myositis (IBM) is a progressive myopathy that lies at the intersection of aging, inflammation and mitochondrial dysfunction. We aimed to perform a comprehensive profiling of mitochondrial respiration in muscle tissue from patients with IBM. Methods A wide battery of complementary tests from RNA level to high-resolution respirometry on permeabilized muscle fibers was performed. The relationship between respiration, mitochondrial content, mitochondrial DNA (mtDNA) abnormalities and mitophagy was examined, along with the correlation with various clinical parameters to determine the clinical significance of the findings. Results The study included a total of 67 patients with IBM and 45 controls. IBM muscle tissue exhibited reduced maximal respiration per tissue weight in State 3 (high substrates, high ADP) and uncoupled state with decreased coupling efficiency and higher leak control ratios. When adjusting for citrate synthase reflecting mitochondrial content, males had decreased State 3 intrinsic respiration, whereas females had greater intrinsic respiration in leak states. Complex II control ratio strongly correlated with disease duration and severity only in females. IBM was associated with decreased RNA and protein expression of OXPHOS complexes. Complex I activity was decreased mainly in females. IBM samples exhibited lower maximal H 2 O 2 emission, accompanied by a higher total antioxidant capacity that correlated with disease duration in females. In IBM, there was decreased mtDNA content, and impaired mitophagy, both of which strongly correlated with respirometry measures and markers of disease severity, indicating these pathways are likely interconnected and of clinical significance. Conclusion IBM is characterized by multilevel impairments in mitochondrial coupling efficiency, revealing several potential therapeutic targets to improve mitochondrial fitness, while accounting for sex-specific differences.

Abstract Objective To assess the role of small‐molecule calcitonin gene–related peptide receptor antagonists (gepants) in the acute treatment of migraine, particularly in relation to triptan treatments. Background Triptans have established efficacy and are widely prescribed for the acute treatment of migraine. However, triptans may not be recommended for some individuals due to cardiovascular contraindications and precautions, as well as other comorbidities, and many may discontinue triptans because of inadequate or inconsistent symptom relief or poor tolerability. Several gepants are also indicated for the treatment of migraine (both acute and preventive), and their demonstrated efficacy and safety may address some challenges associated with triptans. Methods This narrative review addresses considerations for the acute treatment of migraine through summarizing literature and data from preclinical studies and clinical trials of triptans and gepants. Results We consider triptans and gepants, where available, first‐line treatment options for the acute treatment of migraine. Triptans may be prescribed in the absence of contraindications, significant risk of cardiovascular disease, or risk for or history of medication‐overuse headache. In those who have contraindications or precautions for triptans, those who do not have an adequate response to triptans, and those unable to tolerate them, gepants are often an appropriate option. The efficacy and safety of gepants for the acute treatment of migraine has been established through clinical trials and open‐label extension studies and based on real‐world evidence. Gepants have demonstrated efficacy and tolerability in triptan insufficient responders, perhaps because of their distinct mechanisms of action. Additionally, the safety of gepants, including relative cardiovascular safety, is supported in pivotal controlled trials and open‐label extension trials. In experimental settings and through their use as preventive treatment for migraine, gepants appear unlikely to produce medication‐overuse headache. In addition, one gepant (ubrogepant) has demonstrated efficacy in preventing headache onset when given during the prodrome, a finding that has not been demonstrated for triptans. A single‐arm, open‐label study of naratriptan given during the prodrome suggested fewer subsequent headaches, but interpretation is limited because there was no contemporaneous control group. Limited head‐to‐head clinical trials comparing gepants and triptans have not demonstrated significant differences. Prescribers of both triptans and gepants should be mindful of potential drug–drug interactions. Conclusions Key advantages of gepants include their favorable tolerability, efficacy for the acute treatment of both the prodromal/premonitory phase (ubrogepant) and the headache phase of migraine (ubrogepant, rimegepant, zavegepant), lack of cardiovascular contraindications, and lack of association with medication‐overuse headache. Disadvantages include limitations due to cost and access and CYP3A4 drug interactions for most gepants. Together, the advantages may help to optimize patient care and lead to better persistence and effectiveness in a real‐world setting. Head‐to‐head studies are needed to clarify the comparative effectiveness of triptans and gepants.

Abstract Background: Treatment for patients with triple-negative breast cancer (TNBC) relies on non-specific chemotherapy, underscoring the need for precision-based approaches. Our lab discovered that MALT1, the effector protein of the CARMA3-BCL10-MALT1 (CBM) signaling complex, is activated downstream of several oncogenic G protein-coupled receptors (GPCRs) implicated in breast cancer, including the thrombin (PAR1), angiotensin II (AGTR1), and lysophosphatidic acid (LPAR) receptors. When activated, MALT1 functions as a protease to cleave select protein substrates. Based on our finding that CBM activity in TNBC cells promotes tumor growth in immunocompetent but not in immunodeficient mouse models, we hypothesized that MALT1 protease activity induces a pro-tumor secretome that creates an immune-suppressed tumor immune microenvironment (TIME). Methods/Results: We confirmed by western that MALT1 protease is active in multiple human and mouse TNBC cell lines. Next, to identify MALT1-dependent secreted factors, we performed transcriptomic and proteomic analyses comparing TNBC cells treated with or without MALT1 protease inhibitors. We found that several secreted factors, including GM-CSF, CXCL1, and Pentraxin 3, were reduced by MALT1 protease inhibition. To assess the functional impact of the MALT1 protease-dependent secretome, we performed media transfer experiments comparing the effects of conditioned media (CM) from TNBC cells treated with or without MALT1 protease inhibitors. To account for species differences, experiments were performed evaluating human TNBC cell CM added to human PBMCs and mouse TNBC cell CM added to murine bone marrow cells. We found that the MALT1 protease-dependent secretome reduces the expression of iNOS in both human and murine macrophages. For use in validating our findings in human TNBC clinical specimens, we developed a “MALT1 protease active gene signature” using RNA-seq analysis. Conclusions/Future Directions: Our studies indicate that MALT1 protease activity in TNBC cells promotes expression of numerous immune-suppressive factors. In both human and mouse systems, blockade of MALT1 protease alters the tumor cell secretome and promotes an increase in expression of the anti-tumor M1-like marker iNOS in macrophages. Future studies will evaluate how this change in iNOS expression impacts functional properties of TNBC-associated macrophages. We will also assess the influence of the TNBC MALT1-dependent secretome on the TIME in vivo by comparing the effects of intratumoral injection of CM from MALT1 wild-type or MALT1 protease-deficient TNBC cells. Finally, we will utilize our MALT1 activity gene signature to evaluate TNBC clinical specimens for an association between MALT1 activity and tumor immune contexture, with an emphasis on tumor-associated macrophages. Our studies could nominate MALT1 protease as a potential therapeutic target for improving anti-tumor immunity in TNBC. Since multiple MALT1 protease inhibitors are in clinical trial, our findings could be rapidly translated to improve outcomes for patients with TNBC. Citation Format: John W. Little IV, Jeffrey A. Meridew, Dong Hu, Juliana Hofstätter Azambuja, Linda M. McAllister-Lucas, Peter C. Lucas. The GPCR-MALT1 protease signaling axis drives an immunosuppressive secretome in triple-negative breast cancer [abstract]. In: Proceedings of the AACR Immuno-Oncology Conference (AACR IO): Discovery and Innovation in Cancer Immunology: Revolutionizing Treatment through Immunotherapy; 2026 Feb 18-21; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Immunol Res 2026;14(2 Suppl):Abstract nr B046.

Background Increased chronological age correlates with reduced relapse rates and increased disability in multiple sclerosis (MS). Biological age may better capture ageing’s impact on MS and might accelerate due to MS itself. Establishing accelerated biological ageing in adults is complicated by normal ageing and comorbidities. Telomere length, a well-recognised biological ageing marker, is shortened in adults with MS and associated with disability. Demonstrating accelerated biological ageing in paediatric-onset MS (POMS) would strengthen the hypothesis that MS drives premature biological ageing. This study aimed to determine if telomere length differs in POMS compared to age-similar healthy controls. Methods We performed a cross-sectional case-control study of whole blood samples and clinical data from The US Network of Pediatric MS Centers. Real-time quantitative PCR measured telomere length, expressed as a telomere to somatic DNA ratio (T/S ratio). T/S ratio was compared between cases and age-similar healthy controls using multivariate regression analysis adjusting for chronological age, sex, race, ethnicity, tobacco exposure, socioeconomic status and body mass index. Results We analysed 300 POMS cases and 200 controls. The unadjusted mean T/S ratios were 1.66 (SD 0.32) for cases and 1.71 (SD 0.29) for controls (mean difference –0.05, 95% CI –0.10 to 0.01, p=0.08). After adjusting for key covariables with face validity, POMS participants had a mean 0.086 shorter T/S ratio than controls (95% CI 0.015 to 0.157, p=0.018). Conclusions POMS participants demonstrated shorter telomeres than age-similar controls in a multivariable model adjusting for sociodemographic variables, suggesting that MS may contribute to accelerated biological ageing.

Abstract BACKGROUND: Obesity is prevalent in Hispanic patients (pts) with breast cancer (BC), but this population is often underrepresented in studies of weight loss interventions (WLIs). The BWEL trial (Alliance A011401; NCT02750826) is a phase III randomized trial testing the impact of a 2-year (yr) telephone-based WLI on invasive disease-free survival in pts with stage II-III HER2-negative BC and a body mass index (BMI) > 27 kg/m2. At 12 months (mo), Hispanic pts lost less weight than White pts on the WLI. Here, we evaluate differences in intervention engagement over the first 12 mo by language preference and ethnicity among BWEL pts on the WLI. METHODS: BWEL randomized pts 1:1 to WLI + health education (HE) or HE alone. WLI +HE pts received semi-structured telephone-based health coaching in English or Spanish, in addition to access to an activity monitor, wireless scale and meal replacement shakes. Pts self-reported ethnicity and their preferred language for the WLI. Kruskal Wallis and chi-square tests were used to assess language and ethnicity differences in demographic and treatment factors for continuous and categorical variables, respectively. Percent weight change and mean values for intervention attrition, number of calls, call duration, number of shake shipments, and frequency of activity monitor use and weight tracking over 12 mo were compared between Spanish-preferred Hispanic pts (SH), English-preferred Hispanic (EH) pts and non-Hispanic (NH) pts using ANOVA. Pts with missing language, ethnicity or 12 mo weight data were excluded from analysis. RESULTS: 1591 pts were randomized to the WLI + HE from 08/2018 to 02/2021. 80.5% of pts were White, 12.8% Black and 7.1% Hispanic. 1190 pts had 12 mo weight and language available. Among the 87 WLI + HE pts who had available data and identified as Hispanic, 34% were SH and 66% EH. SH WLI pts were younger (in yrs: 49.5 SH, 51.1 EH, 53.9 NH, p=0.006) and had lower BMI (32.2 SH, 35.1 EH, 34.5 NH, p=0.007). At 12 mo, SH WLI pts lost 2.4% of baseline body weight vs 3.3% in EH and 5.1% in NH (p=0.051) (Table). Compared with EH and NH WLI pts, SH WLI pts participated in fewer calls (15.7 SH, 21.1 EH, 24.3 NH, p< 0.0001), had fewer days of activity monitor use (134.2 SH, 177.3 EH, 205.3 NH, p=0.015) and fewer days of weight tracking (65.3 SH, 96.8 EH, 148.2 NH, p<0.0001), but had more shake shipments (3.9 SH, 3.5 EH, 3.0 NH, p=0.015). There were no significant differences in attrition rate or call duration by language preference or ethnicity. CONCLUSIONS: In a large phase III WLI study in breast cancer patients, engagement with the WLI appeared lower in SH pts, despite provision of the intervention in Spanish. More work is needed to improve accessibility and efficacy of WLI studies among non-English speaking populations. Support: U10CA180821, U10CA180882, UG1CA189823; https://acknowledgments.alliancefound.org. Citation Format: A. Odai-Afotey, K. V. Ballman, L. M. McCall, C. Cao, C. Alfano, V. Bernstein, T. E. Crane, L. M. Delahanty, L. Frank, P. J. Goodwin, O. Hahn, D. L. Hershman, J. O. Hopkins, M. Irwin, E. L. Mayer, L. Minasian, L. Nebeling, M. Neuhouser, E. D. Paskett, P. A. Spears, V. Stearns, C. A. Thomson, T. A. Wadden, A. Weiss, J. White, C. Hudis, E. P. Winer, L. Carey, A. H. Partridge, J. Ligibel. Variation in weight loss and intervention engagement in the Breast Cancer Weight Loss (BWEL) trial by language and ethnicity (Alliance) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-29.

Abstract Background: Obesity is a poor prognostic factor in early breast cancer (BC). The BWEL trial (Alliance A011401; NCT02750826) is a phase 3 randomized trial testing the impact of a weight loss intervention (WLI) on invasive disease-free survival in women with stage II-III BC and a body mass index (BMI) ≥27 kg/m2. Here we report trajectories of weight change in BWEL WLI participants (pts). Methods: Eligible pts were within 16 months of diagnosis of stage II-III HER2-negative BC, had completed chemotherapy (chemo) and radiation (if given), and were randomized 1:1 to a telephone-based WLI, focused on caloric restriction and exercise, plus health education (HE) or to an HE-alone control group. WLI pts were assigned a trained coach at the BWEL call center and received 42 phone calls over the 2-year (yr) WLI period. Weight and height at baseline, 6 and 24 months were collected by study staff. All WLI pts were provided with a Fitbit wireless scale. Fitbit weight records (FWRs) were automatically imported to the BWEL portal for pts with wireless access and self-reported in the portal for pts without wireless access. FWRs were averaged (avg) by week (wk) from the WLI start date up to 104 wks. Baseline pt factors were self-reported; treatment history was abstracted from the medical record. Linear mixed-effect models were used to evaluate trajectories of weight change over the 104-wk WLI. Principal component analysis and multinomial models were used to examine distinct clusters of weight trajectories. Results: 3180 pts were enrolled from 637 sites between 8/2016 and 2/2021. FWRs were available from 1508 of 1591 WLI pts, with a total of 366,294 FWRs collected during the 2-yr WLI period. In pts with FWRs, mean baseline BMI was 34.4 ± 5.6 kg/m2, mean age was 53.2 ± 10.3 yrs, 10.8% self-identified as Non-Hispanic (NH) Black and 6.1% as Hispanic, 81.1% received chemo and 56.9% were postmenopausal. No statistically significant differences in baseline factors were observed between pts with and without FWRs. Intraclass correlation coefficient of baseline weights collected by study staff and by Fitbit scales was 0.99. In the WLI cohort, avg weekly weight (kg) decreased from 91.4 (95% CI: 90.6-92.3) at baseline to 85.6 (95% CI: 84.8-86.5) by wk 40, corresponding to a peak loss of 6.1% (95% CI: 5.7-6.4) of baseline weight. Weight remained stable until wk 52 and then gradually increased to 87.0 kg (95% CI: 86.2-87.9) at wk 104, corresponding to a 4.4% (95% CI: 4.0-4.8) loss at wk 104 vs. baseline. Principal component analysis identified 3 distinct weight trajectories: 67.6% of pts experienced peak weight loss of 6.6% (95% CI: 6.3-6.9) of baseline weight, 10.0% experienced peak loss of 17.5% (95% CI: 16.8-18.2) of baseline weight, and 22.4% did not achieve weight loss, gaining on avg 2.2% (95% CI: 1.7-2.6) of baseline weight. Pts with college (relative risk ratio [RRR]=1.41, 95% CI: 1.03-1.92) and post-graduate education (RRR= 1.58, 95% CI: 1.13-2.20) and those who were premenopausal (RRR=1.70, 95% CI: 1.28-2.26) were more likely to be in the cluster that did not lose weight. Pts who were NH White (RRR=3.60, 95% CI: 1.95-6.68), postmenopausal (RRR=1.94, 95% CI: 1.28-2.95), had no alcohol use (RRR=1.49, 95% CI: 1.03-2.16), had not received chemo (RRR=1.76, 95% CI: 1.15-2.72), and had <3 chronic conditions (RRR: 2.12, 95% CI: 1.23-3.66) were more likely to be in the cluster with the highest weight loss. Conclusion: Longitudinal weight data from BWEL demonstrate peak weight loss of 6.1% in the WLI cohort at 40 wks, with distinct trajectories indicating differential responses to the WLI. This work demonstrates the feasibility of using digital health tools to track outcomes in the setting of a large-scale weight loss intervention study and informs future precision behavioral interventions in oncology. Support: U10CA180821, U10CA180882, UG1CA189823; U10CA180863. https://acknowledgments.alliancefound.org. Citation Format: C. Cao, K. Ballman, L. McCall, C. Alfano, V. Bernstein, T. Crane, L. Delahanty, L. Frank, P. Goodwin, O. Hahn, D. Hershman, J. Hopkins, M. Irwin, E. Mayer, L. Minasian, L. Nebeling, M. Neuhouser, E. Paskett, P. Spears, V. Stearns, C. Thomson, T. Wadden, A. Weiss, J. White, C. Hudis, E. Winer, A. Partridge, L. Carey, J. Ligibel. Weight Trajectories in the Breast Cancer Weight Loss (BWEL) Trial (Alliance) [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PD8-01.

Abstract Background: Incorporation of Polygenic Risk Scores (PRS) can refine traditional breast cancer (BC) risk assessment models to provide precise estimates of BC risk. However, the impact of such an integrated model on BC risk estimates and clinical decision-making related to BC screening and preventive strategies in germline pathogenic variant (PV) carriers is not fully understood. Methods: The GENRE-2 is a prospective single-arm multisite clinical trial (NCT04474834) incorporating 313-PRS into standard BC risk assessment models to determine the impact of PRS on risk estimates and clinical decisions on prevention and screening. All women received pre- and post-PRS BC risk estimates and completed surveys on their screening and cancer prevention decisions before and after integrating PRS estimates. Herein, we report on the impact of integrating PRS into CanRisk-based BC risk estimates among women enrolled in GENRE-2 due to PVs in ATM, BRCA1, BRCA2, CHEK2, or PALB2. Women were categorized into average risk (<20%), moderate risk (20-40%), or high risk (>40%) for BC based on clinically relevant lifetime risk thresholds for supplemental MRI screening and risk-reducing bilateral mastectomies. Changes in categories of lifetime BC risk estimates were then evaluated before and after integration of PRS. Impact of PRS on patient decisions to undertake screening or preventive action (medication or prophylactic mastectomy) was evaluated based on pre- and post-PRS surveys. Results: Between 2020 and 2025, 933 women were enrolled, 633 received PRS results and completed a survey to date. Of those who received PRS results, 214 (33.8%) were PV carriers (ATM: 24, BRCA1: 54, BRCA2: 73, CHEK2: 54 and PALB2: 9). Among PV carriers, the CanRisk-based median 10-year and lifetime pre-PRS risk estimates were 6.0% and 23.9% for ATM, 22.5% and 77.5% for BRCA1, 17.9% and 77.6% for BRCA2, 7.1% and 26.6% for CHEK2, and 16.6% and 42.4% for PALB2, respectively. A total of 7 (29.2%) ATM PV carriers had a shift in lifetime BC risk categories after integration of PRS, with 1 (4.2%) shifting from average to moderate-risk, 3 (12.5%) shifting from moderate to average-risk category, and 3 (12.5%) shifting from moderate to high-risk category. Among CHEK2 PV carriers, 9 (16.7%) had a shift in lifetime risk categories, with 4 (7.4%) shifting from moderate to average-risk, 2 (3.7%) shifting from moderate to high-risk, and 3 (5.6%) shifting from high to moderate-risk. None of the BRCA1 and 4.1% of BRCA2 PV carriers had a shift in lifetime risk categories after PRS integration. Only 1 (11.1%) PALB2 PV carrier had a change in lifetime risk category after integration of PRS, although this was limited by a small sample. A significantly higher proportion of PV carriers with a high lifetime risk intended to take preventative action compared to the PV carriers with average lifetime risk (41.4% vs. 20.0%, p=0.007). Conclusions: Integration of PRS into BC lifetime risk estimates led to a clinically meaningful change in risk categories in 29.2% of ATM PV carriers and 16.7% of CHEK2 PV carriers, but in <5% of BRCA1 or BRCA2 PV carriers. These findings suggest that PRS may be helpful for BC risk stratification in moderate-risk genes such as ATM and CHEK2 but may have limited clinical utility in high-risk genes such as BRCA1 or BRCA2. Citation Format: S. Yadav, C. Klassen, D. Stan, J. Fraker, S. Sahni, S. A. Khan, L. Khatri, C. Vachon, D. Schaid, J. P. Sinnwell, E. Carlson, L. Hasadsri, F. J. Couch, S. Pruthi. Impact of Polygenic Risk Scores on Breast Cancer Risk Assessment and Clinical Decision Making in Carriers of Germline Pathogenic Variants in ATM, BRCA1, BRCA2, CHEK2, and PALB2: Results from the Prospective Multisite GENRE-2 Clinical Trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PD4-04.