Researchers find tumor microbiome interactions may identify new approaches for pancreatic cancer treatment – EurekAlert

Investigators from Rutgers Cancer Institute of New Jersey, the states leading cancer center and only National Cancer Institute-Designated Comprehensive Cancer Center, together with RWJBarnabas Health, examined the microbiome of pancreatic tumors and identified particular microorganisms at single cell resolution that are associated with inflammation and with poor survival. According to the researchers, these microorganisms may be new targets for earlier diagnosis or treatment of pancreatic cancer, which is the fourth leading cause of cancer death for both men and women in the United States. The findings are published in the online version of Cancer Cell (10.1016/j.ccell.2022.09.009).

Microbes are living things that are too small to be seen with the naked eye. We have more microbes living in our body than the total number of human cells, and can be found in organs like the pancreas, which at one time was considered microbe-free. Subhajyoti De, PhD, principal investigator at Rutgers Cancer Institute and senior author of the study along with graduate student Bassel Ghaddar, a student in the MD/PhD program at Rutgers Robert Wood Johnson Medical School, began exploring if there are microbes residing in pancreatic tumors, and if they have consequences for cancer progression or treatment. However, studying microbes in tumors is difficult, in part since every patient is different, and because microbial footprints are too subtle to detect reliably.

To explore further, the researchers teamed up with Martin Blaser, MD, Henry Rutgers Chair of the Human Microbiome at Rutgers University and world-renowned microbiome expert. The investigators developed a genomic approach called SAHMI (Single-cell analysis of Host-Microbiome Interactions) to identify microorganisms associated with individual human cells. Sifting through millions of RNA sequences using sophisticated software, they identified which ones likely represent human genes, and which ones are microbial in origin. This new technique allowed us to identify tumor-associated microbes and measure the activity of the host cells at the same time, which is a significant technical advance, and the results were stunning, notes Dr. De, who is also an associate professor of cancer systems biology at Rutgers Robert Wood Johnson Medical School.

Studying two independent groups of pancreatic tumors, the team found that some had bacteria that associated with specific cell-types within the tumor, which were essentially absent in normal pancreatic tissues. These bacteria were predominantly located within tumor cells, and their abundance correlated with cancer-related cell activities. The specific signatures of the microbes that were found predicted particularly aggressive cancer progression and poor prognosis.

The microbial footprints within the pancreatic tumors raised the question of whether the immune cells that were present were responding to the cancer or to the microbes. The study findings suggested that the immune responses were mostly responding to the microbes in the tumor and not to the cancer cells. Our observations provide a new view about why pancreatic cancers are so difficult to treat, notes Dr. Blaser, who is also a research member at Rutgers Cancer Institute and professor of epidemiology and biostatistics at Rutgers School of Public Health. But better understanding these interactions may identify new approaches for therapies.

Along with Drs. De, Ghaddar, and Blaser, other investigators include: Antara Biswas, PhD, Center for Systems and Computational Biology, Rutgers Cancer Institute; Chris Harris, PhD, Department of Surgery, University of Rochester Medical Center; M. Bishr Omary, PhD, Center for Advanced Biotechnology and Medicine, Rutgers University and Darren R. Carpizo, MD, PhD, Department of Surgery, University of Rochester Medical Center.

About Rutgers Cancer Institute of New Jersey

As New Jerseys only National Cancer Institute-designated Comprehensive Cancer Center, Rutgers Cancer Institute, together with RWJBarnabas Health, offers the most advanced cancer treatment options including bone marrow transplantation, proton therapy, CAR T-cell therapy and complex surgical procedures. Along with clinical trials and novel therapeutics such as precision medicine and immunotherapy many of which are not widely available patients have access to these cutting-edge therapies at Rutgers Cancer Institute of New Jersey in New Brunswick, Rutgers Cancer Institute of New Jersey at University Hospital in Newark, as well as through RWJBarnabas Health facilities. To make a tax-deductible gift to support the Cancer Institute of New Jersey, call 848-932-8013 or visitwww.cinj.org/giving.

Observational study

Cells

Tumor microbiome links cellular programs and immunity in pancreatic cancer

10-Oct-2022

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Researchers find tumor microbiome interactions may identify new approaches for pancreatic cancer treatment - EurekAlert

UMass Chan and Wellinks study mobile tools to keep COPD patients healthy – UMass Medical School

Apurv Soni, MD, PhD21

Researchers from UMass Chan Medical Schools Program in Digital Medicine are leading an innovative study with virtual health care company Wellinks to improve management of chronic obstructive pulmonary disease (COPD) at home.

The study, Healthy at Home, aims to assess the feasibility of app-based consumer technology and comprehensive virtual disease management to improve quality of life and achieve better health outcomes among people with COPD. According to the Centers for Disease Control and Prevention (CDC), COPD is the third leading cause of death by chronic disease in the United States and the fifth most costly chronic disease.

The study plan fits into a broader vision of innovation for health care at home. It will enhance our ability to understand what patients are going through in their home environment surrounding social determinants of health and use that information to predict and try to avert urgent care needs such as emergency room visits or hospitalization, said principal investigator Apurv Soni, MD, PhD21, assistant professor of medicine and co-director of the Program in Digital Medicine. Partnership with UMass Memorial Health and newly formed Center for Digital Health Solutions is critical for growth of innovative programs like this.

John P. Broach, MD, MPH, MBA, FACEP, associate professor of emergency medicine, and Laurel Caren O'Connor, MD, assistant professor of emergency medicine, are co-principal investigators on the study. Healthy at Home will plug in via the Wellinks study app to the mobile integrated health service paramedic response team set up by Drs. Broach and OConnor.

OConnor said COPD patients tend to be very complex with multiple factors affecting their disease progression. When a patient gets admitted to the hospital, the chance of readmission for that person is one in three. COPD patients utilize much more health care services and have nearly double the mortality odds at a given time than a similar person without COPD.

Pulmonary rehabilitation exercise along with care management is among the most effective treatments, but Broach said there is a shortage of respiratory therapists, and the service is underprescribed and underutilized.

Working with the Wellinks disease management model and CareEvolution health data platform, the Healthy at Home program will enroll in the pilot study 100 adults diagnosed with COPD who are part of the UMass Memorial Medicare Accountable Care Organization and at risk of requiring acute care within the next six months.

The study will follow patients over six months, evaluating the impact of components of the program including: mobile integrated health service, a physician-supervised team of paramedics available 24/7 to perform in-home medical care; mobile integrated health dashboard that displays biometric data from wearable sensors, results of patient-reported outcomes and relevant clinical data from the electronic health record; and Wellinks virtual-first COPD management solution, which combines virtual pulmonary rehabilitation, personalized health coaching, monitoring through connected devices to measure spirometry and pulse oximetry, and an easy-to-use patient app.

The UMass Memorial ACO will work with its partners to scale the intervention model with a larger patient population to increase clinical impact, if the study results demonstrate its effectiveness, according to Thomas Scornavacca, DO, chief medical officer for UMass Memorial Healths Office of Clinical Integration, the program that operates the ACO.

Soni said Healthy at Home differs from other COPD research in a few ways. One, were focused on maintenance of health at home prior to ER visits and hospitalizations, he said. And second, were increasing our ability to capture and understand data of patients from their home environment to improve our ability to predict what their medical needs are going to be.

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UMass Chan and Wellinks study mobile tools to keep COPD patients healthy - UMass Medical School

‘Long Covid is going to push us to get outside of our comfort zone’ – STAT – STAT

I first met Wes Ely in 2016, when I wrote about ICU delirium and Elys attempts, as a critical-care physician at Vanderbilt University Medical Center, to urge fellow health care workers to rethink the use of heavy sedation in ICUs. His research was an attempt to limit the crippling cognitive and physical impairments he saw develop in many critical-care patients long after they left the hospital, something he came to call post intensive care syndrome, or PICS.

Well, a lots happened since 2016. I thought of Elys work often as ICU care became a mainstay of the Covid-19 pandemic and wondered about the long-term prognosis of people who were so sickened by the virus theyd been heavily sedated and placed on ventilators to survive. Then long Covid showed up, and became something Ely grappled with as well.

Through a new book, op-eds, and a steady stream of TikToks, Ely has become a leading voice on the recovery that can take place after trauma or grueling illness and on the importance of preventing new Covid infections. As the pandemic marches on, hes increasingly concerned about the resulting epidemic of chronic disease society may face. I spoke with Ely about his concerns, what he initially got wrong about long Covid, what he finds humbling about medicine, and, why, despite all the suffering he sees and treats, he still holds hope. The conversation has been lightly edited for length and clarity.

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In your book Every Deep-Drawn Breath, you describe how you came to understand that ICU treatment may harm patients even as it allows them to survive. Can you describe this awakening you had and how it started you on your research trajectory?

I had the opportunity to care for a woman in her 20s named Tracy Martin. She had made a mistake and found herself, after an overdose, in the ICU. I was the primary doctor helping to take care of her. We worked so hard, with all the technology that we had, to try to get her through. At the end of the day, I thought, What a great doctor I am, I helped you survive this. When she came back to clinic weeks later, I was expecting a high-five, but I saw a woman who couldnt walk, who couldnt go to the bathroom, who couldnt shower. Her mother said, Wheres my daughter? What happened to her? She looks like an old woman now.

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As a physician, I had to face the fact that none of that stuff she was suffering was what she came into the ICU with and that I was complicit. I felt guilty about it. I knew that something that Id done had injured her but I didnt even know what. I started grappling with that and became kind of obsessed with figuring out how to get people off the ventilator sooner so they didnt get so much injury in the ICU. And thats what started me on a 25-year journey in this area.

Can you describe these issues you work on: post-intensive care syndrome and ICU delirium?

What happens with people who get critically ill and live in an ICU is they come in with one problem and under our noses, in the ICU, under our care [and due to sedation, ventilation and immobilization], they accrue problems in their brain, such as acquired dementia, PTSD, and depression. And then they accrue profound problems neck down in their muscles and nerves which leave them unable to walk, climb stairs, and live a normal life physically. So they become very disabled, cognitively, mentally, and physically. Thats what PICS is. ICU delirium is one of the strongest predictors of the development of post-ICU syndrome.

Like so many ICU physicians and other staff, you were on the front lines of the first Covid waves. What were your first impressions, and how did those evolve during the pandemic?

Taking care of the most critically ill patients who were on ventilators, dialysis, and other forms of life support was just an immensely profound experience. And I knew that those patients were going to leave the hospital, those who survived, with an immense amount of acquired disease, that this was going to be PICS to the extreme. So when people started talking about being long haulers and having long Covid, I just thought, those are the ICU survivors who have PICS. Through our CIBS (Critical Illness, Brain Dysfunction, and Survivorship) center, we started offering Covid survivor support groups we didnt even call it long Covid in the beginning. We started finding people who got out of the ICU and had PICS. And we had patients, and this was shocking to me, who got out of the ICU, their PICS was in a strong state of recovery, then 100 days later they would fall off a cliff. And I thought, What is that? That is not PICS.

Then there was a third group that never came to the ICU at all, went through a mild case of Covid but then came to our support group and said, I didnt have a problem until three months after Covid and now my life is ruined. I cant think well anymore, and I cant work. I have all these heart-racing problems and GI disturbances. I had originally thought, this is PICS and all these people dont know about PICS yet, but then I realized that long Covid was something completely different.

That must have been startling because your research focuses on people post-ICU?

Yes, I had to admit I was wrong. And I was so sure I was right. It was super humbling. But thats what I love about medicine: The second we think we know what we are doing, we fall flat on our face.

Youve spent two decades trying to get people to realize that being released from the ICU may not necessarily be the end of their medical or mental health issues. Do you see an analogy with Covid that just because you test negative after an infection, your problems are not necessarily over?

Absolutely. The rapid antigen test tells you when you have that virus active in your body, and when it starts going negative, you think, this has passed. But now we know that the virus can persist as a viral ghost in your GI tract, brain, and cardiovascular system, and that it can also alter your immune reactions. What happens is that over ensuing weeks and months, your body takes on a new set of diseases that you did not have at the end of acute Covid. Thats what we call long Covid.

Unfortunately way too many people with this are not being believed about their illness. And this has happened before, with long Lyme, and CFS, and fibromyalgia. And I will tell you, as a medical insider, that I used to think that those werent real. I was taught in medical school that they werent real. I was just with some medical students last week, and I talked to them about a patient of mine who had long Lyme. And they said we were taught that thats not real and these are current med students. This is something the ivory tower medical profession needs to realize long Covid is going to push us to get outside of our comfort zone with illnesses that we cant define. Because we dont like it when we cant understand something, but we have to get over that.

In your book, you describe saying to patients, I will not leave you. Its not something you typically hear doctors saying to patients, even in movies. Can you talk about how you communicate with patients, especially those with PICS and long Covid?

If a person is suffering pain, fear, illness with uncertainty about where theyre going to be going with this illness and they are seeking somebody who can help, they want to be cuddled and lifted up and have things explained on their level. And by cuddled, I dont mean physically holding because some people wouldnt want that. What I mean is paid attention to at an intimate level. You know, if somebody was in the streets and they were broken, Im not going to stand 20 feet away from that person and minister to them at a distance. And yet, when patients come into the ICU and theyre super, super sick, that distance caring is exactly what our culture evolved into, where instead of being at the bedside and holding their hands, looking in their eyes, oftentimes were caring for them from the door. Were looking at their monitors. Were adjusting their life support machines at a distance. And throughout Covid, we literally were outside their room with the glass door shut, a worst-case scenario. Thats why Ill whisper in their ear and say, Im present. Im your doctor. Im not leaving you.

Whats your message to doctors, not just in critical care but in any speciality, who are seeing patients with these complicated symptoms that are difficult to understand, let alone treat?

The first thing I say to my fellow physicians and nurses and health care providers is were busy. We dont have a lot of extra time, I get that. But it does not take that much time to be at eye level with a patient, look them in the eyes, hold their hands, and give them this compassionate message of your presence and the fact that you will not abandon them during this illness. And also to say, I dont have all the answers for you. For example, for long Covid, theres no treatment yet, but you can say to them, Ill stick with you as we learn more in the months and years ahead and well figure this out together.

Why did you decide to write your book?

As a physician who is also a scientist, I have an intense amount of discomfort at the bedside when I see that we do things that dont have evidence to back them up. As a scientist, Ive conducted 25, 30 years of research and I realized there was a story evolving that no matter how many papers I published was never going to reach the lay public or other health care professionals who dont really keep up with the literature. Growing up in Louisiana with my mom, we read poetry, she edited my essays, she taught me to love words. So I love writing and reading and literature and thats why I thought, Why dont I use the stories of my patients, with their permission, to leverage the power of literature to show people how we can be caring for people in the most humanistic way.

I asked each patient for permission to use their story. And one patient said, OK, but I dont want you to make any money off my story. After she said that to me, we decided that every penny in proceeds from Each Deep-Drawn Breath would go into an endowment to help people with long Covid. Weve hired social workers and are helping people find disability services all over the country and the world.

On a very different end of the communication spectrum, theres your TikTok account. Why did you start that?

So, Im 58 years old. You know, an old doctor. And if you had told me two years ago that I was going on social media and Twitter, I would have said, Youre crazy. Theres no way. But two things happened. One was that at the beginning of the pandemic, a lot of doctors around the world were writing me and saying, theres so much ICU delirium, weve got to study this. And they said if you get on Twitter, we can find the patients faster. I said fine. Ill open a Twitter account and we will advertise for the study on Covid delirium. We enrolled 2,100 patients in two weeks. And so I decided to stay on Twitter to share and validate peoples stories and spread good science about long Covid and brain dysfunction and PICS and such.

And then about six months ago, people in the office said you need to get on TikTok and I said, No, Im drawing the line. But theres this crazy set of misinformation being spread on TikTok, misinformation so egregious that I thought, You know what, Im just going to try five videos and see what happens. So all I do is I sit in my office, flip my phone around, and give a two to three minute message on some topic, and I post it. I dont spend any time on it, theres no production. Its super old school. But if its helping people, then Ill keep doing it.

Entering the third year of the pandemic, there is so much anguish and strife right now, and possibly a wave of chronic disease that patients, health workers, and society at large will be facing. Yet you remain hopeful. Can you explain why people with long Covid should hold similar hope?

They can absolutely heal. The brains capacity to heal is so much greater than what people give it credit for. We have trillions and trillions of neurons and connections, and these things can regrow. So, if a patient gets this brain fog and they think, Oh, my gosh, Im never going to get back again, I always tell them, do not lose hope because you will find recovery. And whether its mitochondrial disease or glial cells that have died, or vascular clotting that develops into long Covid, your body has this capacity to recover, and you must remain hopeful that you can get through this. And we are working hard as scientists to do the right trials to find answers. I just want people to hang on and know were going to stick with them and not abandon them during the process.

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'Long Covid is going to push us to get outside of our comfort zone' - STAT - STAT

Decolonizing Healthcare Education and Practice – Non Profit News – Nonprofit Quarterly

Anna Tarazevich onpexels.com

This is the fourth installment of a five-part series,Reclaiming Control: The History and Future of Choice in Our Health, examining how healthcare in the US has been built on the principle of imposing control over body, mind, and expression. However, that legacy stands alongside another: that of organizers, healers,and care workers reclaiming control over health at both the individual and systems levels.Published in five monthly installments from July to November 2022, this series aims to spark imagination amongstNPQs readers and healthcare practitioners by speaking to both histories, combining research with examples of health liberation efforts.

In their new book, Inflamed, doctors Rupa Marya and Raj Patel explore how colonialism makes us sick while also shaping our core beliefs about how healthcare providers should make us better. For example, Lakota elders in the book describe the forces that led to widespread prevalence of diabetes in their communities: colonizers arrived and dammed a river that traditionally fertilized a rich river valley where nutritious food and medicinal plants utilized by local peoples grew. As this ecosystem was erased, and as the impacts of erasure and assimilation took hold, the Lakota became less active and were forced to rely on the food and medicine of their oppressors, rather than their ancestors. Marya and Patel point out that skeletal evidence backs up these claims, showing a marked difference in Indigenous remains excavated before and after European invasion. However, they also point out a paradox that comes with this data, writing:

If you find yourself more convinced by studying skeletal remains than by listening to the oral histories of Indigenous people, youre a participant in a colonial system of organizing truth. Reconstructing history through bones misses much that oral histories capture. Yet, in a colonial world, stories passed down by Indigenous elders cannot be considered true until they are validated by the empires that colonized them.

This tenet applies not only to our society writ large, but also to healthcare professionals. As physicians, the authors grapple with their own training, pointing out that modern clinical professionals are taught to be biomedical technicians rather than healers. Inevitably, they fall short when root causes of poor health, from structural racism to food insecurity, present themselves.

The COVID-19 pandemic and the national uprisings on race that took place in summer 2020 further exposed the shortcomings of our current paradigm for training, recruiting, and deploying healthcare workers. Coverage of the harrowing experiences that healthcare workers endured over the past two and a half years highlights not only the trauma that the pandemic inflicted on such workers as they cared for surges of critically ill patients with limited supplies and equipment; it also shows the stress caused by underpayment and overwork, divisive, politically driven policy shifts, and the disproportionate morbidity and mortality burden that low-income and BIPOC communities face. BIPOC healthcare workers, as well as frontline support staff, home care workers, and service staff, all of whom are deprioritized within the medical hierarchy, experienced additional layers of threat: racism and xenophobia inside and outside of their institutions and a compounded mental health toll. Since the pandemic began, 20 percent of healthcare workers in the US have quit their jobs, and healthcare labor shortages are now a major challenge for the sector.

Healthcare staffs feelings of powerless in the face of broader societal forces, however, are not unique to the pandemic. Almost two decades ago, as an undergraduate patient advocate, I experienced this dynamic up close. At clinics in East and West Baltimore, I had the opportunity to partner with individuals and families who presented not just with individual health issues like asthma and lead poisoning, but also with social issues: a crumbling rowhome with asbestos dust; limited fresh food options in the neighborhood; a bureaucratic social services system quick to judge Black and Brown families. Many of the clinics I worked in had one social worker for every 5,000 patients, presenting an impossible capacity challengeeven when medical staff asked about patients life situations and referred patients to social work or our advocacy program to identify helpful resources. While not all the clinics physicians, nurses, or medical staff felt obliged to address the impacts of social forces on their patients lives, most didbut they had limited training, resources, and time to do so.

In the first few articles of this series, we covered the political history of our healthcare system and the role that organizers and healers play in imagining what the future could hold. But what role will healthcare workers have in that future? As actors who benefit from the existing healthcare system while facing harsh challenges within it, healthcare professionals hold a specific positional power and can play a unique role. Even for those of us that have faced trauma inside healthcare institutions, or who have reason to distrust the system as a whole, healthcare workers can still act as trusted messengers and crucial lifelines during the uncertainty of seeking care for ourselves or loved ones.

Much of medical educations current pillarsthe separation of public health and medicine, a focus on treatment rather than preventioncan be traced to a 1910 report prepared by Abraham Flexner. In an effort to standardize curricula across medical schools, the report prioritized a biomedical care model that excludes social and environmental factors. It reinforced a healthcare model, including a paternalistic doctor-patient complex, adopted by institutions that only white males could access. That prioritization also led to the closure of many historically Black medical colleges.

What would it look like to reimagine the tenets of healthcare education through a host of lenses, voices, and teachers who take a more holistic, healer-rooted approach? Many training programs are now adding anti-racism frameworks and a focus on health equity to their classrooms. The Institute for Healing Medicine and Justice, launched in 2020 by a community of medical and graduate students at the Joint Medical Program of UCSF School of Medicine and UC Berkeley School of Public Health, envisions a new medicine that centers healing, community, and justice. They seek to bridge their own educational experiences with multidimensional healing paradigms that have long been promoted by women, people of color, disability activists, queer organizers, and healers across cultures.

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With a community of more than 3,000 people representing 300 institutions, the institute focuses on establishing a new, ground-up praxis for medicine, consisting of interdisciplinary research working groups, community healing gatherings, a justice hub, and a peer-reviewed publication. Along with the Othering and Belonging Institute and the Center for Race and Gender at UC Berkeley, the group published Toward the Abolition of Biological Race in Medicine: Transforming Clinical Education, Research, and Practice, which traces the history of white supremacy and racism in healthcare training. The publication also points out that epigenetics, the study of how the environment can alter gene expression, promises to deepen understanding of how racismand not raceimpacts health outcomes. The also launched the Freedom School for Intersectional Medicine and Health Justice, a community organizing effort led by Bernie Lim and Nicole Carvajal, both women of color in the Joint Program. The Freedom School re-imagines medical praxis and creates community for women of color in medicine, offering a community organizing model, an alternative syllabus populated by critical studies frameworks, and a fellowship for people interested in intersectional healing, medicine, and/or public health initiatives.

One additional effect of the Flexner recommendations was that advocacy training is largely absent from clinical curricula. While this has started to shift in the past 20 years, such training is still rarely seen in clinical classrooms, and when included, it varies from program to program: some programs focus on social determinants of health policy, while others focus more on advocacy to ensure the healthcare professions viability as a whole. This lack of training contributes to missed opportunities for the sizable healthcare workforce trusted experts with a front row view of the challenges involved in improving patients healthto leverage their collective power to enact change.

People Power Health, which trains health professionals in community organizing skills in order to set them up to redress power and resource inequities, aims to agitate healthcare workers to co-create just systems for communities, caregivers, and clinicians alike via trainings and fellowships targeted at different sections of the healthcare worker ecosystem, including clinicians interested in health justice, immunization professionals, climate health organizers, healthcare professionals focused on civic engagement and voting, and more.

Pedja Stojicic, executive lead of People Power Health and a physician by training, shares the role that a power-building community for healthcare professionals can play in moving physicians from an individualistic, passive mindset to one of collective action:

Right now, many [medical residency programs] are thinking about health equity tracks. But what is still problematic is its [just] awareness generation. Medical education itself is organized in such a way that is focused on individuals. The fact that [participants in People Power Health programs] often need us to see their colleagues as a sense of solidarity in pursuit of change is mind blowing. These are the facts of the system: a session outside of it can bring solidarity, hope, etc.

A collectivist approach may also enable healthcare professionals to move beyond defensiveness about their role in a system that often causes harm and to leverage their power beyond the context of an individual patient. Sam Gonzales, a member of the People Power Health core team, points out the value of the relational organizing on which the organization is focusing. Such organizing can be built upon to identify institutional or policy-level campaigns that members want to engage inan antidote to project proliferation, in which healthcare trainees identify an initiative they want to engage patients or community members in, but without first building rooted relationships. When I was in high school, I had a cancer diagnosis, and that helped me to see some of the health inequities that were in the Mexican health system. and when I went into medical school, I saw that it was more than just a drug or a treatment that was involved, shares Gonzales. Racism, classism, poverty. That is how I came to politics, policy to organizing. And then wow, to meet other professionals who are working on these topics was incredible.

Significant work remains to be done if we are to shift the healthcare systems core pedagogy. These efforts, however, point to a small but growing movement that is underway, spearheaded by a growing number of healthcare professionals who refuse to accept the status quo. Often lifted up as heroes, healthcare staff are in reality humans frequently tasked with doing challenging jobs in a system with a long history of harmand are increasingly also challenged to examine their own agency within that system. These models provide an emerging vision of how these individualscharged with caring for the rest of uscan move from healthcare to healing.

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Decolonizing Healthcare Education and Practice - Non Profit News - Nonprofit Quarterly

Where Iowa House District 30 candidates stand on the issues – Des Moines Register

Des Moines Register staff| Des Moines Register

From 2022 races to caucus action, what to watch for in Iowa politics

It's an election year: Look for no shortage of news from Gov. Kim Reynolds' and Sen. Chuck Grassley's reelection races to early Iowa caucus action.

Megan Bridgeman, Wochit

Republican Jerry Cheevers is running against Democrat Megan Srinivas to represent Des Moines' south side in the Iowa Legislature.

The two are seeking to succeed Democratic state Rep. Bruce Hunter, who is retiring at the end of his term, for the seat in the redrawn Iowa House District 30. Cheevers has run unsuccessfully against Hunter in two previous campaigns. Srinivas won June's Democratic primary, defeating Democrat Eddie Mauro.

To help voters, the Des Moines Register sent questions to all federal, statewide and Des Moines area legislative candidates running for political office this year. Their answers have been lightly edited for length and clarity.

Cheevers did not respond to the Register's request to fill out a questionnaire.

Early voting begins Oct. 19 for the Nov. 8 election.

More:A guide to voter rights in Iowa. What you need to know before you cast a ballot

Age:No response

Party: Republican

Where did you grow up? No response

Current town of residence: Des Moines

Education: No response

Occupation: No response

Political experience and civic activities: No response. Cheevers previously ran for the Iowa House in 2018 and 2020.

Age:35

Party:Democrat

Where did you grow up?Fort Dodge

Current town of residence:Des Moines

Education:

Occupation:Physician

Political experience and civic activities:

Cheevers: Did not respond.

Srinivas:I became a doctor to help my community, but so many of the challenges that my patients and neighbors face are systemic problems that I cannot solve with my prescription pad. The reason Im running is to address those issues, the social determinants of health that keep people from living the quality of life they deserve. This includes making sure people have access to the things that they need to succeed, such as food, housing, transportation, good jobs, and education. All of these factors are critical to ones health, and I will advocate for my community using this holistic approach.

More:Where Sonya Heitshusen & David Young stand on key issues in the House District 28 race

Cheevers: Did not respond.

Srinivas:We need to bolster our small businesses, especially after the economic hardship of the last few years. Ill also work for all Iowans to have access to a living wage protect pensions, including IPERS and 411, so workers enrolled in these plans remain secure in their retirement. Additionally, affordable childcare is a hurdle for many in the workforce. We must support childcare businesses in the face of rising operational costs that caused many to close over the pandemic. We can also adopt an income-based tax credit to create affordable childcare options. These upfront investments to create viable childcare options will spur economic growth for the state.

Cheevers: Did not respond.

Srinivas:As a physician, I strongly believe that an individuals healthcare decisions are their own and should only be discussed with their medical team. Ill advocate for an individuals right to abortion care. Ill also fight against efforts to remove insurance coverage for contraception and family planning. In 2017, our state stripped family planning health centers of public funding if they are affiliated with an abortion provider or even discuss abortion as a healthcare option. One of my goals is to reverse this policy and improve delivery of reproductive health services in every part of our state.

More:Where Iowa House District 27 candidates Kenan Judge & Kristen Stiffler stand on key issues

Cheevers: Did not respond.

Srinivas:We need to increase our supplemental state aid (SSA funding) to public schools to not just meet inflation, but to make up for the underfunding of the last decade. We need to change the narrative from our legislative leaders about our teachers and school staff, recognizing the critical and hard work they do rather than attacking them. We can improve teacher recruitment and retention by increasing teacher pay and creating programs to help with education loans for individuals teaching in high-need areas. We also must properly fund our public universities and community colleges. Additionally, I'll advocate to reinstate vocational curricula into schools.

More:Meet Todd Halbur & Rob Sand, running for Iowa state auditor in the 2022 election midterms

Cheevers: Did not respond.

Srinivas:

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Where Iowa House District 30 candidates stand on the issues - Des Moines Register

What is relational health, and why is it so important? – Contemporary Pediatrics

Rebecca Baum, chief, section of Development, Behavior, and Learning at the University of North Carolina, Hillsborough, North Carolina; and Katherine Wu, MD, FAAP, Pediatric Health Care Associates in Cambridge, Massachusetts began their presentation, Promoting relational health during health supervision visits with an anecdote of a mother sitting in a pediatricians office with 2 of her children, one rather unruly. If you dont stop misbehaving, Im going to get the doctor to give you a shot, the very stressed mother warned her child.

Comical or concerning? Using the Bright Futures Guidelines, 4th edition, a book that offers principles, strategies, and tools to improve the health and well-being of children through culturally appropriate interventions, the 2 practitioners went on to explain relational health, how the pediatric HCP can promote relational health during office visits, and offered both strategies and resources for attendees.

Baum and Wu explored 4 concepts during their session: adverse childhood experiences (ACEs); toxic stress; relational health; and strength-based approach. ACEs were categorized into 3 different types; neglect, abuse and household challenges, such as substance misuse, divorce, etc) along with other adversity (bullying, community violence, etc). ACEs can increase the risk for disease, early death, and poor social outcomes, Baum stated.

Toxic stress was explained as biological processes that occur after the extreme or prolonged activation of the bodys stress response in the absence of safe, stable, and nurturing relationships (SSNRs), the crux of this conversation. With SSNRs, children, even in the face of ACEs, can still grow up to be mentally and emotionally stable adults.Relational health, in essence is what creates these SSNRs, and the focus is on finding patient, family, and community capacities that can promote these SSNRs. How to create, though? As the presenters explained, the strength-based approach shifts the focus from a deficient model (emphasizing problems and disease detection) to health promotion and disease prevention, acknowledging the patient and familys particular skills that can promote family (and particularly patient) overall well-being.

Baum and Wu then shared examples through videos of doctors and parents discussing challenges in the family that could be impacting the patient. The key takeaways here:--the clinician should echo the mothers concerns (I am sorry to hear that you are going through the challenge of a divorce right now)-- then through positive reinforcement, help the parent to strategize additional solutions to the problem (It is great that you can work with your ex-husband in that way; would it be OK if I help you explore some additional options to come up with a solution to your childs misbehaving?).

If a family is successfully executing SSNRs, it will reap positive benefits; the child will demonstrate interest and curiosity to learn new things; complete tasks; and (one of the most important), stay calm and in control when faced with a new challenge (ie, moving to a new school).

Additionally, Baum and WU shared both screening tools and resources, and offered these final suggestions:--Assess a childs level of relational health as part of pediatric health supervision visits--Support families by utilizing the common factors approach (using hope, empathy, lay language, support; ask the family for permission to delve further with questions; and partner with family for solutions)--Provide prevention and treatment counseling and guidance to children and adolescents and their parents/families--Refer to local parent/child services when relationships are strained--Advocate for effective opportunities for focusing on relational health in schools, communities, and hospitals--Incorporate relational health in medical school curricula

ReferenceBaum R, Wu K. Promoting relational health during health supervision visits. 2022 AAP National Conference & Exhibition. October 9, 2022. Anaheim, California.

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What is relational health, and why is it so important? - Contemporary Pediatrics

Is the doctor’s office heading for extinction? – Medical Economics

Survey shows that alternative sites for care are gaining popularity with consumers

When it comes to where Americans prefer to receive their care, retail clinics, virtual health, and community centers are all growing in popularity, according to a survey from the Deloitte Center for Health Solutions. These changes reflect patient preferences to have health care be more similar to other consumer retail experiences.

There is a growing desire to use retail clinics, and this is especially true among underserved populations, according to the survey. Only 10% of consumers have used a retail clinic in the past year, but many more say the would be likely to or maybe would use retail clinics for preventive care (55%) or mental health care (47%). Black, Asian, and Hispanic respondents were more likely than White respondents to use retail clinics, and urban respondents were more likely than rural ones.

Virtual care, which became popular during the worst months of the pandemic, continues to be popular with patients. Nearly three in four consumers with Medicaid (74%) or HIX plans (73%) would use virtual health for mental health visits, and nearly two-thirds of all consumers would use virtual visits for preventive care.

According to the report, health care organizations looking to stay relevant need to take several steps. They should create more access points and include opportunities to address the drivers of health. They need to develop diverse care teams, ensure care continuity, and invest in virtual health technology and training.

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Is the doctor's office heading for extinction? - Medical Economics

How to improve the prior authorization process for Medicare Advantage – Medical Economics

Study looks at how prior auths help and hurt health care - and how they can be made better

A study from the University of Colorado and Johns Hopkins University on the prior authorization process for Medicare Advantage plans identified several areas for improvement.

The study, published in JAMA, examined the benefits and problems with prior authorizations, which 99% of MA plans use for at least some medical services. The goal of prior authorization is to ensure appropriate use criteria are met and the right care is provided to the patient to reduce unnecessary spending. This also can benefit the patient through reduction in premiums and lower out-of-pocket costs through better care allocation and reduced denials. The study also notes that when applied to medications, prior auths can provide an additional level of safety review.

On the other hand, patients must content with inappropriate denials due to omissions or errors in the medical record, or inappropriate application of clinical practice guidelines. An HHS report in 2018 found that 56% of audited MA contracts inappropriately denied prior auth requests. Approximately 75% of audited denial appeals were successful, raising concerns that MA plans were denying services and payments that should have been approved, according to the report.

Prior auths can also cause delays in care, which for serious conditions, can cause possible harm to the patient, according to the report. Prior auths create a substantial administrative burden, with 93% of physicians reporting care delays and 82% reporting abandonment where the patient does not follow through because of prior authorization policies, and can contribute to physician burnout.

Because of these issues, the report notes that calls for reform have resulted in Congressional bills to establish requirements for MA plans with respect to the timeliness and efficiency of prior auths.

The report outlines the following proposed measures that may help improve the use of prior authorization in Medicare:

Plans should use an electronic-based prior authorization process with time-bound requirements for initial and appeal decisions.

Plans should be mandated to report guidelines used to make prior authorization decisions and seek input from respective medical societies and stakeholder groups on an annual basis.

In addition, to expand the congressional legislation, the following proposed measures could be considered:

The relative benefits and costs of prior authorization should be reviewed by the CMS at the procedure level. Such review could consider evidence from other care rationing mechanisms, including price. All else equal, unnecessary care is less of a concern in clinical scenarios for which demand is inelastic and there is little price sensitivity (eg, high-cost chemotherapy when there is not a lower-cost alternative). In such cases, restrictions on access due to prior authorization will introduce little change in wasteful or unnecessary care while still generating additional administrative costs.

Medicare Advantage insurers should report approval and denial rates annually to the CMS based on beneficiary sociodemographic characteristics and by procedure type so that the CMS can monitor whether prior authorization policies may be increasing disparities in access to care.

Drawing upon MA insurersubmitted data on denial rates, the CMS should audit the denials of plans with high-denial rates. Setting thresholds for audit could be based on a comparison with other MA plans, as well as in consultation with patient, caregiver, clinician, and insurer stakeholders.

The authors conclude that by improving transparency and accountability of the process, prior authorization can better function as a tool to improve high-value care for Medicare beneficiaries.

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How to improve the prior authorization process for Medicare Advantage - Medical Economics

Manchester Half Marathon 2022 in pictures as thousands race along sunny streets of Greater Manchester – Manchester Evening News

Kris Jones came out on top with an incredibly quick time of 63 minutes and 46 seconds

Around 11,000 runners descended upon a gloriously sunny Trafford this morning (Sunday October 9) for the Manchester Half Marathon. Competitors and spectators alike were treated to perfect weather and gorgeous blue skies for the 13.1 mile run through the streets of Sale, Stretford, and for the first time ever, Manchester city centre.

Kris Jones, of Swansea Harriers, came out on top with an incredibly quick time of 63 minutes and 46 seconds. James Tilley (Nantwich) and Chorlton's own Tom Charles came second and third respectively.

James' dad Neil Tilley was bursting with pride as he spoke with the Manchester Evening News after watching his son get silver. He said: "I'm so proud. It's his first year of proper marathon running and that's the fastest I've ever seen him. He came 25th in the full marathon earlier this year but this is his best result in a major race over here."

Stockport Harriers runner Mollie Williams won in the women's category for a second year in a row, with an impressive time of 73 minutes and 29 seconds. David Sinclair took the wheelchair half marathon crown, finishing in 84 minutes and nine seconds.

Competitors' friends and family created a great atmosphere throughout, with many bringing signs and cheering their loved ones on, while Manchester music from the likes of Oasis, Courteeners and M People blasted out of the PA system speakers at the start and finish lines.

Plenty of runners donned fancy dress and ran for charities, with the highlight probably being The Justice League's Wonder Woman, The Flash and Batman, running alongside Avenger Captain America. Despite athletes trying to better their own personal records, a couple of competitors stopped to help a runner named Andy Matthews over the line, when it became clear that he was struggling.

A gallery of photos from the race can be found below:

Link:
Manchester Half Marathon 2022 in pictures as thousands race along sunny streets of Greater Manchester - Manchester Evening News

Over 55s turn to house shares to save money and avoid loneliness – Express

Home sharing is growing in popularity among older adults, as new research reveals, one in three people over 55 would consider having a housemate in later life to save money and avoid living alone.

Proving best friends are forever, almost a third (31 percent) of the 2,000 over 55-year-olds surveyed said they would be open to moving in with a friend in retirement, with more than one in six (18 percent) admitting that theyd rather live with friends than family. An adventurous four percent said theyd consider renting with a complete stranger.

According to property management service provider, FirstPort, who commissioned the study, the retirement roomie trend will only continue to grow as people look to save money.

The company has already seen a 27 percent increase in enquiries for independent-living retirement developments in the last year, with many requesting to move to the same development as their friends some even as next-door neighbours.

According to the research, 12 percent of the Baby Boomers questioned said the pandemic had changed their attitude towards communal living. However, for 63 percent of surveyors, financial fears remained their biggest concern.

Other reasons cited for co-living were company (40 percent), safety (25 percent) and sharing household chores and admin (15 percent).

Suggesting its not all doom and gloom, one in five (20 percent) said theyd live with others to have fun and 17 percent would do so to enjoy shared hobbies and interests together.

READ MORE:Best trick to successfully clean grout - costs pennies

When asked what they fear most about later life living, a solid 68 percent of people said losing their independence, closely followed by not having enough money at 48 percent. One in six (15 percent) were concerned about losing touch with family and friends, whereas 38 percent of people said being alone was their biggest fear.

A review of social media and retirement forums online found that friends and making friends were the most frequently used words in conversations about later life.

David Sinclair, Chief Executive of the International Longevity Centre UK (ILC) says: "As we get older, we spend an increasing amount of time at home alone and watching television. In old age our network of friends and family is often smaller than it was. One in five of us doesnt have children and we are more likely than in the past to be divorced or separated.

Wed like to see more diverse options for housing for older people, and this includes living with friends, which shouldnt just be for younger people. House-sharing is a great way to build and strengthen relationships and enjoy the company of others, rather than just the characters on our TV screens.

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Gareth Cayford, Director Retirement at FirstPort says: The events of the last few years have had a seismic impact on peoples attitudes towards later life, leading many to completely rethink what they want in retirement, and who they want to spend it with.

We are seeing a growing number of enquiries for friends and families looking to live near each other or in the same development buildings, and we expect this to continue to rise in the future especially with increasing living costs.

"Its not just a prudent choice but one that demonstrates that independent retirement development living - with communal lounges and spaces to socialise with friends - is more important than ever.

Ceinwen Kerslake (85) and Gillian Morgan (77), have been friends for over 40 years and live next door to each other in communal development, Homegower House, Swansea.

Gillian says: After both losing our husbands, we each experienced the loneliness of being widows living in larger houses and wanted to downsize. I would come and visit Cei who moved into the development first, and eventually decided to buy a flat of my own right next door!

Living next door to each other has brought us closer together as friends, we now spend five days a week together, doing activities like eating out with friends and joining in the development activities.

Cei added: Living so close to each other gives us the peace of mind that we can rely on each other when needed, whether thats a medical emergency or just borrowing milk for a cup of tea.

We actually tend to share food and save money on our weekly shop! We never expected to live so close to each other in later life but the company we offer has brought us so much joy, we would encourage anyone in a similar situation to us to do the same.

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Over 55s turn to house shares to save money and avoid loneliness - Express

Lineage to Present at Alliance for Regenerative Medicine 2022 Cell & Gene Meeting on the Mesa – Business Wire

CARLSBAD, Calif.--(BUSINESS WIRE)--Lineage Cell Therapeutics, Inc. (NYSE American and TASE: LCTX), a clinical-stage biotechnology company developing allogeneic cell therapies for unmet medical needs, announced today that Brian M. Culley, Lineages Chief Executive Officer, will present at the Alliance for Regenerative Medicine 2022 Cell & Gene Meeting on the Mesa, on October 12th, 2022 at 2:15pm PT / 5:15pm ET at the Park Hyatt Aviara, Carlsbad, CA. Virtual meeting attendance is available and includes a livestream of Lineages presentation and the ability to view all conference sessions on-demand. Interested parties can visit the 2022 Cell & Gene Meeting on the Mesa website for full information on the conference, including registration.

The Cell & Gene Meeting on the Mesa is the sectors foremost annual conference bringing together senior executives and top decision-makers in the industry to advance cutting-edge research into cures. Tackling the commercialization hurdles facing the cell and gene therapy sector today, this meeting covers a wide range of topics from clinical trial design to alternative payment models to scale-up and supply chain platforms for advanced therapies. The program features expert-led panels, extensive partnering capabilities, exclusive networking opportunities, and dedicated presentations by the leading publicly traded and privately held companies in the space. This conference enables key partnerships through more than 3,000 one-on-one meetings while highlighting the significant clinical and commercial progress in the field.

About the Alliance for Regenerative Medicine

The Alliance for Regenerative Medicine (ARM) is the leading international advocacy organization dedicated to realizing the promise of regenerative medicines and advanced therapies. ARM promotes legislative, regulatory, reimbursement and manufacturing initiatives to advance this innovative and transformative sector, which includes cell therapies, gene therapies and tissue-engineered therapies. In its 13-year history, ARM has become the global voice of the sector, representing the interests of 450+ members worldwide, including small and large companies, academic research institutions, major medical centers and patient groups.

About Lineage Cell Therapeutics, Inc.

Lineage Cell Therapeutics is a clinical-stage biotechnology company developing novel cell therapies for unmet medical needs. Lineages programs are based on its robust proprietary cell-based therapy platform and associated in-house development and manufacturing capabilities. With this platform Lineage develops and manufactures specialized, terminally differentiated human cells from its pluripotent and progenitor cell starting materials. These differentiated cells are developed to either replace or support cells that are dysfunctional or absent due to degenerative disease or traumatic injury or administered as a means of helping the body mount an effective immune response to cancer. Lineages clinical programs are in markets with billion dollar opportunities and include five allogeneic (off-the-shelf) product candidates: (i) OpRegen, a retinal pigment epithelial cell therapy in development for the treatment of geographic atrophy secondary to age-related macular degeneration, is being developed under a worldwide collaboration with Roche and Genentech, a member of the Roche Group; (ii) OPC1, an oligodendrocyte progenitor cell therapy in Phase 1/2a development for the treatment of acute spinal cord injuries; (iii) VAC2, a dendritic cell therapy produced from Lineages VAC technology platform for immuno-oncology and infectious disease, currently in Phase 1 clinical development for the treatment of non-small cell lung cancer; (iv) ANP1, an auditory neuronal progenitor cell therapy for the potential treatment of auditory neuropathy; and (v) PNC1, a photoreceptor neural cell therapy for the treatment of vision loss due to photoreceptor dysfunction or damage. For more information, please visit http://www.lineagecell.com or follow the company on Twitter @LineageCell.

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Lineage to Present at Alliance for Regenerative Medicine 2022 Cell & Gene Meeting on the Mesa - Business Wire

Study finds microprotein correlated to Alzheimers risk – Daily Trojan Online

(Aylish Turner | Daily Trojan)

A mutation in a newly discovered microprotein might lead to a significant risk for Alzheimers disease, according to research from the Leonard Davis School of Gerontology. The discovery expanded the gene target to treat the disease and provided a new potential therapeutic solution to the incurable disease.

The newly-discovered protein, named SHMOOSE, is encoded by a gene that exists within the cells mitochondria, which is responsible for cells energy production. A mutation within this gene, which partially inactivates the SHMOOSE microprotein, is associated with a 30% increase in ones risk of developing Alzheimers disease. The mutated version of the protein has reportedly appeared within nearly a quarter of people of European ancestry.

Brendan Miller, a 2022 doctoral graduate who studied neuroscience and the studys first author, relied on big data techniques to identify genetic variations associated with disease risk, after analyses revealed that mutations are linked to increased risk of Alzheimers, brain atrophy and energy metabolism.

Researchers began studying the genes mutated and default forms and found that SHMOOSE is the first mitochondrial-DNA-encoded microprotein to be detected using both antibodies and mass spectrometry.

Miller said one of the biggest obstacles in the research process was the sheer amount of data that researchers had to compile to make these findings. Miller described this big data as taking up terabytes of storage, containing research gleaned from dozens of individuals. His team was able to overcome this by utilizing new and advanced technology, which allowed them to make discoveries not otherwise possible.

Computational power over the last ten years has grown exponentially. With that means youre going to see in the field of medicine and biology a lot of rapid discoveries, Miller said. At USC, we have infrastructure, and we have a lot of talented computational scientists to help us with that.

Being able to manipulate and understand big data was essential for the success of this project, Miller said.

The big challenge is starting from hundreds of potential gene targets and narrowing them down to one, Miller said. The way we did this was [by] implementing a lot of genetics data and omics data from similar individuals with different data types.

The study highlights the importance of the emerging field of microprotein studies. Microprotein, a small protein encoded from a small open reading frame, appears to modify energy signaling and metabolism in the central nervous system. A variety of studies have found microproteins in mitochondria of neurons and showed that SHMOOSE alters energy metabolism in the brain, in part by inhibiting the inner mitochondrial membrane.

When you look at microproteins, there are many hundreds of thousands of them, [which] creates a whole new dimension of things that need to be discovered, said Pinchas Cohen, a professor of gerontology, medicine and biological sciences and the senior author of the study.

There is currently no approved medicine for Alzheimers disease developed based on microproteins, while microprotein- or peptide-related treatments have been employed in treatments of diabetes, heart diseases and some other chronic illnesses. The therapeutic potential of microproteins in Alzheimers cases was thus exciting news for many researchers in the field.

Helena Chang Chui, chair and professor of neurology at Keck School of Medicine, said the paper is very rich and has significant potential impact for understanding the causes of Alzheimers.

Were getting a little bit closer with immunological approaches with monoclonal antibodies[and] antibodies against amyloid proteins, but theres been no particular no peptide treatments, Chui said.

Researchers are, on the whole, cautiously optimistic about the therapeutic potential of the study, Cohen said, and it is still too early to contemplate applying the findings of the study into therapeutic research. Cohen said he hopes that the team could use standard mouse models of Alzheimers and demonstrate that SHMOOSE does have benefits on the treatment of Alzheimers disease.

Then, as Cohen implied, the team might pick individuals who have the SHMOOSE mutation to do the research, which will lend to the precision medicine approaches.

The issue is that Alzhmeimers disease is very heterogeneous. [Its] not really one specific condition, its multiple conditions, each being a result of various genetic susceptibilities, that all present in a similar way, Cohen said. Thats why I believe that treatments that will be focused on the primary genetic abnormality, also known as precision medicine approaches, will be more efficacious.

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Study finds microprotein correlated to Alzheimers risk - Daily Trojan Online

Blood from a baby at birth can be gene sequenced to prevent diseases – USA TODAY

Risky at-birth surgery saves baby with rare disorder

Doctors have performed a dramatic surgery to save a baby who was born with a life-threatening rare disorder that hampered his ability to breathe. (Sept. 21) (AP Video: Emma H. Tobin)

AP

Every baby born in the United States is pricked in the heel shortly after birth. A blood sample is then analyzed to look for one of 20 to 30 inherited diseases.

Early identification of a particular disease meanstreatment can start right away, potentially saving or extending thechild's life.

Now, doctors want to go even further: They want to look not just atblood, but atgenes.

A new effort announced Wednesday by a genetic testing company paired withresearchers at NewYork-Presbyterian/Columbia Universityaims to sequence 100,000 newborns in New York City over the next five years.

The sequencing would look for about 250 diseases that strike before age 5 and for which there are treatments or approaches that can make a difference in a child's life.

A similar effort in the United Kingdom is also examining the genes of 100,000 newborns, looking for diseases for which there is a treatment or a cure.

The programs promiseto bring treatments to babies before symptoms become obvious and at a time when something can be done to help them.

"The appetite for this is growing. The awareness of this is growing. We all see it as inevitable," said Dr. Robert Green, a medical geneticist atBrighamand Women's Hospital and Harvard Medical School, both in Boston."We are grossly underutilizing the life-saving benefits of genetics and we have to get past that."

This week,Green is hosting a conference in Boston, bringing together researchers and industry representatives from the U.S., U.K., European Union and Australia to set standards and discuss the challenges and opportunities presented byscaling upnewborn genetic sequencing.

This kind of early sequencing and treatment is possible now for the first time because of dramatic advances in diagnostics, therapies and digital data storage, as well as a reduction in the cost of sequencing, said Dr. Paul Kruszka, a clinical geneticist and chief medical officer of GeneDx at Sema4, which is leading the new program.

"We're entering the therapeutic era and leaving the diagnostic era," Kruszka said. "This potentially has the opportunity to change the way we practice medicine especially in rare disease."

Right now, families with rare diseases often search for a diagnosis for 5, 10 or even 20 years. If the child could be diagnosed at birth, he said, it would short-circuit that process and treatment could begin much earlier hopefully before the child suffers irreversible damage.

Before deciding whether every family should get access to genetic sequencing for their newborn,large studies like Sema4's are needed to justify the cost, Kruszka said.

The price of gene sequencing has dropped precipitiously, with one company, Illumina. announcing last week that its newest-generation sequencing machinescan run a complete sequence for about $200. Kruszka said Sema4 expects to still payabout $1,000 for each sequence of all 20,000 genes.

Gene sequencing at birth should be able to save money over the child's lifetime by preventing illness, Green said. The costs of sequencing are limited, he said, but the benefits will build up over the child's lifetime and may help family members, too.

Green and his team began analyzing the genetic sequences of newborns in 2013, and has found lots of useful information among the first 320 babies sequenced, he said. He now has funding to expand his sequencing researchto 1,000 newborns.

Large numbers are essential because most of the diseases being diagnosed are extremely rare.

Convincing parents to participate in a sequencing research trial "is not easy," Green said. Many are concerned about privacy and the discrimination their child might face if their genome were made public. And it can be a unpleasant for parents to consider the horrible diseases their perfect newborn might be harboring,he said.

"You've gone through all this pregancy and you're sitting there with a healthy baby (and I'm) offering you the opportunity to find out something that's devastating and terrifying," he said. "How fun is that?"

He doesn't think privacy needs to be a major parental concern. Companies can learn more useful information by tracking someone's cell phone or credit card than their genome and most common diseases are the result of many combinations of genes.

"Many people hear 'genetics' and worry somehow that that is a special kind of privacy threat," he said, adding that he doesn't think there is. "We haven't been paying attention to the medical benefits of genetic testing, particularly predictive genetic testing."

if people don't want to know, that's okay, too, Green said. "We canrespect people who don't want to know, but as also respect people who do want to know," he said. "Some families will say 'I treasure the precious ignorance.' Others will say 'If I could have known, I would have poured my heart and soul into clinical trials or spent more time with the child when she was healthy."

In a five-year review of their research, Green and his colleagues found that "terrible things didn't happen" when they sequenced newborn genomes.

Families, he said, "did not in fact have downstream distress," he said. "They did have appropriate medical follow-up and that there were amazing benefits to the babies and the families as a result of the surveillance and treatment."

The baby sequencing identified several parents who had inherited illnesses and received risk-reducing surgery, he said, as well as a baby who had a narrowed aorta that wouldn't have been detected if its genetics hadn't indicated the need for an echocardiogram.

"Even in a small sample we found much to act on," he said.

At Rady Children's Hospital in San Diego, they're trying to rapidly sequence the genomes of babies who already have problems and are being treated in one of 83 children's hospitals acrossCanada and the U.S.

Every morning, samples arrive by Fedex. In some cases, the baby is in such dire shape than an answer is needed immediately. For those children, "we've got to drop what we're doing and go,"said Dr. Stephen Kingsmore, the president and CEO of Rady's Institute for Genomic Medicine."Even a day can cost a child's life or brain function."

For babies who are stable, sequencing still happens rapidly, but a little less so."Every sample gets onto a sequencer the same day," he said.

So far, the institute, which is also collaborating on a newborn sequencing study in Greece,has been able to provide a 1,500 children with a diagnosis in the first weeks of life in addition to a life-saving treatment.

"That idea, that future is where a child never experiences a sick day, even though they have a fatal condition," the institute's former director of marketing,Graciela Sevilla,said earlier this year. "We'd love to see that on a regular basis."

Contact Weintraub at kweintraub@usatoday.com

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

Air pollution could be contributing to millions of premature births

Estimates in a new study say air pollution could be a factor in up to 3.4 million preterm births.Video provided by Newsy

Newslook

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Blood from a baby at birth can be gene sequenced to prevent diseases - USA TODAY

Passage Bio Announces Appointment of William Chou, M.D. as Chief Executive Officer – Yahoo Finance

Passage Bio

PHILADELPHIA, Oct. 10, 2022 (GLOBE NEWSWIRE) -- Passage Bio, Inc. (Nasdaq: PASG), a clinical-stage genetic medicines company focused on developing transformative therapies for central nervous system (CNS) disorders, today announced the appointment of William Chou, M.D. as chief executive officer (CEO) and a member of the board, effective immediately. Edgar B. (Chip) Cale will resign his position as the companys interim CEO and will continue in his role as general counsel and corporate secretary. Maxine Gowen, Ph.D., will step down as interim executive chairwoman following a brief transition period and will then continue to serve as chairwoman.

The Board and I are delighted to welcome Will to Passage Bio to lead the company through an exciting phase of development, said Dr. Gowen. Wills depth of experience and success in developing and commercializing advanced therapeutics will be instrumental in establishing and solidifying the company as a leader in genetic medicines.

Dr. Chou is an accomplished executive with nearly twenty years of healthcare experience across a range of development and commercialization roles. Most recently, Dr. Chou served as CEO of Aruvant Sciences, a clinical-stage biopharmaceutical company focused on developing gene therapies for rare diseases.

I am thrilled to join the talented team at Passage Bio and build upon the companys many accomplishments and impressive capabilities, said Dr. Chou. With three ongoing clinical programs, we are poised to deliver multiple meaningful milestones over the coming quarters. As a clinician, it is my privilege to lead a company with tremendous potential to bring transformative therapies to patients with CNS disorders for which there are limited or no approved treatment options today.

Prior to joining Aruvant, Dr. Chou served in a variety of leadership roles at Novartis, including vice president, global disease lead for Novartis Cell and Gene Therapy unit where he oversaw the global commercial launch of Kymriah, the first CAR-T cell therapy. Prior to that role, Dr. Chou led the Kymriah lymphoma clinical development program to approvals in the United States, Europe, Australia, Canada and Japan. Before joining Novartis, Dr. Chou worked at the Boston Consulting Group where he focused on commercial and clinical pharmaceutical strategy.

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Dr. Chou holds an M.B.A. from the Yale School of Management, an M.D. from the University of Pittsburgh School of Medicine, and an A.B. in politics and economics from Princeton University. Dr. Chou completed his residency in internal medicine at Yale New Haven Hospital and his fellowship in geriatrics at Yale University.

About Passage Bio

Passage Bio (Nasdaq: PASG) is a clinical-stage genetic medicines company on a mission to provide life-transforming therapies for patients with CNS diseases with limited or no approved treatment options. Our portfolio spans pediatric and adult CNS indications, and we are currently advancing three clinical programs in GM1 gangliosidosis, Krabbe disease, and frontotemporal dementia with several additional programs in preclinical development. Based in Philadelphia, PA, our company has established a strategic collaboration and licensing agreement with the renowned University of Pennsylvanias Gene Therapy Program to conduct our discovery and IND-enabling preclinical work. Through this collaboration, we have enhanced access to a broad portfolio of gene therapy candidates and future gene therapy innovations that we then pair with our deep clinical, regulatory, manufacturing and commercial expertise to rapidly advance our robust pipeline of optimized gene therapies. As we work with speed and tenacity, we are always mindful of patients who may be able to benefit from our therapies. More information is available at http://www.passagebio.com.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of, and made pursuant to the safe harbor provisions of, the Private Securities Litigation Reform Act of 1995, including, but not limited to: our expectations about timing and execution of anticipated milestones, including initiation of clinical trials and the availability of clinical data from such trials; our expectations about our collaborators and partners ability to execute key initiatives; our expectations about manufacturing plans and strategies; our expectations about cash runway; and the ability of our lead product candidates to treat their respective target monogenic CNS disorders. These forward-looking statements may be accompanied by such words as aim, anticipate, believe, could, estimate, expect, forecast, goal, intend, may, might, plan, potential, possible, will, would, and other words and terms of similar meaning. These statements involve risks and uncertainties that could cause actual results to differ materially from those reflected in such statements, including: our ability to develop and obtain regulatory approval for our product candidates; the timing and results of preclinical studies and clinical trials; risks associated with clinical trials, including our ability to adequately manage clinical activities, unexpected concerns that may arise from additional data or analysis obtained during clinical trials, regulatory authorities may require additional information or further studies, or may fail to approve or may delay approval of our drug candidates; the occurrence of adverse safety events; the risk that positive results in a preclinical study or clinical trial may not be replicated in subsequent trials or success in early stage clinical trials may not be predictive of results in later stage clinical trials; failure to protect and enforce our intellectual property, and other proprietary rights; our dependence on collaborators and other third parties for the development and manufacture of product candidates and other aspects of our business, which are outside of our full control; risks associated with current and potential delays, work stoppages, or supply chain disruptions caused by the coronavirus pandemic; and the other risks and uncertainties that are described in the Risk Factors section in documents the company files from time to time with the Securities and Exchange Commission (SEC), and other reports as filed with the SEC. Passage Bio undertakes no obligation to publicly update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.

For further information, please contact:

Passage Bio Investors:Stuart HendersonPassage Bio267-866-0114shenderson@passagebio.com

Passage Bio Media:Mike BeyerSam Brown Inc. Healthcare Communications312-961-2502MikeBeyer@sambrown.com

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Passage Bio Announces Appointment of William Chou, M.D. as Chief Executive Officer - Yahoo Finance

Gene Therapy Rapidly Improves Night Vision in Adults with Congenital Blindness – Newswise

Newswise PHILADELPHIAAdults with a genetic form of childhood-onset blindness experienced striking recoveries of night vision within days of receiving an experimental gene therapy, according to researchers at the Scheie Eye Institute in the Perelman School of Medicine at the University of Pennsylvania.

The patients had Leber Congenital Amaurosis (LCA), a congenital blindness caused by mutations in the gene GUCY2D. The researchers, whose findings are reported in the journal iScience, delivered AAV gene therapy, which carries the DNA of the healthy version of the gene, into the retina of one eye for each of the patients in accordance with the clinical trial protocol. Within days of being treated, each patient showed large increases, in the treated eye, of visual functions mediated by rod-type photoreceptor cells. Rod cells are extremely sensitive to light and account for most of the human capacity for low-light vision.

These exciting results demonstrate that the basic molecular machinery of phototransduction remains largely intact in some cases of LCA, and thus can be amenable to gene therapy even after decades of blindness, said study lead author Samuel G. Jacobson, MD, PhD, a professor of Ophthalmology at Penn.

LCA is one of the most common congenital blindness conditions, affecting roughly one in 40,000 newborns. The degree of vision loss can vary from one LCA patient to another but all such patients have severe visual disability from the earliest months of life. There are more than two dozen genes whose dysfunction can cause LCA.

Up to 20 percent of LCA cases are caused by mutations in GUCY2D, a gene that encodes a key protein needed in retinal photoreceptor cells for the phototransduction cascadethe process that converts light to neuronal signals. Prior imaging studies have shown that patients with this form of LCA tend to have relatively preserved photoreceptor cells, especially in rod-rich areas, hinting that rod-based phototransduction could work again if functional GUCY2D were present. Early results with low doses of the gene therapy, reported last year, were consistent with this idea.

The researchers used higher doses of the gene therapy in two patients, a 19- year-old man and a 32-year-old woman, who had particularly severe rod-based visual deficits. In daylight, the patients had some, albeit greatly impaired, visual function, but at night they were effectively blind, with light sensitivity on the order of 10,000 to 100,000 times less than normal.

The researchers administered the therapy to just one eye in each patient, so the treated eye could be compared to the untreated eye to gauge treatment effects. The retinal surgery was performed by Allen C. Ho, MD, a professor of Ophthalmology at Thomas Jefferson University and Wills Eye Hospital. Tests revealed that, in both patients, the treated eyes became thousands of times more light-sensitive in low-light conditions, substantially correcting the original visual deficits. The researchers used, in all, nine complementary methods to measure the patients light sensitivity and functional vision. These included a test of room navigation skills in low-light conditions and a test of involuntary pupil responses to light. The tests consistently showed major improvements in rod-based, low-light vision, and the patients also noted functional improvements in their everyday lives, such as can [now] make out objects and people in the dark.

Just as striking was the rapidity of the improvement following therapy. Within eight days, both patients were already showing measurable efficacy, said study co-author Artur V. Cideciyan, PhD, a research professor of Ophthalmology at Penn.

To the researchers, the results confirm that GUCY2D gene therapy to restores rod-based photoreceptor functionsand suggest that GUCY2DLCA patients with more severe rod-based dysfunction are likely to benefit most dramatically from the therapy. The practical message is that there should be an emphasis on rod vision measurements at screening of LCA candidates and in monitoring them throughout a treatment trial.

The findings, the researchers said, also underscore the remarkable fact that in some patients with severe congenital vision loss, the retinal cell networks that mediate vision remain largely alive and intact, and need only the resupply of a missing protein to start working again, more or less immediately.

The ongoing clinical trial is registered at clinicaltrials.gov as trial NCT03920007.

Support for the research was provided by Atsena Therapeutics, Inc., the developer of the GUCY2D gene therapy; the National Institutes of Health (R01 EY11522); and by a CURE Formula grant from the Pennsylvania Department of Health.

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Gene Therapy Rapidly Improves Night Vision in Adults with Congenital Blindness - Newswise

Scientists Discover Protein Partners that Could Heal Heart Muscle | Newsroom – UNC Health and UNC School of Medicine

A protein that helps make neurons also works to reprogram scar tissue cells into heart muscle cells, especially in partnership with a second protein, according to a study led by Li Qian, PhD, at the UNC School of Medicine.

CHAPEL HILL, N.C. Scientists at the UNC School of Medicine have made a significant advance in the promising field of cellular reprogramming and organ regeneration, and the discovery could play a major role in future medicines to heal damaged hearts.

In a study published in the journal Cell Stem Cell, scientists at the University of North Carolina at Chapel Hill discovered a more streamlined and efficient method for reprogramming scar tissue cells (fibroblasts) to become healthy heart muscle cells (cardiomyocytes). Fibroblasts produce the fibrous, stiff tissue that contributes to heart failure after a heart attack or because of heart disease. Turning fibroblasts into cardiomyocytes is being investigated as a potential future strategy for treating or even someday curing this common and deadly condition.

Surprisingly, the key to the new cardiomyocyte-making technique turned out to be a gene activity-controlling protein called Ascl1, which is known to be a crucial protein involved in turning fibroblasts into neurons. Researchers had thought Ascl1 was neuron-specific.

Its an outside-the-box finding, and we expect it to be useful in developing future cardiac therapies and potentially other kinds of therapeutic cellular reprogramming, said study senior author Li Qian, PhD, associate professor in the UNC Department of Pathology and Lab Medicine and associate director of the McAllister Heart Institute at UNC School of Medicine.

Scientists over the last 15 years have developed various techniques to reprogram adult cells to become stem cells, then to induce those stem cells to become adult cells of some other type. More recently, scientists have been finding ways to do this reprogramming more directly straight from one mature cell type to another. The hope has been that when these methods are made maximally safe, effective, and efficient, doctors will be able to use a simple injection into patients to reprogram harm-causing cells into beneficial ones.

Reprogramming fibroblasts has long been one of the important goals in the field, Qian said. Fibroblast over-activity underlies many major diseases and conditions including heart failure, chronic obstructive pulmonary disease, liver disease, kidney disease, and the scar-like brain damage that occurs after strokes.

In the new study, Qians team, including co-first-authors Haofei Wang, PhD, a postdoctoral researcher, and MD/PhD student Benjamin Keepers, used three existing techniques to reprogram mouse fibroblasts into cardiomyocytes, liver cells, and neurons. Their aim was to catalogue and compare the changes in cells gene activity patterns and gene-activity regulation factors during these three distinct reprogrammings.

Unexpectedly, the researchers found that the reprogramming of fibroblasts into neurons activated a set of cardiomyocyte genes. Soon they determined that this activation was due to Ascl1, one of the master-programmer transcription factor proteins that had been used to make the neurons.

Since Ascl1 activated cardiomyocyte genes, the researchers added it to the three-transcription-factor cocktail they had been using for making cardiomyocytes, to see what would happen. They were astonished to find that it dramatically increased the efficiency of reprogramming the proportion of successfully reprogrammed cells by more than ten times. In fact, they found that they could now dispense with two of the three factors from their original cocktail, retaining only Ascl1 and another transcription factor called Mef2c.

In further experiments they found evidence that Ascl1 on its own activates both neuron and cardiomyocyte genes, but it shifts away from the pro-neuron role when accompanied by Mef2c. In synergy with Mef2c, Ascl1 switches on a broad set of cardiomyocyte genes.

Ascl1 and Mef2c work together to exert pro-cardiomyocyte effects that neither factor alone exerts, making for a potent reprogramming cocktail, Qian said.

The results show that the major transcription factors used in direct cellular reprogramming arent necessarily exclusive to one targeted cell type.

Perhaps more importantly, they represent another step on the path towards future cell-reprogramming therapies for major disorders. Qian says that she and her team hope to make a two-in-one synthetic protein that contains the effective bits of both Ascl1 and Mef2c, and could be injected into failing hearts to mend them.

Cross-lineage Potential of Ascl1 Uncovered by Comparing Diverse Reprogramming Regulatomes was co-authored by Haofei Wang, Benjamin Keepers, Yunzhe Qian, Yifang Xie, Marazzano Colon, Jiandong Liu, and Li Qian. Funding was provided by the American Heart Association and the National Institutes of Health (T32HL069768, F30HL154659, R35HL155656, R01HL139976, R01HL139880).

Media contact: Mark Derewicz, 919-923-0959

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Scientists Discover Protein Partners that Could Heal Heart Muscle | Newsroom - UNC Health and UNC School of Medicine

The Pros and Cons of Lentiviral and Adeno-Associated Viral Vectors – The Medicine Maker

Demand for viral-vector-based gene therapies has risen to unprecedented levels, thanks to their potential to help treat previously incurable diseases. The two vectors most in the spotlight? Lentiviral (LV) vectors and adeno-associated viral (AAV) vectors due to the increased research and positive clinical results they are seeing across a wide range of applications, including cancer, heart disease, and hematologic and genetic disorders. The more drug developers look to expand this range of therapeutic areas, the greater the demand for commercial-scale development. So its important to understand not only how these two vectors can be applied to drug development, but also the capabilities required for scale-up that allows us to bring these innovative therapies to patients.

LV vectors are derived from the single-stranded RNA retrovirus HIV-1, and have been used extensively because of their ability to infect non-dividing cells, efficiently integrate into the host genome, carry large transgene loads, and allow for long-term transgene expression. They are predominantly used as delivery vehicles for introducing genetic modifications into cell therapies, such as CAR-T, and HSC gene therapies. Importantly, recent regulatory approvals and clinical successes with LV vectors are spurring even more interest among drug developers.

Lets look at the benefits of LV vectors in more detail:

However, LV vectors also present two major risks to safety.

The first is a risk of accidental exposure because HIV can self-replicate during manufacturing thanks to the lentiviruss high mutation and recombination rate.Though research shows that the risk is low, it remains a major safety concern for lab engineers and workers during development. Before using a lentiviral vector system, a risk assessment must be completed and documented. Typically, lentiviral vectors may be safely handled using either BSL-2 or BSL-2 enhanced controls, depending upon the risk assessment.

The second risk is the potential for oncogenes to occur in cells through insertional mutagenesis. For this reason, lentiviral vectors are predominantly used for cell therapy applications with genetic modification of cells ex-vivo. Only limited use is seen for direct in vivo therapies.

Unlike their LV cousins, AAV vectors are single-stranded DNA parvoviruses that can replicate only in the presence of helper viruses, such as the adenovirus, herpes virus, human papillomavirus, and vaccinia virus. Following several landmark approvals, AAV vectors are currently being used for in vitro, ex vivo, and in vivo research. AAV therapies predominantly target rare genetic disorders for which the patient population tends to be highly limited. As the market is so small, drug developers feel immense pressure to be first to market to commercialize their therapies.

The biological elements of AAV vectors make them a very attractive candidate for gene therapy for several reasons:

As with LV vectors, AAV vectors come with several drawbacks that affect their applications and efficiency.

Firstly, AAV vectors are limited by their restricted capacity for insertion of transgene DNA; because of their relatively small transgene size, they are unable to deliver genes larger than 4.8 kilobytes. Secondly, the generation of neutralizing antibodies against AAV in non-human primates (NHP) and humans may attenuate the curative effects of AAV-mediated gene therapies and limit the size of patient populations suitable for these therapies. Thirdly, there are several different serotypes and capsids for AAVs, all of which have different production and purification requirements and vary greatly with respect to function and efficacy. Fourthly, AAV drug products have varying degrees of empty and partially filled capsids, and these have implications for safety and efficacy. Generally, the highest possible percentage of AAV particles with the full transgene DNA is desired, and this varies significantly depending on the production method, AAV serotype, and the transgene itself. The latter two factors introduce significant manufacturing challenges for AAV therapies.

Overall, the industrys collective ability to successfully scale up LVV and AAV vectors faces two challenges:

i) Manufacturing each viral vector currently requires different processes, so companies cannot apply a one-size-fits-all approach to their upstream and downstream processes. Therefore, manufacturing requires immense scientific and market expertise to make the informed decisions necessary for developing a robust plan.

ii) Given the industrys limited experience with commercial-scale viral vector supply, companies need to work closely with regulatory agencies. This can be especially challenging during the transition from preclinical to commercial, where complexities arise that can cause potential delays resulting in increased costs.

As demand continues to rise, pharma companies must understand how to navigate these challenges to continue delivering their life-saving medications.

Head of Commercial Development for Viral Vector, Cell and Gene Technologies (CGT) at Lonza

She works closely with the innovation, operations, engineering, strategic marketing, and business teams to enable prioritization, strategic development and commercialization of viral vector production services for CGT. Suparnas background is in Neuroscience, and she earned her PhD in Neuropharmacology from the University of Toronto. She has over 15 years of broad pharmaceutical and CDMO experience driving innovation, drug discovery, product and service development for CNS, oncology, and cell and gene therapy.

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The Pros and Cons of Lentiviral and Adeno-Associated Viral Vectors - The Medicine Maker

LEXEO Therapeutics to Present New Clinical Data from its Investigational Gene Therapy LX1001 for APOE4-Associated Alzheimers Disease at the 29th…

NEW YORK, Oct. 05, 2022 (GLOBE NEWSWIRE) -- LEXEO Therapeutics, Inc. (LEXEO), a clinical-stage biotech company advancing a pipeline of adeno-associated virus (AAV)-based gene therapy candidates for cardiovascular and central nervous system (CNS) diseases, today announced new clinical data from its ongoing study of LX1001 for APOE4-associated Alzheimers disease will be presented at the 29th European Society of Gene and Cell Therapy Annual Meeting (ESGCT), which is being held live in Edinburgh, Scotland and virtually from October 11-14, 2022.

In an oral presentation, LEXEO will present clinical data from the ongoing study of LX1001 for APOE4-associated Alzheimers disease. LX1001 is an AAV-based investigational gene therapy designed to deliver the apolipoprotein E2 (APOE2) gene into the CNS of APOE4 homozygous Alzheimers disease patients to halt or slow disease progression. This marks the first clinical data from a gene therapy program targeting APOE4-associated Alzheimers disease presented at a scientific meeting.

Details of the oral presentation are:

Title: Gene Therapy in APOE4 Homozygote Alzheimers Disease interim dataPresenter: Michael Kaplitt, M.D., Ph.D., Weill Cornell MedicineDate/Time: Wednesday, October 12th, session start - 9:00 AM ET (15:00 CEST)Session Title: CNS and sensory disease I (Parallel 3a)

To view full event programming, please visit the ESGCT website.

About LEXEO TherapeuticsLEXEO Therapeutics is a New York City-based, clinical-stage gene therapy company focused on addressing some of the most devastating genetically defined cardiovascular and central nervous system diseases affecting both larger-rare and prevalent patient populations. LEXEOs foundational science stems from partnerships and exclusive licenses with leading academic institutions at Weill Cornell Medicine and the University of California, San Diego. LEXEO is advancing a deep and diverse pipeline of AAV-based gene therapy candidates in rare cardiovascular diseases, APOE4-associated Alzheimers disease, and CLN2 Batten disease, and is led by pioneers and experts with decades of collective experience in genetic medicines, rare disease drug development, manufacturing, and commercialization. For more information, please visit http://www.lexeotx.com or LinkedIn.

Media Contact:Evan FeeleyEvoke Canale for LEXEO(619) 849-5392evan.feeley@evokegroup.com

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LEXEO Therapeutics to Present New Clinical Data from its Investigational Gene Therapy LX1001 for APOE4-Associated Alzheimers Disease at the 29th...

Insights & Outcomes: Foreign DNA, quantum potholes and relapsing fever – Yale News

This month, Insights & Outcomes digs into the nitty gritty of quantum potholes, foreign DNA, relapsing fever, and the thermodynamics of hydrogen binding.

As always, you can find more science and medicine research news on Yale News Science & Technology and Health & Medicine pages.

In some quantum mechanical systems, researchers say, the energy landscape is going to have a few potholes touching points where the state of the system is not defined. Understanding how these potholes, known as singularities, affect a quantum systems behavior is a key area of physics research.

In a new study in the journal Science, incoming Yale assistant professor of physics Charles D. Brown II and his collaborators found a new approach for probing certain types of quantum singularities.

For the study, Brown and co-authors from the University of California-Berkeley conducted a unique quantum simulation experiment with intersecting lasers that trap and manipulate ultra-cold atoms in crystals made of light. The researchers moved the atoms along trajectories that entered, turned, and exited singularities at linear touching points (called Dirac points) and quadratic touching points.

A quadratic band touching point is a point at which two energy bands have equal values but away from this point the energy values are non-equal, and the gap between the energy bands grows proportional to the square of the distance from the point.

The researchers found that the ultimate state of the system depended only on the entry and exit angles through the singularities.

We developed a distinct method to probe singularities, importantly including non-Dirac singularities, in ultracold atom quantum simulators, Brown said.

Brown is first author and co-corresponding author of the study. Dan Stamper-Kurn of the University of California-Berkeley is the senior and co-corresponding author.

Relapsing fever, a condition caused by bacterial infections transmitted by lice or tick bites, is characterized by recurrent bouts of fever, headache, and muscle aches. If left untreated, it can cause severe disability and even death.

Yet the condition which often afflicts people living in poorer regions of Africa, central Asia, and Central and South America remains a relatively unstudied disease.

In a new study, a team of Yale researchers analyzed different species of Borellia bacteria that cause many cases of relapsing fever and Lyme disease in humans, identifying a single molecule that allows two species of Borrelia to avoid immune system detection. They found that mice infected with relapsing fever but lacking the molecule CD55 had lower levels of the pathogen and a bolstered immune response.

While CD55 normally acts as a regulator of immune system response to protect potentially damaging response to host tissues, in cases of relapsing fever it is hijacked by bacteria to avoid detection and eradication, explained co-lead author Gunjan Arora, associate research scientist in the lab of senior author Erol Fikrig, the Waldemar Von Zedtwitz Professor of Medicine (Infectious Diseases) and Professor of Epidemiology (Microbial Diseases) and of Microbial Pathogenesis. The pathogens got very smart and used a molecule designed to balance our immune system response to survive in the host, Arora said.

Geoffrey Lynn, associate research scientist, is co-lead author of the study published in the journal mBio.

For decades, researchers studying the conversion of light energy into electrical or chemical energy such as in solar cells have focused on the movement of electrons, which are central to the process.

But in a new study in the journal Chem, Yale chemists James Mayer and Hyunho Noh take a different approach. They looked at energy conversion reactions as a type of whole atom transfer of hydrogen atoms, which have one electron and one proton, and are found in most energy conversion reactions.

For the study, Mayer, the Charlotte Fitch Roberts Professor of Chemistry in Yales Faculty of Arts and Sciences, and Noh, a postdoctoral associate in chemistry, measured the thermodynamics of hydrogen-atom binding to nickel oxide electrodes when in contact with three solvents: water, dimethylformamide, and acetonitrile.

Our work shows that the electron-only model is not sufficient, Mayer said. The other new approach this paper develops is that the solid/solution interface has a range of surface sites, with somewhat different strengths of chemical bonds. While this range of energies is well known in some areas of surface science, the importance of this effort has not been emphasized.

They found that the binding of hydrogen was the same no matter which solvent they used or what was dissolved in the solution, showing that this parameter is the best intrinsic property of the electrode, while the electron-only parameters vary strongly with the nature of the medium.

A medication commonly used to treat heart failure may also reduce alcohol drinking, especially among those diagnosed with alcohol use disorder, researchers from Yale School of Medicine and the National Institutes of Health Intramural Research Program (NIH IRP) report.

The effects of the drug spironolactone on drinking behavior in mice, rats, and humans were reported in the journal Molecular Psychiatry.

This is a remarkable example of bench to bedside team science showing that an inexpensive, off-patent drug, may help reduce alcohol consumption, said co-senior author Amy Justice, the C.N.H. Long Professor of Medicine and professor of public health.

In animal models of excessive alcohol drinking, researchers from the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) IRPs found that when administered to rats and mice, spironolactone reduced consumption of alcohol, and it did so in a dose dependent manner.

The Yale team, headed by Justice, then analyzed data from the U.S. Department of Veterans Affairs to assess the effects of spironolactone taken for at least 60 days on individuals reporting current alcohol use. Compared to similar individuals who did not receive the drug, those who took spironolactone reported greater decreases in alcohol consumption, the researchers found.

And those who had more severe alcohol problems, particularly those diagnosed with alcohol use disorder, benefitted the most, Justice said.

There are limited number of drugs that can help reduce harmful alcohol consumption, which costs the U.S. healthcare system $28 billion annually and another $179 billion in lost productivity, according to the Centers for Disease Control and Prevention.

Spironolactone is a medication in widespread use and a proven safety profile that is no longer on patent offering a ready additional tool to treat alcohol use disorder, the authors said.

All together, our findings provide strong justification for randomized clinical trials to further investigate the potential of this medication in patients with alcohol use disorder, said co-first author Christopher Rentsch, assistant professor at the Yale School of Medicine and London School of Hygiene & Tropical Medicine.

Lorenzo Leggio of the NIDA and NIAAA IRPs and Leandro Vendruscolo of the NIDA IRP are co-senior authors.

Yale scientist Emily Sandall will spend a year with the Office of Trade Policy & Geographic Affairs in the U.S. Department of Agriculture as a recipient of the American Association for the Advancement of Sciences Science & Technology Policy Fellowship.

Sandall is a postdoctoral researcher in the Department of Ecology and Evolutionary Biology, in Yales Faculty of Arts and Sciences.

Her research has focused primarily on insect biodiversity patterns, through geographic, morphological, and phylogenetic methods. As a postdoctoral research associate in the Yale Center for Biodiversity & Global Change, she examined global dragonfly biogeography and led a team of species experts. In her fellowship role, her research background in insect biodiversity, taxonomy, natural history, and data standards will enable her to share expertise on topics related to agricultural policy throughout the U.S. government, including species-level protections or restrictions. For instance, on topics related to an endangered or invasive species, she will be able to provide critical insights into scientific literature about how that affects trade agreements and provide summaries to negotiators and policymakers to inform their decisions.

Foreign DNA, or genetic material that comes from an organism of the same or different species, is key to the survival of bacteria, helping them resist antimicrobial agents and adapt to a variety of changing environments. Bacterial pathogens also often rely on foreign genes to cause disease in humans. But how do bacteria know which foreign genes to accept?

To answer this question, researchers in the lab of Eduardo Groisman, the Waldemar Von Zedtwitz Professor of Microbial Pathogenesis, zeroed in on the role of a widespread protein known to prevent the expression of foreign DNA. In doing so, they solved the question of how bacteria can overcome foreign gene silencing to access the benefits of foreign DNA.

Specifically, the researchers explored how bacteria can express genes otherwise suppressed by the foreign gene silencing protein H-NS. Because H-NS amounts were believed to remain constant, researchers had ascribed the overcoming of foreign gene silencing to other proteins. In the new study, however, Jeongjoon Choi, an associate research scientist, and Groisman found that the human pathogen Salmonella Typhimurium degrades H-NS when inside a mammalian host and they identified the enzyme responsible for H-NS degradation.

According to their findings, the researchers identified a mutant form of H-NS that resists degradation and found that the beneficial bacterium Escherichia coli cannot express foreign genes or colonize the gut of mice when it harbors the mutant H-NS.

The researchers demonstrated that H-NS degradation is essential for different bacterial species to express foreign genes, showing that beneficial E. coli and pathogenic Salmonella both use the same strategy to overcome gene silencing and thus adapt to the specific environments they face during infection. The research was published in the Proceedings of the National Academy of Sciences.

Creating new neuropsychiatric drug candidates from a virtual library

Study finds all African carnivores at risk for range loss

Yales Spielman wins $3 million Breakthrough Prize

The roots of biodiversity: how proteins differ across species

Jumping genes yield new clues to origins of neurodegenerative disease

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Insights & Outcomes: Foreign DNA, quantum potholes and relapsing fever - Yale News

Influence of the microbiome, diet and genetics on inter-individual variation in the human plasma metabolome – Nature.com

Untargeted plasma metabolites in Dutch cohorts

In this study, we examined plasma metabolomes in 1,679 fasting plasma samples from 1,368 individuals from two LLD5 sub-cohorts (LLD1 and LLD2) and the GoNL6 cohort (Extended Data Fig. 1 and Supplementary Table 1). The LLD1 cohort was the discovery cohort, with information about genetics, diet and the gut microbiome available for 1,054 participants. Moreover, 311 LLD1 subjects were followed up 4years later (LLD1 follow-up). We also included two independent replication cohorts: 237 LLD2 participants for whom we had genetic and dietary data and 77 GoNL participants for whom only genetic data were available (Extended Data Fig. 1 and Supplementary Table 1). Untargeted metabolomics profiling was done using flow-injection time-of-flight mass spectrometry (FI-MS)10,11, which yielded plasma levels of 1,183 metabolites (Supplementary Table 2). These metabolites covered a wide range of lipids, organic acids, phenylpropanoids, benzenoids and other metabolites (Extended Data Fig. 2a). As we observed weak (absolute rSpearman<0.2) correlations among the 1,183 metabolites (Extended Data Fig. 2b), data reduction was not required and, consequently, all metabolites were subjected to subsequent analyses. We validated the identification and quantification of some metabolites (for example, bile acids, creatinine, lactate, phenylalanine and isoleucine) by comparing their abundance levels from FI-MS with those previously determined by liquid chromatography with tandem mass spectrometry (LC-MS/MS)12 or NMR13 (rSpearman>0.62; Extended Data Fig. 2c,d).

To compare the relative importance of diet, genetics and the gut microbiome in explaining inter-individual plasma metabolome variability, we calculated the proportion of variance explained by these three factors for the whole plasma metabolome profile and for the individual metabolites separately. We have detailed information on 78 dietary habits (Supplementary Table 3), 5.3million human genetic variants and the abundances of 156 species and 343 MetaCyc pathways for each individual of the LLD1 cohort. Diet, genetics and the gut microbiome could explain 9.3, 3.3 and 12.8%, respectively, of inter-individual variations in the whole plasma metabolome, without adjusting for covariates (see the Methods section Distance matrix-based variance estimation; false discovery rate (FDR)<0.05; Fig. 1a and Supplementary Table 4), whereas intrinsic factors (age, sex and body mass index (BMI)) and smoking collectively explained 4.9% of the variance. Together, these factors explain 25.1% of the variance in the plasma metabolome (Fig. 1a).

a, Inter-individual variation in the whole plasma metabolome explained by the indicated factors, estimated using the PERMANOVA method. All, all of the indicated factors combined; smk, smoking status. b, Venn diagram indicating the number of metabolites whose inter-individual variation was significantly explained by diet, genetics or the gut microbiome, as estimated using the linear regression method (FDRF-test<0.05). c, Inter-individual variations in metabolites explained by diet, genetics or the gut microbiome, as estimated using the linear regression method (the lasso regression method was applied for feature selection) with a significant estimated adjusted r2>5% (FDRF-test<0.05). The blue bars represent dietary contributions to metabolite variations, the yellow bars indicate genetic contributions and the orange bars indicate microbial contributions. The other colors indicate the metabolic categories of metabolites (see legend). The yaxis indicates the proportion of variation explained. TMAO, trimethylamine N-oxide.

Next, we tested for pairwise associations between each metabolite and the dietary variables, genetic variants and microbial taxa. We observed 2,854 associations with dietary habits (Supplementary Table 5), 48 associations with 40 unique genetic variants (metabolite quantitative trait loci (mQTLs); Supplementary Table 6), 1,373 associations with gut bacterial species (Supplementary Table 7) and 2,839 associations with bacterial MetaCyc pathways (Supplementary Table 8) (see the Methods sections Associations with dietary habits, QTL mapping and Microbiome-wide associations). In total, 769 metabolites were significantly associated with at least one factor (Fig. 1b and Supplementary Tables 58). We then performed interaction analysis to assess the role of dietmicrobiome, geneticsmicrobiome and dietgenetics interactions in regulating the human metabolome using an interaction term in the linear model (see the Methods section Interaction analysis). Among these, 185 metabolites were associated with multiple factors and seven were affected by either geneticsmicrobiome, geneticsdiet or dietmicrobiome interactions (Supplementary Table 9).

As interactions were limited, we further assessed the proportion of variance of each metabolite that was explained by these factors using an additive model with the least absolute shrinkage and selection operator (lasso) method (see the Methods section Estimating the variance of individual metabolites). In general, the inter-individual variations in 733 metabolites could be explained by at least one of the three factors (FDRF-test<0.05; Supplementary Table 10). In detail, dietary habits contributed 0.435% of the variance in 684 metabolites; microbial abundances contributed 0.725% of the variance in 193 metabolites; and genetic variants contributed 328% of the variance in 44 metabolites (adjusted r2; FDRF-test<0.05; Supplementary Table 10). We also estimated the explained variance of metabolites using Elastic Net14, which is designed for highly correlated features, and found that the estimated explained variances were comparable between linear regression and the Elastic Net regression (Supplementary Fig. 1).

We further compared the variance explained by each type of factor (diet, genetics or the microbiome) and assigned the dominant factor for each metabolite if one factor explained more variance than the other two. Inter-individual variations in 610 metabolites were mostly explained by diet, 85 were explained by the gut microbiome and 38 were explained by genetics (Supplementary Table 10). Hereafter, we refer to these as diet-dominant, microbiome-dominant and genetics-dominant metabolites, respectively. The dominant factors of metabolites highlight their origin. For instance, ten out of the 21 diet-dominant metabolites for which diet explained >20% of the variance (FDRF-test<0.05; Supplementary Table 10) were food components based on their annotation in the Human Metabolome Database (HMDB)15. Similarly, of the 85 microbiome-dominant metabolites, 23 were annotated in the HMDB as microbiome-related metabolites (including 15 uremic toxins). Furthermore, out of the 38 genetics-dominant metabolites, ten were lipid species and eight were amino acids. Taken together, our analysis highlights that one factoreither dietary, genetic or microbialcan have a dominant effect over the other two in explaining the variances of plasma metabolites, with diet or the microbiome being particularly dominant. However, we also found that the variances in 185 metabolites were significantly attributable to more than one factor (Supplementary Table 10), including six metabolites associated with both genetics and the microbiome and 153 metabolites associated with both diet and the microbiome. For example, genetics and the microbiome explained 4 and 5%, respectively, of the variance in plasma 5-carboxy--chromanol (Fig. 1c)a dehydrogenated carboxylate product of 5-hydroxy--tocopherol16 that may reduce cancer and cardiovascular risk17. Another example is hippuric acida uremic toxin that can be produced by bacterial conversion of dietary proteins18, with 13% of its variance explained by diet and 13% explained by the microbiome (Fig. 1c).

Temporal changes in plasma metabolites can reflect changes in an individuals diet, gut microbiome and health status. When assessing the plasma metabolome in the 311 LLD1 follow-up samples, we indeed observed a significant shift in the plasma metabolome, with a significant difference in the second principal component (PPC1 paired Wilcoxon=0.1 and PPC2 paired Wilcoxon=1.3105; Fig. 2a). Baseline genetics, diet and microbiome, together with age, sex and BMI, could explain 59.4% of the variance in the follow-up plasma metabolome (PPERMANOVA=0.004) (Supplementary Fig. 2). We also observed that temporal stability can vary substantially between different metabolites (see the Methods section Temporal consistency of individual metabolites; Supplementary Table 11). Previously, we had assessed the changes in the gut microbiome in the LLD1 follow-up cohort and linked these to changes in the plasma metabolome7. Here, we further checked the temporal variability of the plasma metabolome and assessed the stability of diet-, microbiome- and genetics-dominant metabolites over time. Interestingly, the temporal correlation of the microbiome-dominant metabolites was similar to that of the genetics-dominant metabolites (PWilcoxon=0.51; Fig. 2b), whereas the temporal correlation between diet-dominant metabolites was significantly lower than between microbiome- and genetics-dominant metabolites (PWilcoxon<3.4105; Fig. 2b). However, the dominant dietary, microbial and genetic factors identified at baseline also explained similar variance in metabolic levels in the follow-up samples (Extended Data Fig. 3 and Supplementary Table 10). Our data also revealed a positive correlation between stability and the amount of variance that could be explained: the more variance explained, the more stable a metabolite is over time (Fig. 2c). For a few metabolites, we could not replicate the variance explained at baseline at the second time point, and these metabolites also showed weak or no correlation in their abundances between the two time points. For example, N-acetylgalactosamine showed very weak correlation between the two time points (r=0.13; P=0.02), and its genetic association was not replicated at the second time point.

a, Principal component analysis of metabolite levels at two time points (Euclidean dissimilarity). The green dots indicate baseline samples and the orange dots indicate follow-up samples (n=311 biologically independent samples). The KruskalWallis test (two sided) was used to check differences between baseline and follow-up. b, Temporal stability of metabolites stratified by the dominantly associated factor for each metabolite. The Wilcoxon test (two sided) was used to check the differences between groups. Each dot represents one metabolite. The yaxis indicates the Spearman correlation coefficient of abundances of each metabolite between two time points (n=311 biologically independent samples). In a and b, the box plots show the median and first and third quartiles (25th and 75th percentiles) of the first and second principal components (a) or correlation coefficients (b); the upper and lower whiskers extend to the largest and smallest value no further than 1.5 the interquartile range (IQR), respectively; and outliers are plotted individually. c, Correlation between metabolite stability and the metabolite variance explained by diet (left), genetics (middle) and the microbiome (right). The xaxis indicates the inter-individual variation explained by each factor and the yaxis indicates the Spearman correlation coefficient (two sided) of abundances of each metabolite between the two time points. The dashed white lines show the best fit and the gray shading represents the 95% confidence interval (CI) (n=311 biologically independent samples).

Having established the variances in metabolites explained by diet, genetics and the gut microbiome and the dominant factors that explained most of this variance, we focused on detailing specific associations and on the potential implications of our findings for assessing diet quality and improving our understanding of the genetic risk of complex diseases and the interaction and causality relationships among diet, the microbiome, genetics and metabolism.

We observed 2,854 significant associations (FDRSpearman<0.05) between 74 dietary factors and 726 metabolites (Fig. 3a and Supplementary Table 5; see the Methods section Lifelines diet quality score prediction). Associations with food-specific metabolites can, in theory, be used to verify food questionnaire data. For instance, the strongest association we observed was between quinic acid levels and coffee intake (rSpearman=0.54; P=1.61080; Fig. 3b). Quinic acid is found in a wide variety of different plants but has a particularly high concentration in coffee. Another example is 2,6-dimethoxy-4-propylphenol, which was strongly associated with fish intake (rSpearman=0.53; P=1.51076; Fig. 3c). This association is expected as this compound is particularly present in smoked fish according to HMDB annotation15. In addition, we also detected associations between dietary factors and metabolic biomarkers of some diseases. For example, 1-methylhistidine is a biomarker for cardiometabolic diseases including heart failure19 that is enriched in meat, and we observed significant associations between 1-methylhistidine and meat (rSpearman=0.12; P=7.2105) and fish intake (rSpearman=0.11; P=3.1104) as well as a lower level of 1-methylhistidine in vegetarians (rSpearman=0.15; P=9.7107; Fig. 3d).

a, Summary of the associations between diet and metabolites. The bars represent dietary habits, with the bar order sorted by the number of significant associations. Association directions are colored differently: orange indicates a positive association, whereas blue indicates a negative association. The length of each bar indicates the number of significant associations at FDR<0.05 (Spearman; two sided). b, Association between plasma quinic acid levels and coffee intake. The x and yaxes indicate residuals of coffee intake and the metabolic abundance after correcting for covariates, respectively (n=1,054 biologically independent samples). c, Association between plasma 2,6-dimethoxy-4-propylphenol levels and fish intake frequency (n=1,054 biologically independent samples). The x and yaxes refer to residuals of fish intake and metabolic abundance after correcting for covariates, respectively. d, Differential plasma levels of 1-methylhistidine between vegetarians and non-vegetarians (n=1,054 biologically independent samples). The yaxis indicates normalized residuals of metabolic abundance. The Pvalue from the Wilcoxon test (two sided) is shown. The box plots show the median and first and third quartiles (25th and 75th percentiles) of the metabolite levels. The upper and lower whiskers extend to the largest and smallest value no further than 1.5 the IQR, respectively. Outliers are plotted individually. e, Association between the diet quality score predicted by the plasma metabolome (yaxis) and the diet quality score assessed by the FFQ (xaxis) (n=237 biologically independent samples). In b, c and e, each gray dot represents one sample, the dark gray dashed line shows the linear regression line and the gray shading represents the 95% CI. In b and c, the association strength was assessed using Spearman correlation (two sided; the correlation coefficient and Pvalue are reported) and in e, the prediction performance was assessed with linear regression (F-test; two sided; the adjusted r2 value and Pvalue are reported).

Given the relationship between diet, metabolism and human health, we wondered whether the plasma metabolome could predict diet quality. For each of the Lifelines participants, we constructed a Lifelines Diet Score based on food frequency questionnaire (FFQ) data that reflected the relative diet quality based on dietdisease relationships8. To build a metabolic model to predict an individuals diet quality, we used LLD1 as the training set and LLD2 as the validation set. The resulting metabolic model included 76 metabolites, 51 of which were dominantly associated with diet. The diet score predicted by metabolites showed a significant association with the real diet score assessed by the FFQ in the validation set (r2adjusted=0.27; PF-test=3.5105; Fig. 3e). We also tested four other dietary scores (the Alternate Mediterranean Diet Score20, Healthy Eating Index (HEI)21, Protein Score22 and Modified Mediterranean Diet Score23) and found that the HEI predicted by plasma metabolites was also significantly associated with the FFQ-based HEI (r2adjusted=0.23; PF-test=6.5105; Supplementary Table 12).

Genetic associations of plasma metabolites may provide functional insights into the etiologies of complex diseases. After correcting for the first two genetic principal components, age, sex, BMI, smoking, 78 dietary habits, 40 diseases and 44 medications, QTL mapping in LLD1 identified 48 study-wide, independent genetic associations between 44 metabolites and 40 single-nucleotide polymorphisms (SNPs) (PSpearman<4.21011; clumping r2=0.05; clumping window=500kilobases (kb); Fig. 4a and Supplementary Table 6). All 48 genetic associations were replicated in either LLD1 follow-up or the two independent replication datasets (LLD2 and GoNL; Supplementary Fig. 3 and Supplementary Table 6). We also assessed the impact of physical activity, as assessed by questionnaires24, on the genetics association of metabolism, but found its influence to be negligible (Supplementary Fig. 4). Functional mapping and annotation (FUMA) of genome-wide association studies (GWAS)25 analysis revealed that the identified mQTLs were enriched in genes expressed in the liver and kidney (Extended Data Fig. 4) and related to metabolic phenotypes (Supplementary Table 6).

a, Manhattan plot showing 48 independent mQTLs identified linking 44 metabolites and 40 genetic variants with P<4.21011 (Spearman; two sided). Representative genes for the SNPs with significant mQTLs are labeled. b, Association between a tag SNP (rs1495741) of the NAT2 gene and plasma AFMU levels. c, Association between a SNP (rs13100173) within the HYAL3 gene and plasma levels of N-acetylgalactosamine-4-sulfate. d, Association between a tag SNP (rs17789626) of the SCLT1 gene and plasma mizoribine levels. e, Differences in coffee intake between participants with different genotypes at rs1495741. f, Correlations between coffee intake and AFMU in participants with different genotypes at rs1495741. g, Differences in bacterial fatty acid -oxidation pathway abundance in participants with different genotypes at rs67981690. h, Correlations between bacterial fatty acid -oxidation pathway abundance and 5-carboxy--chromanol in participants with different genotypes at rs67981690. In be and g, the xaxis indicates the genotype of the corresponding SNP and the yaxis indicates normalized residuals of the corresponding metabolic abundance (n=927 biologically independent samples). Each dot represents one sample. The box plots show the median and first and third quartiles (25th and 75th percentiles) of the metabolite levels. The upper and lower whiskers extend to the largest and smallest value no further than 1.5 the IQR, respectively. Outliers are plotted individually. The association strength is shown by the Spearman correlation coefficient and corresponding Pvalue (two sided). In f and h, the xaxis indicates the normalized abundance of coffee intake (f) or the bacterial fatty acid -oxidation pathway (h) and the yaxis indicates the normalized residuals of the corresponding metabolic abundance. Each dot represents one sample (n=927 biologically independent samples). The lines indicate linear regressions for each genotype group separately. Areas with light gray shading indicate the 95% CI of the linear regression lines. The association strength per genotype is shown by the Spearman correlation and the corresponding Pvalue (two sided).

The strongest association we found was between the caffeine metabolite 5-acetylamino-6-formylamino-3-methyluracil (AFMU) and SNP rs1495741 near the N-acetyltransferase 2 (NAT2) gene (rSpearman=0.52; P=1.71066; Fig. 4b), which showed strong linkage disequilibrium (r2=0.98) with a SNP, rs35246381, that was recently reported to be associated with urinary AFMU26. AFMU is a direct product of NAT2 activity and has been associated with bladder cancer risk27. Interestingly, the plasma level of AFMU was associated not only with coffee intake (rSpearman=0.29; P=9.21022; Supplementary Table 5) and the genotype of rs1495741, but also with their interactions (Supplementary Table 9). Individuals with a homologous AA genotype had a similar level of coffee intake, but their correlation between coffee intake and plasma AFMU level was significantly lower compared with individuals with GG and GA genotypes (Fig. 4e,f).

Pleotropic mQTL effects were also observed at several loci, including SLCO1B1, FADS2, KLKB1 and PYROXD2 (Supplementary Table 6). For example, three associations (related to three metabolites, two of them lipids) were observed for two SNPs (rs67981690 and rs4149067; linkage disequilibrium r2=0.72 in Northern Europeans from Utah) in SLCO1B1, which encodes the solute carrier organic anion transporter family member 1B1. Expression of the SLCO1B1 protein is specific to the liver, where this transporter is involved in the transport of various endogenous compounds and drugs, including statins28, from blood into the liver. The SLCO1B1 locus has also been linked to plasma levels of fatty acids and to statin-induced myopathy29. Furthermore, we detected a geneticsmicrobiome interaction between rs67981690 and microbial fatty acid oxidation pathways in regulating plasma levels of 5-carboxy--chromanol (P=1.5103), where the association of the bacterial fatty acid oxidation pathway with plasma levels of 5-carboxy--chromanol was dependent on the genotype of rs67981690 (Fig. 4g,h).

To identify novel mQTLs, we performed a systematic search of all published mQTL studies from 2008 onwards (Supplementary Table 13). This approach identified three novel mQTLs in our datasets (Supplementary Table 13) that were either not located close to previously reported mQTLs (distance>1,000kb) or not in linkage disequilibrium (r2<0.05). The first two novel SNPsrs13100173 at HYAL3 and rs11741352 at ARSBwere associated with N-acetylgalactosamine-4-sulfate (Fig. 4c,d), which is associated with mucopolysaccharidosis30. Interestingly, N-acetylgalactosamine-4-sulfate can bind to HYAL proteins (HYAL1, HYAL2, HYAL3 and HYAL4), suggesting that mQTLs can also pinpoint potential metaboliteprotein interactions. The third novel mQTL was rs17789626 at SCLT1, which was associated with mizoribinea compound used to treat nephrotic syndrome31.

We established 4,212 associations between 208 metabolites and 314 microbial factors (114 species and 200 MetaCyc pathways) (FDRLLD1<0.05; PLLD1 follow-up<0.05; Supplementary Tables 7 and 8). Interestingly, many of the metabolites that were associated with microbial species and MetaCyc pathways are also known to be gut microbiome related based on their HMDB annotations15. For instance, we observed 919 associations with 25 uremic toxins, 142 associations with thiamine (vitamin B1) and 117 associations with five phytoestrogens (FDR<0.05; Supplementary Tables 7 and 8). Uremic toxins and thiamine have been shown to be related to various diseases, including chronic kidney disease and cardiovascular diseases32,33. Phytoestrogens are a class of plant-derived polyphenolic compounds that can be transformed by gut microbiota into metabolites that promote the hosts metabolism and immune system33,34.

To assess whether gut microbiome composition causally contributes to plasma metabolite levels, we carried out bi-directional MR analyses (see the Methods section Bi-directional MR analysis). Here, we focused on the 37 microbial features that were associated with at least three independent genetic variants at P<1105 and with 45 metabolites (Supplementary Table 14). At FDR<0.05 (corresponding to P=2103 obtained from the inverse variance weighted (IVW) test)35, we observed four potential causal relationships at baseline that could also be found in the follow-up in the microbiomes to metabolites direction (Fig. 5ad and Supplementary Tables 15 and 16) but not in the opposite direction (Supplementary Table 17), and these outcomes were maintained following weighted median testing (P<0.03; Supplementary Fig. 5). To ensure that the data followed MR assumptions, we performed several sensitivity analyses, including checking for horizontal pleiotropy (MR-Egger36 intercept P>0.05; Supplementary Table 15) and heterogeneity (Cochrans Q test P>0.05; Supplementary Table 15) and leave-one-out analysis (Extended Data Fig. 5). We did not use causal estimates derived using the MR-Egger method to filter the results, as its power to detect causality is known to be low36. These sensitivity checks further confirmed the reliability of these four MR causal estimates.

a, Analysis of the association between adenosylcobalamin biosynthesis pathway abundance and 5-hydroxytryptophol levels. b, Glycogen biosynthesis pathway abundance versus 5-sulfo-1,3-benzenedicarboxylic acid levels. c, E. rectale abundance versus hydrogen sulfite levels. d, Veillonella parvula abundance versus 2,3-dehydrosilybin levels. In the top panels of ad, the xaxis shows the SNP exposure effect, and the yaxis shows the SNP outcome effect and each dot represents a SNP. Error bars represent the s.e. of each effect size. The bottom panels of ad, show the MR effect size (center dot) and 95% CI for the baseline (blue) and follow-up (green) datasets of the LLD1 cohort, estimated with the IVW MR approach (two sided) (n=927 biologically independent samples at baseline and n=311 biologically independent samples at follow-up).

We further found that increased abundance of microbial adenosylcobalamin biosynthesis (coenzyme B12) was associated with reduced plasma levels of 5-hydroxytryptophol (Fig. 5a)a uremic toxin related to Parkinsons disease37. We also found that plasma hydrogen sulfite levels were related to Eubacterium rectale (Fig. 5c)a core gut commensal species38 that is highly prevalent (presence rate=97%) and abundant (mean abundance=8.5%) in both our cohorts and in other populations39,40,41. As a strict anaerobe, E. rectale promotes the hosts intestinal health by producing butyrate and other short-chain fatty acids from non-digestible fibers42, and a reduced abundance of this species has been observed in subjects with inflammatory bowel disease39,43 and colorectal cancer44 compared with healthy controls. As a toxin, hydrogen sulfite interferes with the nervous system, cardiovascular functions, inflammatory processes and the gastrointestinal and renal system45. Our results thus reveal a potential new beneficial effect of E. rectale.

To further investigate the metabolic potential of individual bacterial species, we applied newly developed pipelines to identify microbial primary metabolic gene clusters (gutSMASH pathways)46 and microbial genomic structural variants (SVs)47. These two tools profile microbial genomic entities that are implicated in metabolic functions. By associating 1,183 metabolites with 3,075 gutSMASH pathways and 6,044 SVs (1,782 variable SVs (vSVs) and 4,262 deletion SVs (dSVs); see Methods), we observed 23,662 associations with gutSMASH pathways and 790 associations with bacterial SVs (FDRLLD1<0.05; PLLD1 follow-up<0.05; Supplementary Tables 1820). These associations connect the genetically encoded functions of microbes with metabolites, thereby providing putative mechanistic information underlying the functional output of the gut microbiome. In one example, we observed that the microbial uremic toxin biosynthesis pathways, including the glycine cleavage pathway (in Olsenella and Clostridium species) and the hydroxybenzoate-to-phenol pathway (in Clostridium species) responsible for hippuric acid and phenol sulfate biosynthesis, were associated with the hippuric acid (Olsenella species: rSpearman=0.15; P=9.3107; Clostridium species: rSpearman=0.18; P=5.9109) and phenol sulfate (rSpearman=0.17; P=4.2108; Extended Data Fig. 6a) levels measured in plasma, respectively (FDRLLD1<0.05 and PLLD1 follow-up<0.05; Extended Data Fig. 6b).

Next, we carried out a mediation analysis to investigate the links between diet, the microbiome and metabolites. For 675 microbial features that were associated with both dietary habits and metabolites (FDR<0.05), we applied bi-directional mediation analysis to evaluate the effects of microbiome and metabolites for diet (see the Methods section Bi-directional mediation analysis). This approach established 146 mediation linkages: 133 for the dietary impact on the microbiome through metabolites and 13 for the dietary impact on metabolites through the microbiome (FDRmediation<0.05 and Pinverse-mediation>0.05; Fig. 6a,b and Supplementary Table 21). Most of these linkages were related to the impact of coffee and alcohol on microbial metabolic functionalities (Fig. 6a).

a, Parallel coordinates chart showing the 133 mediation effects of plasma metabolites that were significant at FDR<0.05. Shown are dietary habits (left), plasma metabolites (middle) and microbial factors (right). The curved lines connecting the panels indicate the mediation effects, with colors corresponding to different metabolites. freq., frequency; PFOR, pyruvate:ferredoxin oxidoreductase; OD, oxidative decarboxylation; HGD, 2-hydroxyglutaryl-CoA dehydratase; TPP, thiamine pyrophosphate. b, Parallel coordinates chart showing the 13 mediation effects of the microbiome that were significant at FDR<0.05. Shown are dietary habits (left), microbial factors (middle) and plasma metabolites (right). For the microbial factors column, number ranges represent the genomic location of microbial structure variations (SVs) in kilobyte unit, and colons represent the detailed annotation of certain gutSMASH pathway. c, Analysis of the effect of coffee intake on the abundance of M. smithii as mediated by hippuric acid. d, Analysis of the effect of beer intake on the C. methylpentosum Rnf complex pathway as mediated by hulupinic acid. e, Analysis of the effect of fruit intake on urolithin B in plasma as mediated by a vSV in Ruminococcus species (300305kb). In ce, the gray lines indicate the associations between the two factors, with corresponding Spearman coefficients and Pvalues (two sided). Direct mediation is shown by a red arrow and reverse mediation is shown by a blue arrow. Corresponding Pvalues from mediation analysis (two sided) are shown. inv., inverse; mdei., mediation.

Coffee contains various phenolic compounds that can be converted to hippuric acid by colonic microflora48. Hippuric acid is an acyl glycine that is associated with phenylketonuria, propionic acidemia and tyrosinemia49. We observed that hippuric acid can mediate the impact of drinking coffee on Methanobrevibacter smithii abundance (Pmediation=2.21016; Fig. 6c). We also observed that hulupinic acid, which is commonly detected in alcoholic drinks, can mediate the impact of beer consumption on the Clostridium methylpentosum ferredoxin:NAD+ oxidoreductase (Rnf) complex (Pmediation=2.21016; Fig. 6d)an important membrane protein in driving the ATP synthesis essential for all bacterial metabolic activities50.

Of the dietary impacts on metabolites through the microbiome (Fig. 6b and Supplementary Table 21), one interesting example is a Ruminococcus species vSV (300305kb) that encodes an ATPase responsible for transmembrane transport of various substrates51. This Ruminococcus species vSV mediated the effect of fruit consumption on plasma levels of urolithin B (Pmediation=2.21016; Fig. 6e). Urolithin B is a gut microbiota metabolite that protects against myocardial ischemia/reperfusion injury via the p62/Keap1/Nrf2 signaling pathway52. Taken together, our data provide potential mechanistic underpinnings for dietmetabolite and dietmicrobiome relationships.

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